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A Pap smear is a microscopic examination of cells scraped from the opening of the cervix. The cervix is the lower part of the uterus (womb) that opens at the top of the vagina.
It is a screening test for cervical cancer.
You will lie on a table and place your feet in stirrups. The health care provider will insert an instrument (called a speculum) into the vagina and open it slightly to see inside the vaginal canal. Cells are gently scraped from the cervix area, and sent to a lab for examination.
Tell your health care provider if you:
Avoid the following for 24 hours before the test:
Avoid scheduling your Pap smear while you have your period (are menstruating), because it may affect the accuracy of the Pap smear. If you are having abnormal bleeding, your doctor may still recommend you have the test done.
Empty your bladder just before the test.
A Pap smear may cause some discomfort, similar to menstrual cramps. You may also feel some pressure during the exam.
You may bleed a little bit after the test.
The Pap smear is a screening test for cervical cancer. Most cervical cancers can be detected early if women has routine Pap smears and pelvic examinations.
Screening should start at age 21. After the first test:
You may not need to have a Pap smear if you have had a total hysterectomy (uterus and cervix removed) and do not have a history of cervical dysplasia (abnormal cells), cervical cancer, or other pelvic cancer.
A normal (negative) value means there are no abnormal cells present.
Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.
Abnormal results are grouped as follows:
When a Pap smear shows abnormal changes, further testing or follow-up is needed. The next step depends on the results of the Pap smear, your previous history of Pap smears, and risk factors you may have for cervical cancer.
This may include:
For minor cell changes, doctors usually recommend having a repeat Pap smear in 3-6 months.
The Pap smear test is not 100% accurate. Cervical cancer may be missed in a small number of cases. Fortunately, cervical cancer develops very slowly in most women and follow-up Pap smears should identify worrisome changes in time for treatment.
Make sure your doctor knows about all the medicines you are taking. Some, including estrogen and progestins, may affect the result of your Pap smear.
ACOG Practice Bulletin No. 99: management of abnormal cervical cytology and histology. Obstet Gynecol. 2008;112(6):1419-1444.
ACOG Committee on Gynecological Practice. ACOG Practice Bulletin No. 109: Cervical Cytology Screening. Obstet Gynecol. 2009 Dec;114(6):1409-1420.
Cervical cancer in adolescents: screening, evaluation, and manage- ment. Committee Opinion No. 463. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2010;116:469–72.
Noller KL. Intraepithelial neoplasia of the lower genital tract (cervix, vulva): etiology, screening, diagnostic techniques, management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap. 28.