Listen to the Cancer.Net Podcast: Pap Test–What to Expect, adapted from this content.
A Pap test, also called a Pap smear, detects cervical cancer and can also find early changes in the cells of a woman's cervix that, if left untreated, could turn into cancer. It is most often used as a screening test for cervical cancer in women who have no symptoms, typically done at the same time as a gynecologic checkup.
A Pap test involves gathering a sample of cells from the cervix. The sample is placed on a glass slide and sent to a laboratory for examination under a microscope by a pathologist (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. If the Pap test finds an abnormality, it is most commonly related to 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 a virus called the human papilloma virus (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 associated with certain types of cancer. Cervical cancer screening guidelines recommend the HPV test with a Pap test for women with a history of abnormal cells and women older than 30. Learn more about HPV and cancer.
The medical team
A Pap test is typically performed in a doctor's office by a gynecologist, a medical doctor who specializes in treating diseases of the female reproductive organs. Pap tests are also sometimes performed by other health care professionals, including physician assistants and nurse practitioners. If your gynecologist is a man, a female assistant or nurse will be in the room during the Pap test.
If the results of the Pap test indicate cancer, an oncologist (a doctor who specializes in cancer) will treat the cervical cancer.
Questions to ask your doctor before 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 the human papillomavirus (HPV)?
- When will I get the test results?
- Who will explain the results to me?
- What happens 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?
Preparing for the procedure
To ensure that the Pap test results are as clear 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 can be uncomfortable, but it is not usually painful. Emptying your bladder before the examination and taking deep breaths and relaxing your muscles during the procedure may make it more comfortable.
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 recently taken?
- Do you smoke?
- When was your last menstrual period, and how long did it last?
- Do you have any problems or symptoms, including 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?
When you are ready for your examination, you will remove your clothes below the waist, lie on your back on an examination table, and cover your waist and legs with a sheet. In addition, you will raise your feet and put your heels in stirrups at the end of the table, allowing your knees to relax to the sides. You can keep your socks on to keep your feet warm.
Next, the 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 the cervix (the part of the uterus that opens to the vagina), the health care professional will use a cotton swab, a spatula, or a cervical brush to gather cells from two places on the cervix: the ectocervix (the part closest to the vagina) and the endocervix (the part next to the body of the uterus). This area is called the transition zone, and it is where cervical cancers develop. As the cells are collected, you may feel pulling or pressure.
The 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 complete, your health care professional will complete the pelvic examination. He or she will put two lubricated, gloved fingers inside your vagina, using the other hand to feel from the outside for any lumps or tenderness in other reproductive organs, including your fallopian tubes, ovaries, and uterus.
After the procedure
You may have a small amount of vaginal bleeding after your Pap test. However, tell your doctor if you have excessive bleeding. You can resume your normal activities immediately after the test.
Although the Pap test is an excellent screening tool, it is not perfect. Thus, sometimes the results are normal even when there are abnormal cervical cells present; this 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 abnormalities can be found with regular screening and treated before they become cancerous.