Listen to the Cancer.Net Podcast: Pap Test–What to Expect, adapted from this content.
A Pap test is the most common test used to look for early changes in cells that can lead to cervical cancer. This test is also called a Pap smear. It involves gathering a sample of cells from the cervix. The cervix is the part of the uterus that opens to the vagina.
The sample is placed on a glass slide or in a bottle containing a solution to preserve the cells. Then it is sent to a laboratory for a pathologist to examine under a microscope. A pathologist is a doctor who specializes in reading laboratory tests and evaluating cells, tissues, and organs to diagnose disease. A pathologist can identify abnormal cells by looking at the sample.
Abnormal cells can be cancerous, but they are most often treatable, precancerous cellular changes, rather than cervical cancer. Some of the cells collected from the cervix during a Pap test may also be tested for 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. Some strains are more strongly linked with certain types of cancer.
Your health care provider may test for HPV at the same time as a Pap test. Or you may need testing for HPV only after Pap test results show abnormal changes to the cervix. HPV testing may also be done separately from a Pap test. 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.
Who performs my Pap test?
A gynecologist typically performs a Pap test. A gynecologist is a medical doctor who specializes in treating diseases of a woman’s reproductive organs. Sometimes other health care providers perform Pap tests. This may include primary care doctors, physician assistants, or nurse practitioners. If the person performing the test is a man, a female assistant or nurse may also be in the room.
If the results of the Pap test show cervical cancer, your health care provider will refer you to a gynecologist or an oncologist. An oncologist is a doctor who specializes in treating cancer.
How should I prepare for a Pap test?
To ensure that the Pap test results are as accurate as possible, do not have sexual intercourse for 2 to 3 days before the test. Also, to avoid washing away abnormal cells, do not use the following for 2 to 3 days before the test:
Birth control foams
Vaginal creams or powders
The best time to schedule your Pap test is at least 5 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 Pap test
Your health care provider will perform the Pap test during a pelvic exam in a private room in his or her 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. Also, try taking deep breaths and relaxing your muscles during the procedure.
When you arrive for your Pap test, your health care provider may ask you some basic questions related to the test. These may include:
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?
Before the procedure, you may need to change into a hospital gown in a private area or when your health care provider leaves the room. During the procedure, you will lay on your back on the exam table with your heels in the stirrups at the end of the table.
Next, your health care provider performing the exam will gently insert a lubricated plastic or metal instrument into your vagina. This tool, called a speculum, slowly spreads apart the vaginal walls. It may cause some discomfort.
After a visual inspection of your cervix, your health care provider will use a cotton swab or a cervical brush to gently scrape cells from 2 places on the cervix:
The ectocervix, which is the part closest to the vagina
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, but it typically does not hurt.
Your health care provider will smear the cells onto a glass microscope slide or put the cells into a container with liquid that preserves the sample. He or she will then send the sample to a pathologist for evaluation.
After a Pap test
You can resume your normal activities right after having a Pap test. You may have a small amount of vaginal bleeding after your Pap test. But tell your health care provider if you experience excessive bleeding.
If the Pap test shows abnormal cells and an HPV test is positive, your health care provider may suggest one or more additional tests. The Pap test is an excellent screening tool, but it is not perfect. Sometimes the results are normal even when abnormal cervical cells are present. This is called a "false negative" test result.
Regular screening is important. Talk with your health care provider 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 health care team
Before having a Pap test, consider asking 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?