Pap Test

Approved by the Cancer.Net Editorial Board, 08/2014

Listen to the Cancer.Net Podcast: Pap Test–€”What to Expect, adapted from this content.

Key Messages:

  • A Pap test involves gathering a sample of cells from the cervix to test for early changes in these cells that can lead to cervical cancer if left untreated.
  • Some of the cells may also be tested for the human papillomavirus, which is a risk factor for cervical cancer.
  • Learning how to prepare for a Pap test and what to expect during and after the test may help relieve anxiety.

A Pap test, also called a Pap smear, is the most common screening test for cervical cancer in women who have no symptoms of cancer. It is often performed during a woman’s gynecologic checkup.

A Pap test involves gathering a sample of cells from the cervix, which is the part of the uterus that opens to the vagina. The sample is placed on a glass slide and sent to a laboratory for examination under a microscope by a pathologist. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. The pathologist can identify abnormal cells, which may be precancerous or cancerous, but are most often treatable, precancerous cellular changes, rather than cervical cancer.

Some of the cells collected from the cervix during the Pap test may also be tested for the human papillomavirus, also called HPV. Infection with HPV is a risk factor for cervical cancer. HPV is most commonly passed from person to person during sexual activity. There are different types, or strains, of HPV, and some strains are more strongly linked with certain types of cancer. A doctor may test for HPV at the same time as a Pap test or after Pap test results show abnormal changes to the cervix. Learn more about HPV and cancer.

How often you need to have a Pap test depends on your age, results of previous tests, and other factors. Learn more about cervical cancer screening guidelines.

The medical team

A Pap test is typically performed in your doctor's office by a gynecologist, a medical doctor who specializes in treating diseases of a woman’s reproductive organs. In addition, Pap tests are sometimes performed by other health care professionals, including physician assistants and nurse practitioners. If your gynecologist is a man, a female assistant or nurse may be in the room during the Pap test.

If the results of the Pap test indicate cervical cancer, your doctor will refer you to an oncologist, a doctor who specializes in treating cancer.

Preparing for the procedure

To ensure that the Pap test results are as accurate as possible, do not have sexual intercourse for two to three days before the test. In addition, do not use tampons, birth-control foams, vaginal medicines, douches, or vaginal creams or powders for two to three days before the test; these products may wash away abnormal cells.

The best time to schedule your Pap test is at least five days after the end of your menstrual period. A Pap test can be done during your menstrual period, but it is better to schedule the test at another time.

During the procedure

A Pap test is performed during a pelvic examination in a private room in your health care professional's office. It takes only a few minutes. The test may be uncomfortable, but it is not usually painful. You may experience less discomfort if you empty your bladder before the examination and take deep breaths and relax your muscles during the procedure.

When you arrive for your examination, your health care professional may ask you some basic questions related to the test, including the following:

  • Are you pregnant?
  • Do you use birth control?
  • What medications have you taken recently?
  • Do you smoke?
  • When was your last menstrual period, and how long did it last?
  • Do you have any symptoms, such as itching, redness, or sores?
  • Have you had surgery or other procedures on your reproductive organs?
  • Have you ever had abnormal results from a previous Pap test?

Your health care professional will then leave the room while you remove your clothes below the waist, lie on your back on an examination table, cover your waist and legs with a sheet, and raise your feet to put your heels in stirrups at the end of the table, allowing your knees to relax to the sides. If you prefer, you may leave your socks on to keep your feet warm.

Next, your health care professional performing the examination will gently insert a lubricated plastic or metal instrument, called a speculum, into your vagina. This tool slowly spreads apart the vaginal walls. This may cause some slight discomfort.

After a visual inspection of your cervix, your health care professional will use a cotton swab, a spatula, or a cervical brush to gently scrape cells from two places on the cervix: the ectocervix, which is the part closest to the vagina, and the endocervix, which is the part next to the body of the uterus. This area is called the transformation zone, and it is the location where cervical cancer typically develops. You may feel pulling or pressure during the collection of the cells.

Your health care professional will smear the cells onto a glass microscope slide or put the cells into a container and send the sample to a pathologist for evaluation.

Once the Pap test is finished, your health care professional will complete the pelvic examination. This involves putting two lubricated, gloved fingers inside your vagina and placing the other hand on the outside to check for lumps or tenderness in other reproductive organs, including your fallopian tubes, ovaries, and uterus.

After the procedure

You can resume your normal activities immediately after having a Pap test. You may have a small amount of vaginal bleeding after your Pap test. However, tell your doctor if you experience excessive bleeding.

If the Pap test shows some abnormal cells and an HPV test is positive, the doctor may suggest one or more additional diagnostic tests. In addition, although the Pap test is an excellent screening tool, it is not perfect. Sometimes, the results are normal even when abnormal cervical cells are present, which is called a "false negative" test result. That is why regular screening is important; talk with your doctor about how often you should have a Pap test. Research shows that almost all cervical changes can be found with regular screening and treated before they become cancerous.

Questions to ask your doctor about the Pap test

Before having a Pap test, consider asking your doctor the following questions:

  • Who will perform my Pap test?
  • Should I also be tested for HPV?
  • When will I get the test results?
  • Who will explain the results to me?
  • What will happen if the test results are abnormal or unclear?
  • What further tests will be necessary if the test results indicate cancer?
  • After this test, when should I have my next Pap test?

More Information

Cervical Cancer

Cancer Screening

Additional Resources

MedlinePlus Interactive Health Tutorials: Pap Smear

National Cancer Institute: Pap and HPV Testing