The Pap test (sometimes called a Pap smear) is a way to examine cells collected from the cervix (the lower, narrow end of the uterus). This test can show the presence of infection, inflammation, abnormal cells, or cancer.
What is a pelvic exam?
In a pelvic exam, the uterus, vagina, ovaries, fallopian tubes, bladder, and rectum are felt to find any abnormality in their shape or size. During a pelvic exam, an instrument called a speculum is used to widen the vagina so that the upper portion of the vagina and the cervix can be seen.
Why are a Pap test and pelvic exam important?
A Pap test and pelvic exam are important parts of a woman's routine health care because they can detect abnormalities that may lead to cancer. These abnormalities can be treated before cancer develops. Most cancers of the cervix can be prevented if women have Pap tests and pelvic exams regularly. Also, as with many types of cancer, cancer of the cervix is more likely to be treated successfully if it is detected early.
Who performs a Pap test and pelvic exam?
Doctors and other specially trained health care professionals, such as physician assistants, nurse midwives, and nurse practitioners, may perform Pap tests and pelvic exams. These individuals are often called clinicians.
How is a Pap test done?
A Pap test is simple, quick, and painless; it can be done in a doctor's office, a clinic, or a hospital. While a woman lies on an exam table, the clinician inserts a speculum into her vagina to open it. To do the test, a sample of cells is taken from in and around the cervix with a wooden scraper and/or a small cervical brush. The specimen (or smear) is placed on a glass slide and preserved with a fixative, or is rinsed in a vial of fixative, and is sent to a laboratory for examination.
Who should have Pap tests and pelvic exams?
Current guidelines recommend that women who are or have been sexually active, or have reached age 18, should have Pap tests and pelvic exams regularly. Women may want to discuss with their doctor how often to have the test.
There is no known age at which Pap tests cease to be effective. Women who have had consistently normal Pap test results may want to ask their doctor how often they need to have a Pap test.
Women who have had a hysterectomy (surgery to remove the uterus) should talk with their doctor about whether to continue to have regular Pap tests. If the hysterectomy was performed for the treatment of cancer or a precancerous condition, the end of the vaginal canal still needs to be sampled for abnormal changes. If the uterus (including the cervix) was removed because of a noncancerous condition such as fibroids, routine Pap tests may not be necessary. Women who have had a supracervical hysterectomy (removal of the uterus but not the cervix) should continue to have regular Pap tests. It is important for all women who have had a hysterectomy to have regular gynecologic examinations as part of their health care.
When should the Pap test be done?
A woman should have this test when she is not menstruating. The best time is between 10 and 20 days after the first day of the last menstrual period. For about 2 days before a Pap test, she should avoid douching, or using vaginal medicines or spermicidal foams, creams, or jellies (except as directed by a physician). These may wash away or hide abnormal cells.
What do abnormal results mean?
A physician may simply describe Pap test results to a patient as "abnormal." Cells on the surface of the cervix sometimes appear abnormal but are not cancerous. It is important to remember that abnormal conditions do not always become cancerous, and some conditions are more likely to lead to cancer than others. A woman may want to ask her doctor for specific information about her Pap test result and what the result means.
There are several terms that may be used to describe abnormal results.
- Dysplasia
– a term used to describe abnormal cells. Dysplasia is not cancer, although it may develop into very early cancer of the cervix. Depending on how abnormal the cells appear under the microscope, dysplasia can be classified as:
- Squamous intraepithelial lesion (SIL)
– a term that is used to describe abnormal changes in the cells on the surface of the cervix. A doctor may describe SIL as being:
- Low-grade – early changes in the size, shape, and number of cells
- High-grade – precancerous cells that look very different from normal cells
- Cervical intraepithelial neoplasia (CIN)
– a term that is sometimes used to describe abnormal cells. The term CIN, along with a number (1 to 3), describes how much of the thickness of the lining of the cervix contains abnormal cells.
- Atypical squamous cells of undetermined significance (ASCUS)
– a term used to describe abnormalities that do not fulfill the criteria for SIL, CIN, or dysplasia.
- Carcinoma in situ
– a pre-invasive cancer that involves only the surface cells and has not spread into deeper tissues.
- Cervical cancer or invasive cervical cancer
– occurs when abnormal cells spread deeper into the cervix or to other tissues or organs.
What if Pap test results are abnormal?
If the Pap test shows an ambiguous or minor abnormality, the physician may repeat the test or perform a test for human papillomaviruses (HPV) to determine whether further followup is needed.
If the Pap test shows a significant abnormality, the physician may then perform a colposcopy using an instrument much like a microscope (called a colposcope) to examine the vagina and the cervix. The colposcope does not enter the body. A Schiller test may also be performed. For this test, the doctor coats the cervix with an iodine solution. Healthy cells turn brown and abnormal cells turn white or yellow. Both of these procedures can be done in the doctor's office.
The doctor may also remove a small amount of cervical tissue for examination by a pathologist. This procedure is called a biopsy and is the only sure way to know whether the abnormal cells indicate cancer.
