Pap Testing
What is a Pap smear?
A Pap smear (also known as the Pap test) is a medical procedure in which a sample of cells is collected from a woman’s cervix (the lower opening of the uterus) and spread (“smeared”) onto a microscope slide for examination. Pap tests can also be collected in a liquid sample. A Pap smear is done to look for abnormal changes among the cervical cells, which may eventually become cancerous.
A Pap smear is a simple, quick and painless screening test, which can identify minor cellular abnormalities on the cervix while they are still treatable. The Pap smear is not intended to detect other forms of cancer such as those of the ovary, vagina, or uterus.
Who should have a Pap smear? How often should women have Pap smears?
The American Cancer Society recommends that you have your first Pap smear about three years after first having sexual relations or at age 21. After age 21, the guidelines are as follows:
|
Age |
Frequency |
|
21 to 29 |
Once a year using the regular Pap smear or every two years using the liquid-based Pap test. |
|
30 to 69 |
Every two to three years if you've had three normal Pap smears in a row. |
|
70 and older |
You may stop having Pap smears if you've had normal results three tests in a row and you've had normal Pap smears over the past 10 years. |
Regardless of your age, if you have certain risk factors you may need to be screened more often. Let your provider know if you have any of the following risk factors, and he or she will help you decide how often to have a Pap test:
- A history of sexual activity as a teenager, especially if you had more than one sex partner
- Multiple sex partners now
- A partner who began sexual activity at an early age or who had many previous sexual partners
- A history of a sexually transmitted infection
- A family history of cervical cancer
- A diagnosis of cervical cancer or a Pap smear that showed precancerous cells
- Infection with human papillomavirus (HPV)
- HIV infection
- Tobacco use
- Exposure to diethylstilbestrol (DES) before birth - DES is a synthetic estrogen that was used to prevent miscarriage and other pregnancy complications between 1938 and 1971 in the United States
- Weakened immune system due to such factors as an organ transplant, chemotherapy or chronic corticosteroid use
I’ve heard about a new vaccine for HPV. If I’ve had that, do I still need to get Pap smears?
Vaccination is not a substitute for routine cervical cancer screening (Pap testing). Females who have received an HPV vaccine (Gardasil) and have ever been sexually active should continue to receive Pap smears on the recommended basis. This is because about 30% of cervical cancer cases are caused by strains of HPV that the vaccine does not protect against.
How do I need to prepare to have a Pap smear?
Avoid scheduling your appointment when you are menstruating, because the blood and cells shed during your period may interfere with the accuracy of the Pap test.
In the two days before your appointment, avoid douches, spermicidal foams, creams or jellies, and any vaginal medicines (except as directed by a physician). These products may wash away or hide any abnormal cervical cells. Also, 24 hours before your test, do not have intercourse, use tampons or take tub baths.
When you arrive in the clinic, empty your bladder. Also, notify your provider if you have had a prior abnormal Pap smear and/or if you might be pregnant.
How is a Pap smear done?
The Pap smear is performed as part of a gynecological exam. You will lie on your back at the end of a table with stirrups, where you will rest your feet during the examination. A speculum (a plastic or metal instrument used to open the walls of the vaginal canal) will be inserted into your vagina and opened slightly. This allows the provider to see your cervix.
Two samples of cells are collected. First, a sample is taken by using a flexible plastic spatula to gently scrape the outside of the cervix. Then a small, soft brush that looks like a pipe cleaner is inserted into the opening of the cervix and twirled around to collect a sample of cells. The cells are placed on a glass slide and sprayed with a fixative, or put in a bottle containing a preservative, and then sent to the lab for examination.
How will I receive the results of my Pap test?
The results of the Pap smear are usually available in 2 to 3 weeks. Students typically receive their results via e-mail. The e-mail contains information about the test results and the meaning of these results, as well as contact information for a health educator at Student Health who you can contact with additional questions.
How do I schedule an appointment for a Pap smear?
Any provider at Student Health can do a Pap smear. Call 919-681-WELL to schedule an appointment at the Student Health Center.
If possible, aim to schedule your appointment between 10 and 20 days after the first day of your menstrual period. Avoid scheduling your appointment when you will be menstruating.
My Pap test came back abnormal. What does that mean?
An abnormal Pap test result means that some unusual cells were observed in the samples collected from the cervix. Such cells may indicate an infection, a precancerous condition or possibly cancer. However, a Pap smear is just a screening test. It is not 100% accurate. It may suggest a precancerous condition when in fact everything is normal.
Further testing through additional Pap smears, colposcopy, specific screening for sexually transmitted infections may be necessary to accurately diagnose and properly treat the condition. Your provider should give you recommendations about which tests and treatments should follow.
If there is evidence of an HPV infection , a colposcopy will be typically be done to examine and confirm HPV infection by taking tissue samples from abnormal-looking areas. A gentle scraping from inside the cervix (endocervical canal curettage) may be done to obtain a sample of cells from “higher up.” These procedures help make a definite diagnosis, which is essential in deciding if further treatment is necessary.
For more information on this topic, see our entry on abnormal pap smears.
Where can I go for more information and support?
Duke students who want additional information about HPV, Pap smears, dysplasia, and/or colposcopy can make an appointment to see a Health Education Specialist one-on-one at the Student Health Center. The health educator is available to answer any of your questions about Pap testing, as well as any other reproductive health issues that you would like to know more about.
To make an appointment, call 919-681-WELL and ask to schedule an HPV consultation with Lindsey Bickers Bock.
Online resources:
The National HPV and Cervical Cancer Prevention Resource Center
Resource Center Hotline: 1-800-227-8922, Monday – Friday, 9:00 AM – 6:00 PM, Eastern Time
Online HPV Chat Room: 5:00 – 6:00 PM Eastern Time, Tuesdays and Thursdays
HPV e-News: Published six times a year via a secure Web page
National Cervical Cancer Public Education Campaign
References:
Pap Smear information on MedicineNet.com, by Carolyn Crandall, MD
American Academy of Family Physicians
Pap Smears: What They Are and What the Results Mean
Mayo Clinic.
Pap Smear: Screening test for cervical cancer
Smith RA, Cokkinides V, & Eyre HJ. (2006). American Cancer Society guidelines for the early detection of cancer, 2006. CA Cancer J Clin. 56:11-25.
Reviewed by the Office of Health Promotion, August 2006.