The Pap test checks for cervical cancer. Cells scraped from the opening of the cervix are examined under a microscope. The cervix is the lower part of the uterus (womb) that opens at the top of the vagina.
This test is sometimes called a Pap smear.
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How the Test is Performed
You lie on a table and place your feet in stirrups. Your health care provider gently places an instrument called a speculum into the vagina to open it slightly. This allows the provider to see inside the vagina and cervix.
Cells are gently scraped from the cervix area. The sample of cells is sent to a lab for examination.
How to Prepare for the Test
Tell your provider about all the medicines you are taking. Some birth control pills that contain estrogen or progestin may affect test results.
Also tell your provider if you:
DO NOT do the following for 24 hours before the test:
Try not to schedule your Pap test while you have your period (are menstruating). Blood may make the Pap test results less accurate. If you are having unexpected bleeding, do not cancel your exam. Your provider will determine if the Pap test can still be done.
Empty your bladder just before the test.
How the Test will Feel
A Pap test causes little to no discomfort for most women. It can cause some discomfort, similar to menstrual cramps. You may also feel some pressure during the exam.
You may bleed a little bit after the test.
Why the Test is Performed
The Pap test is a screening test for cervical cancer. Most cervical cancers can be detected early if a woman has routine Pap tests.
Screening should start at age 21.
After the first test:
You may not need to have a Pap test if you have had a total hysterectomy (uterus and cervix removed) and have not had an abnormal Pap test, cervical cancer, or other pelvic cancer. Discuss this with your provider.
A normal result means there are no abnormal cells present. The Pap test is not 100% accurate. Cervical cancer may be missed in a small number of cases. Most of the time, cervical cancer develops very slowly, and follow-up Pap tests should find any changes in time for treatment.
What Abnormal Results Mean
Abnormal results are grouped as follows:
ASCUS or AGUS:
LOW-GRADE DYSPLASIA (LSIL) OR HIGH-GRADE DYSPLASIA (HSIL):
CARCINOMA IN SITU (CIS):
ATYPICAL SQUAMOUS CELLS (ASC):
ATYPICAL GLANDULAR CELLS (AGC):
When a Pap test shows abnormal changes, further testing or follow-up is needed. The next step depends on the results of the Pap test, your previous history of Pap tests, and risk factors you may have for cervical cancer.
For minor cell changes, providers will recommend another Pap test or repeat HPV testing in 6 to 12 months.
Follow-up testing or treatment may include:
American College of Obstetricians and Gynecologists. Practice bulletin no. 140: management of abnormal cervical cancer screening test results and cervical cancer precursors. (Reaffirmed 2018) Obstet Gynecol. 2013;122(6):1338-1367. PMID: 24264713 www.ncbi.nlm.nih.gov/pubmed/24264713.
American College of Obstetricians and Gynecologists. Practice bulletin no. 157: cervical cancer screening and prevention. Obstet Gynecol. 2016;127(1):e1-e20. PMID: 26695583 www.ncbi.nlm.nih.gov/pubmed/26695583.
American College of Obstetricians and Gynecologists website. Practice advisory: cervical cancer screening (update). August 29, 2018. www.acog.org/Clinical-Guidance-and-Publications/Practice-Advisories/Practice-Advisory-Cervical-Cancer-Screening-Update. Published August 29, 2018. Reaffirmed November 8, 2019. Accessed March 17, 2020.
Newkirk GR. Pap smear and related techniques for cervical cancer screening. In: Fowler GC, ed. Pfenninger and Fowler's Procedures for Primary Care. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 120.
Salcedo MP, Baker ES, Schmeler KM. Intraepithelial neoplasia of the lower genital tract (cervix, vagina, vulva): etiology, screening, diagnosis, management. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 28.
Saslow D, Solomon D, Lawson HW, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin. 2012;62(3):147-172. PMID: 22422631 pubmed.ncbi.nlm.nih.gov/22422631.
US Preventive Services Task Force website. Final recommendation statement. Cervical cancer: screening. www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/cervical-cancer-screening2. Updated August 2018. Accessed January 22, 2020.
Review Date: 1/1/2020
Reviewed By: John D. Jacobson, MD, Professor of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda Center for Fertility, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Editorial update 03/17/2020.
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