pap smear test cervical cancer

Pap Smear or Pap Test

What is a Pap smear test or Pap test?

The Papanicolaou smear (Pap smear test) and testing for human papillomavirus (HPV) are the tests your doctor does to check for signs of cervical cancer. These tests can find cervical cancer and precancer in the early stages, when it can be treated. The results of your Pap smear test can show whether your cells are going through these changes long before you actually have cancer. If caught and treated early, cervical cancer is not life threatening.

What is Cervical Cancer? pap smear cervical cancer

Cancer can grow on your cervix ( the lower part of the uterus ) the same way it can grow on other body parts. Most times, cervical cancer grows slowly. It can take 10 to 15 years (or more) for abnormal cells to turn into cancer. Cervical cancer often does not cause symptoms until it is advanced. Women with advanced cervical cancer may have abnormal bleeding, discharge, or pain. A unique fact about cervical cancer is that most cases are triggered by a type of virus. When found early, cervical cancer is highly curable.

Did you know?

Cervical cancer is not hereditary like other cancers.
Every year in the United States, about 12,000 women get cervical cancer,
and almost 4,000 women die from it.
It is the most preventable female cancer with regular screening tests and early treatment.

How often and which tests should I have?

How often you should have cervical cancer screening and which tests you should have depends on your age and health history:

  • Women younger than 21 years do not need cervical cancer screening.
  • Women aged 21–29 years should have a Pap smear test alone every 3 years. HPV testing is not recommended.
  • Women aged 30–65 years should have a Pap test and an HPV test every 5 years.
  • It also is acceptable to have a Pap test alone every 3 years.

You should stop having cervical cancer screening after age 65 years if:-

  • You do not have a history of moderate or severe abnormal cervical cells or cervical cancer, and
  • You have had either three negative Pap test results in a row or two negative co-test results in a row within the past 10 years, with the most recent test performed within the past 5 years.

Remember,If you have had a hysterectomy, you still may need screening.  Women who have been vaccinated against HPV still need to follow the screening recommendations for their age group.

How the Pap smear test is performed?how pap smear test is done

To perform a Pap smear test, a doctor or other health care provider will perform a pelvic exam and use a small brush or spatula to collect cells from the cervix. The sample of cells from your cervix will be preserved and sent to a lab to be tested for the presence of abnormal cells. An HPV test can be done along with a Pap test on same sample.

What does the test results mean?

Your Pap test is reported as abnormal, inconclusive or normal.

Normal: A normal (or “negative”) result means that no cell changes were found on your cervix. This is good news. But you still need to get Pap tests in the future. New cell changes can still form on your cervix.

Inconclusive (also called ASC-US): It is common for test results to come back unclear. Your doctor may use other words to describe this result, like equivocal, inconclusive, or ASC-US. These all mean the same thing—that your cervical cells look like they could be abnormal. It is not clear if it’s related to HPV. It could be related to life changes like pregnancy, menopause, or an infection. The HPV test can help find out if your cell changes are related to HPV.

Abnormal: An abnormal result means that cell changes were found on your cervix. This usually does not mean that you have cervical cancer. Abnormal changes on your cervix are likely caused by HPV. The changes may be minor (low-grade) or serious (high-grade). Most of the time, minor changes go back to normal on their own. But more serious changes can turn into cancer if they are not removed. The more serious changes are often called “precancer” because they are not yet cancer, but they can turn into cancer over three to seven years. In rare cases, an abnormal Pap test can show that you may have cancer. You will need other tests to be sure. The earlier you find cervical cancer, the easier it is to treat.

Follow-up tests

Depending on your test results, your health care provider may recommend:

  • Routine testing, according to guidelines. Depending on your age and test results, this may be every 3 years or every 5 years.
  • Follow-up testing with a Pap test and an HPV test in one year.
  • Colposcopy: This is a procedure that involves looking at the cervix using a microscope with a bright light.

How to prepare for Pap test?

  • You should schedule the test when you are not having your period, since blood can interfere with the results of the test.
  • Do not use tampons, douches, vaginal medicines, sprays, or powders for at least 24 hours before having a Pap test.

If I have HPV, do I have Cervical cancer ?

No. HPV is not the same as cervical cancer. HPV is the virus that can cause cervical cancer. Many women have HPV. Few of them get cervical cancer if they follow their doctor’s advice for more testing and/or treatment.

Does a pap smear hurt ?

Pap smears aren’t painful. But sometimes, you can have a mild pain and uncomfortable feeling for a short time. Women frequently describe it as a small pinch, but everyone’s pain threshold is different. Usually the most uncomfortable part is when the speculum is opened inside the vagina which can stretch the vaginal and vulval tissues leading to a pressure feeling. However, some women will find a smear test painful. There are many physical and psychological reasons that can make a smear test painful or uncomfortable. Conditions like vulvodynia, endometriosis or menopausal vaginal dryness might make the pap smear painful or uncomfortable. Sexual violence, female genital mutilation or a previous traumatic medical experience may also lead to the same outcome. If you experience pain and you want to stop, tell the doctor or nurse to do so.

Why is cervical screening painful for some women ?

There are many reasons why pap smear may be painful, including:-

  • Vaginismus, which means that the vagina suddenly tightens as you try to put something into it.
  • Cervical ectropion or cervical erosion.
  • Endometriosis.
  • Vaginal dryness other post-menopausal symptoms.
  • Female genital mutilation (FGM), when the genital area is deliberately cut, injured or changed as in some cultures.
  • Clenching, or feeling unable to relax, due to nerves, anxiety or a previous bad experience of sexual violence.
  • Other gynecological issues.

How can we reduce the discomfort during pap smear ?

You should let your doctor/nurse know about your concerns and any relevant conditions or experiences that could make your smear more uncomfortable or painful. You can ask to lie in a different position that’s more comfortable or use of a smaller speculum with more lubrication. You can also request to pass the speculum yourself if you are experienced in it. Try breathing exercises to help your body relax. Remember, you can ask to stop at any point if you’re feeling pain or overwhelming anxiety.

Is there any bleeding after a smear test ?

A little bit of bleeding and cramping after a smear test is fairly common, as the cervix is sensitive and might be irritated during the procedure. This bleeding should be very light and should stop within a few hours. If the bleeding does not stop in twenty four hours, is heavy, or you are in a lot of pain, you should contact your doctor.

Can you get a pap smear on your period ?

The accuracy of pap smear results is impacted if it is done during periods. Because of the presence of blood, it may be difficult for your provider to obtain a clear sample of cervical cells. There will also be difficulty in reading the slides and giving reliable result.
If your appointment falls during your periods, it is better to reschedule your appointment for a time when you are not menstruating. If you have spotting or light bleeding, you may be able to continue.

Is a pap smear the same as a pelvic test ?

A pap smear is not the same as a pelvic exam, though it is also performed with a speculum. In a pelvic exam the doctor examines in detail the reproductive organs, including the vagina, vulva, cervix, ovaries, and uterus. During pap smear your doctor will only examine your vulva, vaginal opening and cervix for unusual discharge, redness, or other irritation and take a smear from the cervix.

Does pap smear test for chlamydia and other STIs ?

Chlamydia cannot be detected through a Pap smear test. A Pap smear is a test doctors use to check if a woman has any precancerous or cancerous cells in her cervix. It is not a test for chlamydia. Each assessment may incorporate a pelvic examination, yet they obtain samples from distinct areas of the person’s reproductive passage.

Chlamydia, an STI caused by the bacterium Chlamydia trachomatis, has the potential to accumulate in the urethra, throat, and rectum. Consequently, medical professionals might extract swabs from various locations. The Centers for Disease Control and Prevention (CDC) says that doctors may take a cervical swab to test for chlamydia and scrape cervical cells for a Pap smear test if the patient wishes to be tested for chlamydia as well. Doctors may combine a Pap smear with a test for human papillomavirus (HPV), another common STI. HPV infections may become chronic, or long lasting, and increase a woman’s risk of developing cervical cancer.

The CDC recommends regular screening for both cervical cancer and chlamydia. Chlamydia is diagnosed through the application of nucleic acid amplification tests (NAATs). Samples of genital fluids or urine are taken and sent to a laboratory for analysis.
Doctor / nurse can collect samples of vaginal fluids by taking a swab during a pelvic exam.


Dr Sobia Mohyuddin

MCPS, FCPS, MRCOG, Consultant Obstetrics & Gynaecology

Doctor Sobia Mohyuddin is a highly skilled and experienced Obstetrician and Gynecologist, with 25 years of training and experience in renowned, large institutions. She holds the position of Associate Professor and Fellow at the College of Physicians and Surgeons Pakistan. She is also a member of the Royal College of Obstetricians and Gynecologists (UK).