Definition and Overview

A pap smear is a sample of the cells in the cervix taken during a pap test. A pap test is conducted to determine the health of the cervix or detect any abnormal changes in the cells. During the procedure, a sample of cells is collected from the surface of the cervix and laid out on a slide. This sample, called the pap smear, is sent to a laboratory for a microscopic examination.

A pap smear test is used for two main purposes:

  • Routine cervical checkup
  • Diagnosis


In both cases, the pap smear is used to detect abnormal cell changes in the sample. A pap smear is usually included in the list of routine examinations prescribed for women for the prevention of cervical disease. Based on the results of a pap smear, any abnormalities found in the sample cells as well as their underlying cause can be treated early; doing so will greatly lower a woman's chance of developing cervical cancer.

Each woman will have a unique pap test schedule prescribed for her by her doctor; this schedule will be based on her age and her risk of getting cervical disease. In women over the age of 30, a pap smear is sometimes combined with an HPV test because cervical disease is most commonly caused by a high-risk form of HPV, or human papillomavirus. In women younger than 30 years of age, the pap smear is usually enough, but they are also advised to get an HPV shot as a preventive measure.

For purposes of diagnosis, any abnormal cell changes found in the pap smear will be the determining factors in the diagnosis of a disease or disorder of the cervix, such as:

  • Dysplasia
  • Cervical cancer


Both diseases cannot be diagnosed with a pap smear alone. If a pap smear is found abnormal, further tests may be conducted, such as a colposcopy.

Take note, however, that a pap test cannot be used to screen other sexually transmitted infections such as herpes, syphilis, chlamydia, and gonorrhea. There are individual specialized tests for each of these infections.

Key symptoms

Your doctor may prescribe a pap smear if you experience any of the following symptoms:

  • Vaginal itching
  • Redness
  • Pain when urinating or having intercourse
  • Sores, lumps, rashes, blisters, or warts
  • Swelling
  • Unusual odor
  • Changes in vaginal discharge, i.e. color, odor, or texture that is different from what you normally experience
  • Excessive vaginal discharge

Preparing for a pap smear

Certain preparations are necessary prior to getting a pap smear. These include the following:

  • Schedule your pap test when you do not have a menstrual period, since the blood can interfere with the test results.
  • Refrain from using tampons, douches, powders, or any vaginal medicines for 24 hours prior the test.
  • Refrain from sexual intercourse 24 hours prior the test.
  • You will feel more comfortable if you empty your bladder before the test.


If you have a doctor's appointment, make sure to inform him or her about the following as these are important considerations that have to be made during a pap test:

  • If it is your first pap test
  • If you are pregnant
  • If you might be pregnant
  • If you are using any form of birth control
  • The first day of your last menstrual period
  • The average length of your periods
  • If you have had surgical procedures that involve the vagina, uterus, cervix, or vulva
  • If you have rape or sexual abuse history
  • If you have had abnormal pap test results before

Causes of abnormal pap test

An abnormal pap smear occurs when the sample did not contain enough cells for a successful examination or when abnormal cells are detected. The most common causes of abnormal cell changes in the cervix are:

  • Human papillomavirus (HPV), a sexually-transmitted infection – This is the cause that poses the highest risk since it may lead to cervical cancer when left untreated. A pap test is considered very important because an HPV can stay in the body for several years without your knowledge.
  • Bacterial infection
  • Yeast infection


You may have a higher risk of becoming infected with an HPV and thus getting an abnormal pap test due to certain sexual behaviors, such as:

  • Having unprotected sex
  • Having more than one partner
  • Having intercourse with a partner who has other partners


Other cell changes in the cervix may be caused by:

What to expect

To begin the test, you will be asked to remove your clothing from the waist down and drape a cloth over your body. You will be asked to lie on your back on an exam table and place your feet on designated footrests. This position will make it easy for your doctor to examine the external genital area and the vagina. The doctor will then insert a lubricated tool called the speculum into the vagina to spread apart the vaginal walls; this makes access to the cervix easier. Your doctor will then take several cell samples from the cervix using a cytobrush, a cotton swab, or a small spatula-like tool. The cells are collected from different parts of the cervix, such as the endocervical canal just near the opening and the most visible part of the cervix. Once the sample has been taken, it is usually spread on a slide, although sometimes it is mixed in a liquid fixative, before it is sent to the laboratory.

The pap test may cause slight discomfort especially when the speculum is inserted. Discomfort may be worse if your vagina is narrow or you have some tenderness or irritation. You will also feel a pulling action or some pressure when the doctor takes the cell sample. Keeping yourself relaxed, breathing deeply, or tensing your muscles will help relieve the discomfort.

After the test, it is normal to experience slight vaginal bleeding. The risk of a problem arising from a pap test is very low. You may go home the same day and come back for the results, which may take 1 to 2 weeks. It is possible to get a false-negative or a false-positive result, so some doctors may prescribe three pap tests in a row, scheduled separately, to confirm the results.

References:

  • Balachandran I. “Human papillomavirus and pap smear: A review.” American Journal of Lifestyle Medicine.
  • Panaretto K, Larkins S, Manessis V. (2003). “Pap smear participation rates, primary healthcare and indigenous women.” The Medical Journal of Australia.
  • Mehmetoglu HC, Sadikoglu G, Ozcakir A, Bilgel N. (2010). “Pap smear screening in the primary health care setting: A study from Turkey.” North American Journal of Medical Sciences.
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