WELLNESS

What is a Pap Smear?

by MICHELLE KONSTANTINOVSKY

With the exception of online personality quizzes and time-sucking trivia click-throughs, it’s hard to think of too many tests that elicit a ton of excitement. But some, like the Pap test (aka Pap smear), are so important to your health and well-being, that despite their less-than-fun reputations, they deserve a ton of respect. Whether you’ve had one, are scheduled to get one, or are just curious about what the heck it is, it’s time to get a comprehensive education on the Pap. 

What is a Pap smear?

“A pap smear is a quick and easy sampling of cells from the cervix (the opening into the uterus) which screens for cervical cancer,” says New York-based OB/GYN, Alyssa Dweck, MS, MD, FACOG. “Since early detection can prevent advanced disease, a pap smear remains an important part of the well woman gynecology visit.”

During a Pap test, a medical provider inserts a tool called a speculum into your vagina and uses a soft brush or stick to gently collect cervical cells. Those cells are then sent to a laboratory and tested.  

“A Pap smear, also called a Pap test, samples the cells on your cervix, both the outside—the part you can feel with your fingers if you tried—and the inside of the canal,” says Kate White, MD MPH, director of the Family Planning Fellowship and associate professor of OB/GYN at Boston University. “This test can detect abnormal cells on your cervix years before they may turn cancerous, to allow time for the cells to be removed.”

Curious about that curious name? You can credit Greek doctor Georgios Nikolaou Papanikolaou for inventing the now-standard test. The pioneering physician was actually studying sex determination in guinea pigs in the 1920s when he discovered that some cells in the vagina and uterus changed throughout the menstrual cycle. Intrigued to find out if the same changes occur in humans, he began collecting cervical cell samples and examining them under the microscope. It was through this innovative exploration that he found mutated, malignant cancer cells on one sample, and began advocating for widespread screenings using his method.

Why are Pap smears performed?

We now know Papanikolaou was clearly onto something, but it took skeptics in the medical community about a decade to buy into his theory. In 1952, the first mass screening program launched in Tennessee. Of the approximately 100,000 women screened, 773 were diagnosed with cancer. 

Thanks to that groundbreaking work, doctors today continue to rely on Paps to test for cervical cancer. Early detection of cancer cells in the cervix increases a woman’s likelihood of a cure. And the Pap doesn’t just identify already-mutated cancer cells; the test can also detect cell changes that indicate cancer may develop in the future. 

The test is usually performed during a routine pelvic exam. Your doctor will help guide your decisions around when and how often you should get tested, but in general, doctors start performing Pap smears for most women at age 21 and repeat the test every three years from the ages of 21 to 65. For women over 30, doctors may combine their Pap test with a test for human papillomavirus (HPV), done every 5 years, and in some cases, the HPV test can replace the Pap smear. 

However, these are general guidelines that vary from person to person, depending on a variety of factors, including personal health history, exposure to certain chemicals or procedures, and more. These guidelines also apply only when tests show no abnormalities. When there are abnormalities, testing may include other tests besides a pap and usually needs to occur more frequently.

Is a Pap test the same as an HPV test?

Although they’re often performed in conjunction with one another, Pap tests and HPV tests are actually different. HPV is a sexually transmitted infection (STI), and while it goes away on its own in most people, in the cases where it doesn’t resolve itself, it can lead to abnormal cervical cells that may turn cancerous. 

Not all types of HPV are known to cause cancer, but there are about a dozen that are considered “high-risk” strains, and just two of these types cause 70% of all cervical cancers. These high-risk types can cause more than just cervical cancer, too—they’re also responsible for many anal, vaginal, vulvar, mouth, throat, and penile cancers as well. 

While Pap testing looks for abnormal cervical cells, HPV testing looks for the DNA or RNA of those high-risk types of HPV. Since the same sample of cells can be used for both tests, co-testing is an option for some women. That means a doctor will collect a sample of cervical cells and perform both tests (this is typically done every five years for women between the ages of 30 and 65 if they are not at an increased risk for cervical cancer). Co-testing has its perks: the method is more likely to detect cervical cancer or abnormal cervical cells than a Pap test alone.

One thing to know about HPV: it is preventable, so if you haven’t been vaccinated, talk to your doctor about it ASAP. “The HPV vaccine protects against genital warts, cervical cancer, and other HPV related cancers,” Dweck says. “Get it!”

How often do I need a Pap smear?

Again, you and your doctor will decide on a testing schedule that’s appropriate for you, but the most recent screening guidelines from the United States Preventive Services Task Force are as follows: 

  • Women ages 21 through 29 should be screened with a Pap test every 3 years
  • Women ages 30 through 65 should be screened with any of three tests:
  • every 5 years with high-risk HPV testing alone
  • every 5 years with Pap and high-risk HPV cotesting
  • every 3 years with a Pap test alone

If you have certain risk factors, you may need to get Pap testing more frequently and/or continue to be screened after the age of 65. These risk factors include:

  • Having human immunodeficiency virus (HIV)
  • Having a suppressed immune system for any reason 
  • Having been exposed to diethylstilbestrol (a synthetic form of estrogen) before birth
  • A history of being treated for a precancerous cervical lesion or cervical cancer

Is there anyone who shouldn’t have Pap tests?

The same guidelines indicate that Pap smears aren’t recommended for women younger than 21, women older than 65 who have had normal results from screenings and aren’t at a high risk for cervical cancer, and women who have had a total hysterectomy (the removal of the cervix and uterus) who don’t have a history of high-grade cervical lesions or cervical cancer.

Before, during, and after the Pap test

There’s not too much preparation you’ll have to do prior to a Pap smear, but there are a few important things to take into consideration. “Don’t have vaginal intercourse for the two days prior to your pap test,” White says. “It’s also best to not use any products such as creams or gels inside your vagina during this time.”

“It’s best to have a Pap smear done with a pristine cervix,” Dweck says. “No menstrual blood, no sex, lubes, vaginal meds or douches immediately preceding the test.”

While some women find Pap and HPV tests uncomfortable, neither one should be painful. During the test(s), you’ll lie down on an exam table with your feet in footrests, and your doctor will insert a speculum into your vagina to open the cervix (this may cause you to feel some pressure). Then they’ll use a soft brush or special stick to collect a few cells from the cervix and vagina before sending them to a lab to be examined under a microscope and analyzed. The whole testing process usually lasts about five minutes. You may experience some light spotting afterward, but no major discomfort. 

It usually takes about one to three weeks to get Pap and HPV test results back from the lab. In general, the results fall into three categories:

  • Normal. The cervical cells looked as they should and the HPV test was negative (if you had co-testing) You don’t have to do anything until it’s time for your next Pap or HPV test.
  • Unclear. Your doctor can’t tell from the sample whether the cervical cells are normal or abnormal. You may need to go back immediately for additional testing or your doctor may recommend returning in six months or a year for another test.
  • Abnormal. The cervical cells in your sample appear abnormal or your HPV test was positive. This doesn’t necessarily mean you have cancer. Your doctor may order another Pap or additional tests, or wait six months or a year before re-testing. If your doctor is concerned about the abnormal cells, they may perform more tests like a biopsy (removal of tissue sample) and/or a colposcopy (an examination of the abnormal areas of the cervix using a special instrument with a light and microscope).

Want to know more? Talk to your doctor about your specific needs around screening and prevention and don’t be afraid to speak up with questions or concerns.