The Pap (Papanicolaou) Test

Image of woman with her OB/GYN getting a Pap tets

Just like men undergo a prostate test at a certain age, it’s recommended that women take a Pap test after a certain age. This is the main way that we detect early signs of cervical cancer — the fourth most common cancer in the world.

Most women should begin getting a Pap test after the age of 21 or when they become sexually active. The frequency of these tests will further depend on your age, as well as other factors. For instance, a positive Pap test may indicate you’ll need a second one sooner. Generally, most women between the ages of 21 and 65 should have a Pap test every three years. But what is the Pap test anyway?

Put simply, the Pap test involves collecting cells from the cervix. These cells can then be examined in a lab, which can detect abnormalities indicating a risk of cancer. So, let’s explore the ins and outs of this routine test. What should you know before your first one? And how can you ensure an accurate result?

How Is the Pap Test Done?

The Pap test might sound daunting, especially if you’ve never had one before. Yet, this is a routine test that may only involve very slight discomfort. So, what should you expect?

Here’s a quick step-by-step of what happens during a Pap smear test:

  • Your doctor will leave the room for you to change into a gown or remove your clothing below the waist. You will be directed to cover yourself and place your feet in the stirrups or with your knees bent and feet flat on the table.
  • Upon your doctor’s return, they will place a speculum inside the vagina. Every step of the way, your doctor should inform you of what they are doing and what you should feel. The speculum is made of plastic or metal, and it helps keep the vagina open so that your doctor can easily access your cervix.
  • Using a spatula or brush, your doctor lightly scraps the cervix to obtain a sample of cells. Another sample may also be taken from the endocervix. If you have had your cervix removed in the past, they will instead take a sample from the upper vaginal region.
  • From here, these samples are sent to a lab for screening and testing.

The entire process usually takes between five and 20 minutes. Afterward, your doctor informs you of how long you can expect to wait for results. Often, they only call you if you have abnormal (positive) results and require further testing.

It’s also worth noting that although the Pap smear is a very excellent screening test for cancer, there is room for error. This is why it’s important to have regular Pap smears, as advised by your family doctor.

How to Make Your Pap Tests More Accurate

Inevitably, certain things you do before the test may impact results. Thus, some preparation may be key for ensuring accuracy. Some things you may want to consider beforehand include:

  • Avoiding scheduling your pap smear during your period. Ideally, you should schedule it five days after menstruation ends. (Phone apps for tracking the menstrual cycle can be great for determining these dates.)
  • Avoiding the use of tampons, vaginal creams, foams, jellies, moisturizers, lubricants, or vaginal medicines for at least 48 to 72 hours before your Pap test.
  • Not douching or rinsing the vagina for 48 to 72 hours pre-test.
  • Avoiding intercourse for at least 48 hours leading up to your test.

How Pap Test Results Are Reported

So, what can you expect in terms of results? Well, Pap tests are usually reported to patients as positive (abnormal) or negative (normal). Negative (normal) means no pre-cancerous or cancer cells were detected. Meanwhile, positive (abnormal) may indicate a few abnormalities, yet it doesn’t mean you have cancer.

A negative Pap smear may mean:

  • An active infection, like HPV
  • Precancer or cancerous cells
  • Mild inflammation
  • Laboratory error

Your doctor may indicate that you need further testing if your Pap test shows any of the abnormalities below.

Negative for Intraepithelial Lesion or Malignancy

Luckily, this means there aren’t any signs of cancer or even pre-cancer. Instead, this indicates inflammation — and this usually means there is a current ongoing infection, such as herpes, another STI (sexually transmitted infection), or a yeast infection. Your doctor will likely advise you on the best step forward, such as treatment or management.

Epithelial Cell Abnormalities

These results suggest possible cancer or pre-cancerous cell changes. In this case, another Pap smear or further testing may be necessary. However, the next course of action may depend on the type of epithelial cell abnormality. Different types of this include:

Squamous Cell Abnormalities

Atypical Squamous Cells (ASCs) can be divided into two different categories. The first category, atypical squamous cells of uncertain significance (ASC-US), describes abnormal cells but the inability to determine the cause. This requires further testing, such as an HPV test. The second category involves the possibility of high-grade squamous intraepithelial lesion (HSIL). This means that there is a possibility of pre-cancer or cancer, but no diagnosis is made. Again, more testing is necessary.

Meanwhile, squamous intraepithelial lesions (SILs) may be low-grade or high-grade. Low grade may eventually resolve on their own but are often monitored accordingly, such as with further testing. High grade have the ability to develop into cancer and require treatment.

If squamous cell carcinoma is indicative, this means cancerous cells are present. While more testing will conclude this, treatment is often eventually required.

Glandular Cell Abnormalities

Atypical glandular cells require more testing. It means that these cells don’t look normal, but it doesn’t necessarily mean cancer. Meanwhile, a result indicating “adenocarcinoma” means cancer is present. Further testing is necessary for a diagnosis.

Lastly, the Pap test may indicate “Other Malignant Neoplasms,” which means another type of cancer is impacting the cervix, such as malignant sarcomas, lymphoma, or melanoma.


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