A Pap smear, or Papanicolaou test, is a routine screening procedure designed to detect changes in the cells of the cervix, the lower, narrow part of the uterus that opens into the vagina. This test involves collecting a small sample of cells for analysis under a microscope to identify any cellular abnormalities. The goal of a Pap smear is the early detection of precancerous or cancerous conditions, allowing for timely intervention to prevent the development of cervical cancer.
Essential Preparation for the Test
Ensuring the accuracy of a Pap smear begins with careful preparation in the days leading up to the appointment. The presence of foreign substances or blood can obscure the cervical cells, potentially leading to an inconclusive or false-negative result. Scheduling the test during a time when you are not experiencing menstrual bleeding is important, though if you have unexpected bleeding, you should not delay the test.
For at least 24 to 48 hours prior to the procedure, you should avoid inserting anything into the vagina. This includes refraining from sexual intercourse, douching, using tampons, or applying vaginal creams, suppositories, or spermicidal products. These activities can wash away the cells the clinician needs to collect or introduce materials that interfere with the laboratory analysis.
The Examination: A Step-by-Step Guide
The Pap smear procedure itself is typically brief, often taking only a few minutes, though the entire appointment may last longer. The process begins with you lying on your back on the examination table, placing your feet into supports called stirrups. This positioning, known as the lithotomy position, allows the clinician clear access to the cervix.
The clinician will then gently insert an instrument called a speculum into the vagina. The speculum, which can be made of plastic or metal, is carefully opened to hold the vaginal walls apart, allowing the cervix to be visualized. You may be offered a choice of speculum sizes, and the instrument is often lubricated with a water-based gel to ease insertion, though too much lubricant can interfere with the sample.
Once the cervix is visible, the cell collection begins using a small device, typically a soft brush or a combination of a brush and a spatula. The clinician will rotate the collection tool gently but firmly against the surface of the cervix and inside the opening to gather cells from the transformation zone. This area is where most abnormal cell changes originate.
While the collection should not be painful, you may feel a brief sensation of pressure or cramping during the process. Focusing on slow, deep breathing can help relax the pelvic muscles and minimize any discomfort. After the sample is collected, the speculum is carefully closed and removed, and the collected cells are immediately placed into a liquid preservative or onto a slide to be sent to a laboratory for cytological analysis.
Interpreting Your Pap Smear Results
After the sample is analyzed in the laboratory, the results fall into a few main categories that dictate the next steps in your care. A “Normal” or “Negative” result means that no abnormal cells were found, and you will continue with routine screening, which is often every three to five years depending on your age and whether you also had an HPV test.
An “Unclear” or “Atypical” result, often reported as Atypical Squamous Cells of Undetermined Significance (ASC-US), means that some cells did not look completely normal, but the change is minor and its cause is not certain. These changes are often due to a temporary inflammation or an infection like Human Papillomavirus (HPV). For this result, follow-up often involves an HPV co-test, if one was not performed initially, to determine if a high-risk HPV strain is present.
An “Abnormal” or “Positive” result indicates that more significant cell changes were detected, but it does not automatically mean cancer is present. Abnormal results are further categorized as Low-Grade Squamous Intraepithelial Lesion (LSIL) or High-Grade Squamous Intraepithelial Lesion (HSIL). LSIL usually suggests a mild abnormality often caused by HPV, which may clear on its own, while HSIL indicates a more advanced precancerous change that requires immediate attention.
For any abnormal result, the clinician will typically recommend a follow-up procedure called a colposcopy, which uses a magnifying instrument to examine the cervix more closely. Modern screening often includes co-testing for HPV, as persistent infection with high-risk HPV types is the primary cause of cervical cell changes.