Pap smear

Alternative names
Papanicolaou test

A Pap smear is a microscopic examination of cells scraped from the cervix.

How the test is performed

The Pap smear is performed as part of a gynecological exam. You will lie on a table and place your feet in stirrups to position your pelvis for examination. A speculum (an instrument used to open the walls of the vaginal canal to see the interior) will be inserted into your vagina and opened slightly.

A sample of cells from the outside and the canal of the cervix is taken by gently scraping the outside of the cervix with a wooden or plastic spatula, then inserting a small brush that looks like a pipe cleaner into the canal.

The cells are placed on a glass slide and sprayed with a fixative, or put in a bottle containing a preservative, then sent to the lab for examination.

How to prepare for the test

The health care provider should be notified if you have had a prior abnormal Pap smear, if you might be pregnant, or if you are taking any medications or Birth control pills. You should avoid douching, using tampons, having intercourse, and tub baths 24 hours before the test.

Avoid scheduling your Pap smear while you are menstruating, because blood and cells from the endometrial cavity may obscure the accuracy of the Pap smear. Empty your bladder just before the test.

How the test will feel
There may be some discomfort and a feeling of pressure during the procedure. A small amount of bleeding may occur after the test.

Why the test is performed

The Pap smear can detect cancerous or precancerous conditions of the cervix. For recommendations on the frequency of having this test done, see the information on Cervicitis.

Normal Values

A normal value is negative, meaning there are no abnormal cells present.

What abnormal results mean

Abnormal values are based on the test results. The current system of reporting divides the results into three main areas: benign (noncancerous), precancerous (showing some abnormal cell changes), and malignant (possibly cancerous).

A report in the latter two categories will usually lead to a follow-up examination, including a repeat Pap smear and possibly other tests. If you have never had an abnormal Pap smear before, and the result indicates a mild abnormality, the Pap test is repeated in 6 months.

If the test result suggests a severe abnormality or cancer, you may need an immediate colposcopic evaluation with biopsies. If you have had an abnormal Pap test in the past, or have had treatment for a precancerous change, you may need an immediate colposcopy.

The Pap smear is a screening test. Any abnormal results should be discussed with your health care professional, who will help determine if a colposcopy is necessary.

What the risks are

There are no risks involved.

Special considerations

The following drugs may affect Pap smears:

  • Colchicine  
  • Estrogen  
  • Podophyllin  
  • Progestins  
  • Silver nitrate  
  • Compounds in cigarettes

Johns Hopkins patient information

Last revised: December 7, 2012
by Mamikon Bozoyan, M.D.

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