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What is a Papanicolaou Smear?

A Papanicolaou (Pap) smear is a test done to check the presence of any abnormal cells in the cervix. Cervix is the lower and narrow end of the uterus, which opens into the vagina. In this test, cervical cells are examined to identify any changes occurring in them, which can lead to cancer if not treated promptly. The cells, if abnormal, are known as precancerous cells. For the prevention and treatment of cancer, it is crucial to detect precancerous and cancerous cells.

A Pap smear test is the most reliable method for early detection and prevention of cervical cancer among women. It is also known as cervical cytology or vaginal smear technique.

  1. Why is a Pap Smear test performed?
  2. How do you prepare for a Pap Smear test?
  3. How is a Pap Smear performed?
  4. What do test results from a PAP Smear test indicate?

A Pap test is performed for detecting precancerous cells. It also helps detect human papillomavirus (HPV), which when left undetected or untreated can cause changes in cervical cells, leading to cancer.

Pap smear tests along with HPV testing is known as cervical screening. They are preventive measures to lower the number of new cases of cancer, thereby reducing the number of deaths due to cervical cancer.

All women aged 21-65 years should undergo this test irrespective of the following conditions:

The schedule of Pap test is as follows:

  • Women aged 21-29 years should get a Pap test done
    • Every three years.
  •  Women aged 30-65 years should get a Pap test done
    • Every three years
    • Every five years
    • Along with an HPV test every five years
  • Women aged more than 65 years should get a Pap test done
    • If never tested before

No special preparations are needed for this test. However, you have to consider a few things before undergoing this test:

  • Do not have Pap test while you are on your periods
  • Undergo the test preferably after five days of your last period
  • Some additional recommendations are to avoid certain activities before your Pap smear. To ensure accurate results from Pap smear test, you should follow the below-mentioned instructions for 48 hours prior to your test:
    • Do not have sex
    • Do not use tampons
    • Do not use any vaginal lubrication
    • Do not use any vaginal foams or creams
    • Do not use sprays or powders inside or near the vagina

A Pap smear test is often done along with a pelvic examination. During a pelvic examination, the healthcare provider checks for an abnormality in your vulva, vagina, cervix, rectum and pelvis.

For a Pap smear test, you have to lie down on an examination table. The healthcare provider will put a metal or plastic instrument called speculum inside your vagina and will widen it to examine your cervix. You will feel pressure at this stage. Then, he/she will use a stick or soft plastic brush to collect cells from inside and surface of your cervix and vagina. The cells are then placed on a glass slide or in a small container and further sent to a laboratory for testing.

Although there is very minimal risk of pain after a Pap smear test, it can be slightly uncomfortable for some patients. Also, you may have light bleeding from the vagina (spotting) after the procedure.

It can take up to three weeks to get your test results. In case of any abnormality in your result, the doctor will contact you as early as possible. Note that abnormal results do not necessarily mean that you are diagnosed with cancer.

  • Normal results: Normal cervical cells do not indicate any disease. You may be called for another screening depending on your age and medical history.
  • Unclear or unsatisfactory results: In case of an inaccurate or unclear result, you are advised to undergo another test. The reason for the inaccuracy of the result could be fewer cells in the sample or other problems occurring in laboratory, which makes it difficult for the laboratory technicians to give an accurate result. Thus, another test is done to rule out any issues.
  • Abnormal results: In case of the presence of some abnormal cervical cells, do not conclude immediately. Abnormal results do not mean you have cancer; your healthcare provider would recommend further monitoring of cells. This can be done by doing another Pap smear test immediately or after waiting for six months in case of minor cell changes. In the course of time, some cells will return to normal and some may turn into cancer cells. In case major changes are seen in the cervical cells, you need to undergo more tests, such as colposcopy and biopsy.

Disclaimer: All results must be clinically correlated with the patient’s complaints to make a complete and accurate diagnosis. This information is purely from an educational perspective view and is in no way a substitute for medical advice from a qualified doctor.

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References

  1. Office on women's health [internet]: US Department of Health and Human Services; Pap and HPV tests
  2. American Cancer Society [internet]. Atlanta (GA), USA; The American Cancer Society Guidelines for the Prevention and Early Detection of Cervical Cancer
  3. Center for Disease Control and Prevention [internet], Atlanta (GA): US Department of Health and Human Services, What Should I Know About Screening?
  4. National Cancer Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; NCI Dictionary of Cancer Terms: Pap test
  5. University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; Pap
  6. National Cancer Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; HPV and Pap Testing
  7. Office of Population Affairs [internet]. Southwest Washington DC: United States Department of Health and Human Services; Cervical Cancer Screening (Pap Test)