An overview of Pap smear
A Pap smear, also known as a Pap test, is a medical procedure used to screen for cervical cancer in women. During the test, a healthcare professional collects cells from the cervix, the lower narrow end of the uterus situated at the top of the vagina. By detecting cervical cancer early or abnormal cell changes that might develop into cancer, a Pap smear helps improve the chances of a cure.
What is Pap smear used for?
A Pap smear is used for screening cervical cancer in women. It involves collecting cells from the cervix, which can help detect early signs of cervical cancer or abnormal cell changes that may lead to cancer in the future. The Pap smear is usually done in combination with a pelvic exam and may be accompanied by an HPV test for women over 30. If the Pap smear results are abnormal, further examination, such as colposcopy, may be performed to confirm the results.
How often should Pap smear be performed?
Doctors generally recommend repeating Pap testing every three years for women ages 21 to 65. Women aged 30 and older can consider Pap testing every five years if the procedure is combined with testing for HPV, or they might consider HPV testing instead of the Pap test. However, if you have certain risk factors, your doctor may recommend more-frequent Pap smears, regardless of your age. These risk factors include a diagnosis of cervical cancer or a Pap smear that showed precancerous cells, exposure to diethylstilbestrol (DES) before birth, HIV infection, a weakened immune system due to organ transplant, chemotherapy, or chronic corticosteroid use, and a history of smoking.
How to prepare for Pap smear?
There are some patient preparations needed before a Pap smear test. Here's what you should do to prepare:
- Avoid intercourse, douching, or using any vaginal medicines or spermicidal foams, creams, or jellies for two days before the test, as these may wash away or obscure abnormal cells.
- Don't schedule the Pap smear during your menstrual period. It's best to avoid this time of your cycle, if possible. Please note that these preparations are general guidelines. It's always best to follow your doctor's specific instructions for preparing for your Pap smear test.
How is Pap smear conducted?
A Pap smear is performed in a doctor's office, and it typically takes a few minutes. During the procedure:
- You may be asked to undress completely or only from the waist down, depending on the instructions provided by your doctor.
- You'll lie down on your back on an exam table with your knees bent. Your heels rest in supports called stirrups.
- Your doctor will gently insert an instrument called a speculum into your vagina. The speculum holds the walls of your vagina apart, allowing your doctor to easily see your cervix. Inserting the speculum may cause a sensation of pressure in your pelvic area.
- Your doctor will then take samples of your cervical cells using a soft brush and a flat scraping device called a spatula. This usually doesn't cause pain.
After the Pap smear, you can resume your normal activities without any restrictions.
How are Pap smear results reported?
Pap smear results are reported based on the presence or absence of abnormal cells in the sample and whether the test is done in conjunction with an HPV test. If only normal cervical cells are found, the result is considered negative, and no further treatment or testing is typically required until the next scheduled Pap smear and pelvic exam.
If the Pap smear result is abnormal, it means there are suspicious cells that may indicate cancer or a precancerous condition. In such cases, your doctor may perform further tests, such as a colposcopy, to examine the tissues of the cervix, vagina, and vulva more closely. A biopsy might also be taken from any abnormal areas for laboratory analysis and a definitive diagnosis.
Understanding the report
Pap smear results are interpreted based on the presence or absence of abnormal or precancerous cells. A normal Pap smear result indicates that no abnormal cells were found, and you won't need any further treatment or testing until you're due for your next Pap smear and pelvic exam. An abnormal Pap smear result indicates the presence of abnormal or unusual cells that may require further evaluation. Your doctor will then determine the next course of action, which may include a repeat Pap smear, a human papillomavirus (HPV) test, a colposcopy, or a biopsy. The specific terminology used to describe the results and the recommended follow-up actions will depend on the type and degree of abnormality found in the cells.
Limitations and Considerations
The limitations of the Pap smear test include the possibility of receiving false-negative results, inadequate cell collection, small numbers of abnormal cells, or blood or inflammatory cells obscuring the abnormal cells. A Pap smear may also miss some cases of cervical cancer or precancerous cells. In addition, it's not a definitive test and may require further testing, such as a colposcopy or biopsy, for a conclusive diagnosis.