Papanicolaou (Pap) Smear Test

What is a Papanicolaou (Pap) smear test?

A Pap smear involves taking cells at the neck of the womb, located at the end of the vagina. These cells can be abnormal without symptoms in patients having precancer of the cervix, and this method allows prevention of cervical cancer by detecting precancerous changes.

The Pap smear is usually done in conjunction with a pelvic exam.

A Pap smear test is recommended once every 3 years for women above the age of 25 – 29.

For women over the age of 30, a HPV test is also recommended once every 5 years. Together, these test help in the early detection of cervical cancer.

Why do you need a Pap smear?

A Pap smear test is done to look for changes in cervical cells before they turn into cancer.

Early detection greatly improves the chances of successful treatment of pre-cancers and cancer.

If you have certain risk factors, your doctor may recommend more-frequent Pap smears, regardless of age. These risk factors include:

A diagnosis of cervical cancer or a Pap smear that showed precancerous cells
A history of smoking
Exposure to diethylstilbestrol (DES) (a synthetic form of oestrogen) before birth
HIV infection
Weakened immune system due to organ transplant, chemotherapy or chronic corticosteroid use

Cervical cancers almost always develop in patients who have had sexual contact. Hence, patients who have never had sex before need not go for Pap smears.

However, if there are any gynaecological symptoms such as abnormal bleeding or discharge, they should still consult a gynaecologist.

What are the risks and complications of a Pap smear?

A Pap smear is a safe way to screen for cervical cancer, but it cannot detect cancer 100% of the time.

It is possible to get false-negative results, which means the test indicates no abnormality, even though there are abnormal cells.

A false-negative result can be due to:

An inadequate collection of cells
A small number of abnormal cells
Blood or inflammatory cells obscuring the abnormal cells

Even though abnormal cells can go undetected, time is on your side because cervical cancer takes several years to develop. This is why regular tests are important to pick up any changes. If one test does not detect the abnormal cells, the next test most likely will.

How do you prepare for a Pap smear?

To ensure that your Pap smear is most effective:

Avoid intercourse or use lubricants at least 2 days before the test
Do not apply sprays or powders near the vagina
Do not insert anything into the vagina, including tampons, medications, creams or suppositories
Do not rinse the vagina with water, vinegar, or other fluids (douche)
Try not to schedule a Pap smear during your period as bleeding can affect the accuracy of the test

What can you expect in a Pap smear?

A Pap smear test is done in your doctor's clinic. The test doesn’t hurt, but you may feel a little pinch or a bit of pressure. You will be able to carry on with your regular activities afterwards.

Estimated duration

A Pap smear test takes about 5 – 10 minutes.

During the procedure

You may be asked to undress completely or only from the waist down and lie on a table with your feet in stirrups.

Your doctor will insert a metal or plastic tool (speculum) into the vagina to widen the vaginal walls and allows a clear view of the cervix.
Using a soft brush and a flat scraping device called a spatula, some cells will be removed from the cervix.
The sample will be sent for testing and analysis.

After the procedure

After your Pap smear, you can go about your day without restrictions.

Your doctor will notify you about the test results.

Abnormal results

A positive result occurs when abnormal or unusual cells were discovered during your Pap smear.

About 10% of all Pap tests can show some abnormality.

Sometimes infection, inflammation or even dry skin due to menopause can make the cells hard to interpret and require a repeat testing or referral to a gynaecologist.

The classification of the abnormalities in the report will allow your doctor to triage you for either observation or referral to a gynaecologist for further investigation.

If precancerous changes are suspected, your doctor will recommend a colposcopy. During the colposcopy, they will examine the cervix using a magnifying device and apply medication on the cervix so they can better see the precancerous area. Biopsies and treatment may be offered if there are abnormalities seen.

Normal results

A negative result occurs when normal cervical cells were discovered during your Pap smear.

This means no precancerous or cancerous cells were detected in the sample.

You will not need any further treatment or testing until the next Pap smear and pelvic exam.

Frequently asked questions

A: Cervical cancers almost always develop in patients who have had sexual contact. Hence, patients who have never had sex before need not go for Pap smears.

A: If you are pregnant, could be pregnant or have just given birth, you may delay cervical screening because this can make it more difficult to get accurate results. However, if you have had an abnormal result from a previous screening, a smear may be recommended. It will not affect the pregnancy.

For certain patients with abnormal cervical smears/tests, intervention may needed before the end of the pregnancy.

As pregnancy changes resolve by 6 weeks after delivery, the cervical screening can be done at the post-partum gynaecological visit.

A: A Pap smear test is recommended once every 3 years for women from the age of 25 – 29.

For women over the age of 30, a Human papillomavirus (HPV) test is also recommended once every 5 years.

Together, these tests help in the early detection of cervical cancer.

A: If you are pregnant and have an abnormal result from a previous screening, a smear may be recommended. It will not affect the pregnancy.

If you have not had a previous screening or the last screen was too long ago, your gynaecologist may offer a smear at the start of pregnancy for screening.

A: A Pap smear does not hurt, but it may feel a little uncomfortable based on your tolerance.

If you have vaginal dryness, vaginismus (tightening of the vagina muscles), chronic vulva pain or endometriosis, it may be more uncomfortable. Do let your doctor who if you have any of these conditions so they can help make the screening less uncomfortable.

A: If you are having your period, it may interfere with the accuracy of the test, so it is best to reschedule it.

A: In general, it takes about 1 – 4 weeks for you to receive Pap smear results.

A: If you receive an abnormal result, it means that some cell changes have been detected does not necessarily mean you have cervical cancer.

Your doctor may follow-up with some tests. These may include:

Colposcopy – using a tool with a lens and a light to look at the walls of the cervix. To highlight the area, a solution is used to swab the areas.
Biopsy – a small sample of tissues from the area are taken for further testing.

A: You may receive the results of the screening via a call or a letter, or both.

A: It is best to wait a day or two after the screening to have sex so that any irritation and inflammation can resolve.

A: To ensure that your Pap smear is most effective:

Avoid intercourse or using lubricants at least 2 days before the test
Do not apply sprays or powders near the vagina
Do not insert anything into the vagina, including tampons, medications, creams or suppositories
Do not rinse the vagina with water, vinegar, or other fluids (douche)
Try not to schedule a Pap smear during your period as bleeding can affect the accuracy of the test.

After a Pap smear:

You many experience some bleeding or discharge for 1 – 2 days, so you may want to use a panty liner
There may be some inflammation and soreness, so you may want to avoid sexual intercourse for 1 – 2 days afterwards

A: Mild bleeding or discharge after a Pap smear is normal. This is because during the test, a small sample of cells are taken from the cervical or vaginal wall. It will resolve in a day or two.

You may want to bring a pad or pantyliner to use after the test.

A: A Pap smear will not affect implantation or the likelihood of conception.

The test takes place in the cervix, low in the uterus so it is not likely to interfere with pregnancy.

If you are pregnant or trying to conceive, speak with your doctor about your concerns.

A: An intrauterine device (IUD) will not interfere with a Pap smear screening. If you have an IUD, please continue to adhere to your scheduled Pap smear screening.

A: If you have an STD you should still continue with your scheduled Pap smear screening. This will allow the doctor to check for the effect of the STD on your cervical health, as having an STD increases the risk of developing cervical pre-cancer.

A: It will depend on what type of hysterectomy.

If you have had a partial hysterectomy where the uterus is removed but not the lower end of the uterus (cervix), you will still need to continue with your scheduled Pap smear test.

If you have had a total hysterectomy where both the uterus and cervix are removed, you can stop having Pap tests, unless the hysterectomy was done for cervical cancer or pre-cancer treatment.

If you are unsure, discuss with your doctor what is best for you.

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