Know Before You Go: Pap Smear Tests
The Pap screening test looks for precancerous cells on the cervix, the canal that connects the uterus and vagina. The Pap test is named for its inventor, George Papanikolaou, who announced to the world in 1928 that cervical cancer could be diagnosed from a vaginal smear.
Cervical cancer—third in incidence and fourth in mortality for women among cancers worldwide—most commonly occurs in women older than 30 years old, but all women are considered at risk. Risk increases in women who have had long-lasting infections with certain types of HPV, the human papillomavirus, a common sexually transmitted infection (STI).
Receiving regular Paps smear tests has been shown to decrease cervical cancer incidence and mortality in the U.S.
Who needs a Pap test and when?
Pap smears are recommended for most women between 21 and 65 years old and are sometimes done together with an HPV test (called co-testing). Pap tests are generally recommended every three years for women between those ages, though the recommendation can change if the tests are carried out with HPV testing.
You may need more frequent Pap tests if you have received abnormal results on a previous test, and more frequent tests are also recommended if you are immunocompromised, you’re living with HIV or if your mom was exposed to diethylstilbestrol (DES) while she was pregnant with you. Many women who have had a total hysterectomy don’t need a Pap test, but those who had HPV in the past should continue with Pap tests.
How to prep for a Pap test
There’s virtually nothing you need to do to prepare for the test, unless you want to take an Advil or Tylenol an hour in advance. You don’t need to douche—actually, some doctors don’t ever recommend douching—or clean your vagina in any way before the appointment. It is preferable you not be menstruating and not have intercourse immediately before the test.
You will lie on your back on the exam table with your feet on either side of the table or in footrests. A doctor or nurse will insert a speculum, a tool that slightly widens the vagina so the cervix is more easily visualized and accessed, and then use a special stick or brush (like a long Q-tip) to scrape along the outside of your cervix to collect cervical cells that are then sent to a lab for testing.
The same cells tested during the Pap test can also be used to test for HPV.
Test results for a Pap test will come back as negative (normal), unsatisfactory (unclear) or positive for HPV or atypical for precancerous cells. Most women will get normal test results, and if you’re one of them, your only task is to schedule your next visit.
Unclear test results mean that your practitioner couldn’t clearly interpret the results and you may need to repeat the test.
Abnormal test results indicate that some cells taken from your cervix were not normal cells, which doesn’t necessarily mean you have cancer. Speak to your doctor about next steps, which may include repeating a Pap test immediately or in six months to a year, or doing other screening tests, depending on the number and severity of abnormal cells.
Abnormal cells may be the result of HPV, but other causes such as yeast infections, hormonal changes and smoking can also cause Abnormal results.
Misconceptions about the Pap test
Let’s clear up a couple of misconceptions. You do need a Pap smear whether or not you’re having sex. If you’ve never had sex, undergoing a Pap test does not claim your virginity. You’re still a virgin. Last, a Pap test does not leave any permanent marks or scars.
What the Pap test feels like
The typical procedure takes no longer than five minutes, and while it can be uncomfortable for some women, it’s not (or shouldn’t be) painful, though you will feel a little pressure when the speculum is inserted into your vagina. If you’ve never had vaginal sex or are worried about discomfort, you can ask that a smaller speculum be used. You may experience some mild spotting after the procedure, but there should be no pain.
When a Pap test is combined with a pelvic exam, the doctor removes the speculum after the Pap and places two fingers in the vagina and the other hand on the abdomen to feel the uterus and ovaries.
If you’re feeling stressed about undergoing the Pap smear procedure, you may find it helpful to have a friend or your partner go with you. Finding and sticking with a practitioner you like may help make your appointments more comfortable.
Pap smears are essential to protect a woman’s health, promote a happy sex life and reduce the risk of cervical cancer. They’re also a good idea because they work in tandem with using protection during sex to help prevent STIs such as HPV, another major risk factor for cervical cancer.
Protect yourself and your cervix by scheduling this important test as indicated by your healthcare provider. For most women, these aren’t their favorite five minutes, but they are critical.