A Pap smear is a microscopic examination of cells scraped from the opening of the cervix. The cervix is the lower part of the uterus (womb) that opens at the top of the vagina.
It is a screening test for cervical cancer.
You will lie on a table and place your feet in stirrups. The doctor or nurse will place an instrument (called a speculum) into the vagina and open it slightly. This allows the doctor or nurse to better see inside the vagina and cervix.
Cells are gently scraped from the cervix area, and sent to a lab for examination.
Make sure your doctor or nurse knows about all the medicines you are taking. Some birth control pills that contain estrogen or progestin may interfere with test results.
Also tell your doctor or nurse if you:
Avoid the following for 24 hours before the test:
Avoid scheduling your Pap smear while you have your period (are menstruating), because it may affect the accuracy of the Pap smear.
Empty your bladder just before the test.
A Pap smear may cause some discomfort, similar to menstrual cramps. You may also feel some pressure during the exam.
You may bleed a little bit after the test.
The Pap smear is a screening test for cervical cancer. Most cervical cancers can be detected early if a woman has routine Pap smears.
Screening should start at age 21. After the first test:
After age 65-70:
You may not need to have a Pap smear if you have had a total hysterectomy (uterus and cervix removed) and have not had an abnormal Pap smear, cervical cancer, or other pelvic cancer.
A normal (negative) value means there are no abnormal cells present.
Talk to your doctor about the meaning of your specific test results.
Abnormal results are grouped as follows:
ASCUS or AGUS
LSIL (low-grade dysplasia) or HSIL (high-grade dysplasia):
Carcinoma in situ (CIS):
Atypical squamous cells (ASC–H):
Atypical glandular cells (AGC):
When a Pap smear shows abnormal changes, further testing or follow-up is needed. The next step depends on the results of the Pap smear, your previous history of Pap smears, and risk factors you may have for cervical cancer.
Follow-up testing may include:
For minor cell changes, doctors usually recommend having a repeat Pap smear in 3-6 months.
The Pap smear test is not 100% accurate. Cervical cancer may be missed in a small number of cases. Most of the time, cervical cancer develops very slowly and follow-up Pap smears should identify worrisome changes in time for treatment.
ACOG Practice Bulletin No. 99: management of abnormal cervical cytology and histology. Obstet Gynecol. 2008;112(6):1419-1444.
ACOG Committee on Gynecological Practice. ACOG Practice Bulletin No. 109: Cervical Cytology Screening. Obstet Gynecol. 2009 Dec;114(6):1409-1420.
Cervical cancer in adolescents: screening, evaluation, and manage- ment. Committee Opinion No. 463. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2010;116:469–72.
Noller KL. Intraepithelial neoplasia of the lower genital tract (cervix, vulva): etiology, screening, diagnostic techniques, management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap. 28.
Updated by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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