PAP test

What is a PAP test?

A Pap test or Papanicolaou test consists of removing a small sample of cells from the cervix. Cells are then inspected under a microscope to determine if they are normal or not.

A Pap test should be done every one to three years. A woman who received treatment for a pre-cancerous condition of the cervix will usually do a Pap test each year for the rest of her life.

Indications:

A Pap test main purpose is to:

  • help diagnose precancerous conditions of the vagina and vaginal cancer
  • screen for precancerous conditions of the cervix and cervical cancer
  • diagnose infection and inflammation in the lower female reproductive tract

Pap tests are also done to follow up after an abnormal Pap test or to monitor precancerous conditions. They are used to check for abnormal cell changes or to see if cancer comes back (recurs) after treatment.

Who should have a Pap test

All women who have been sexually active should have regular Pap tests by the time they are 21 years of age. This includes:

  • women who have had the human papillomavirus (HPV) vaccine
  • women who have sex with men or women
  • women who have had a partial hysterectomy and still have a cervix
  • women who have stopped having sex

Regular Pap tests are not needed if a total hysterectomy was done for a non-cancerous, or benign, condition and the woman doesn’t have a history of a precancerous cervical condition or HPV.

For omen older than 69 the decision is often based on a woman’s history of having normal, or negative, Pap test results.

How a Pap test is done?

A Pap test may be done as part of a checkup or during a pelvic, or gynecologic, exam. A pelvic exam is done to make sure the pelvic organs are normal and to check for infections.

A Pap test is usually done in a doctor’s or nurse’s office or in a clinic. It only takes a few minutes to do a Pap test. There may be some discomfort, pressure or cramping during the procedure, but it is not usually painful.

To do a Pap test, the doctor or nurse gently places a speculum into the vagina. A speculum is a clear plastic or metal device. It separates the walls of the vagina so the doctor can see the upper part of the vagina and cervix.

The doctor or nurse uses a small stick, or spatula, to gently scrape the surface of the cervix to pick up cells. In some cases, a special brush (called a cytobrush or cytobroom) is used to collect cells from the inner part of the cervix, which leads into the uterus. Samples of tissues from the vagina can also be taken during a Pap test.

After collecting the cells, the doctor or nurse smears them onto a glass slide or places them in a container filled with a special liquid (called a liquid-based Pap test). The liquid containing the sample of cells may also be used to test for HPV. The sample is sent to a lab to be processed.

You may have some light vaginal bleeding for 1–2 days after a Pap test. It may take two to eight weeks to get the results back.

What the results mean?

A Pap test result may be described as normal (also called negative) or abnormal.

Normal.
A normal, or negative, result means that there were enough cells in the sample and no abnormal or cancerous cells were found. A normal Pap test report may also note if non-cancerous, or benign, conditions are present, such as common infections or inflammation.

Abnormal
Abnormal cells in the cervix or vagina may be classified based on how different they look from normal cells. How abnormal they are may be described as mild to severe.

Abnormal results don’t necessarily mean there is a precancerous condition or cancer. Some abnormal cells return to normal on their own. Other abnormal cells or precancerous changes in the cervix or vagina may develop into cancer over time if they aren’t treated. This includes:

  • squamous cell carcinoma (SCC)
  • adenocarcinoma
  • other types of cancer

If the result of a Pap test is abnormal, your doctor will decide if you need to have follow-up tests, treatment or both. Some changes or abnormalities may need to be treated, depending on how severe they are.

Is it painful

It can cause mild discomfort, pressure or cramps, but it is usually not painful.

How to prepare for a Pap test

Avoid having a Pap test when you have your period. For best results, the test should be done in the middle of your cycle, 10–20 days after the first day of your menstrual period. Talk to your doctor or nurse if your appointment falls during your period.

Avoid having sexual intercourse for 24 hours before the test. Do not use a vaginal douche, vaginal medicines, tampons or contraceptive (spermicidal) creams, foams or gels (except as directed by your doctor) for 48 hours before the test. These products can wash away or hide abnormal cells.

Avoid having the test during treatment for any cervical or vaginal infection. Wait 2 weeks after treatment has ended.

Risks with a Pap test

Screening tests, including the Pap test, have a risk of giving misleading results.

A false-negative result means that the test doesn’t find cancer or abnormal cells even though they are present. This may occur if the sample doesn’t have enough tissue or cells. It can also happen when abnormal cells in the sample are missed.

A false-positive result means that the test shows abnormal cells even though they are not present. This means that something looked like a precancerous condition, but it actually isn’t. A false-positive result may lead to unnecessary follow-up tests, procedures and anxiety.

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