What is a Pap Smear?

Pap tests or Pap smears are clinical examinations designed to check for signs of cervical cancer through a sample of cells collected from a woman’s cervix. The cervix is part of a woman’s reproductive system. It is through your cervix that blood is released during menstruation.

Why is it Important?

Pap smears are extremely important in the prevention of cervical cancer, which, behind breast cancer is the most common cancer a woman can be infected with. It has been predicted that if every woman were to have a regular Pap test, some 90% of cervical cancer cases would be prevented. This is because Pap tests can detect infections or abnormalities than could lead to the development of cancer cells.

How it is Done?

During a Pap test, a woman is asked to lie on her back on a medical examination table with her knees bent and her feet in stirrups. The doctor then inserts a tool called a speculum into her vagina that opens like the beak of a duck so that the doctor can conduct the exam. Using a wooden scraper or cervical brush the doctor then takes a sample of cells that will later be studied under a microscope for any abnormalities.

Before or after the doctor collects the cells for the Pap test, she will also conduct a pelvic exam. During the pelvic exam all reproductive organs (uterus, fallopian tubes, vagina, ovaries) are felt for any irregularities.

Although they can be slightly uncomfortable (depending on your own personal comfort level and the number of times you have had a Pap smear), Pap tests should not be painful. If you do feel pain, you should let the doctor know right away, as this could mean there is a health problem she should be aware of.

When to Start and How Often?

In the UK women who have a registered general practitioner (GP) will be asked to have their first Pap test once they turn 25, since before this age cervical cancers rates are extremely low. In the US and Canada, women who are 18 or older are encouraged to take the test. There is, however, no set age at which it is optimal to begin having Pap tests.

If you are under 25 and have been sexually active for more than three years, then it is recommended that you have a Pap test. The three-year waiting period is encouraged so as to avoid overtreating common abnormalities that can occur within the first years a woman becomes sexually active.

However, if you are experiencing pain in your pelvic area, smelly or itchy vaginal discharge, excessive bleeding or cramps during menstruation, or missed or irregular periods then it is recommended you have a Pap test regardless of your sexual experience.

In the US, the American College of Obstetricians and Gynecologists recommends that women under the age of 30 have a Pap smear every year. After that, if you have had three normal Pap tests in a row you may talk to your doctor about lessening the frequency to every two years or so. Once women reach 65 and have had no abnormal Pap tests for 10 years, their doctor may stop conducting the Pap test altogether. However, it is best to speak with your doctor about the frequency level that is right for you.

What You Can do to be Prepared

It is generally not recommended that you conduct your Pap smear during menstruation. In fact, the period of 10 to 20 days after the first day of your period is viewed as the best time to carry out the exam. The day before the exam it is recommended that you abstain from sex, do not douche or use any vaginal creams or spermicides (unless directed by a physician) as these could hide the appearance of abnormalities.

What do Abnormal Test Results Mean?

In the US, some 5% to 7% of all pap smears will yield a positive result. If you receive a positive test result, that means the Pap smear test has encountered some abnormality in the cells. But don’t panic! This does not mean you have cervical cancer. In fact it is more likely that there is only a small problem with the cervix.

Some common terminology associated with abnormal pap smears are:

• Dysplasia:A term used to describe abnormal cells, dysplasia is not cancer, although left untreated in can lead to cervical cancer.
• Squamous intraepithelial lesion (SIL): SIL refers to the presence of abnormal cells on the surface of the cervix.
• Cervical intraepithelial neoplasia (CIN): CIN describes the degree to which the thickness of the cervix contains abnormal cells.
• Atypical squamous cells: If the squamous cells are atypical that implies they are not clearly representative of either dyslplasia, SIL or CIN, which means they may or may not be abnormal.

To find out more about what abnormal test results mean, see our section on abnormal smear tests.