What is a Pap smear?
The Papanicolaou test is commonly known as the Pap smear, Pap test, or simply Pap. The Pap smear is a routine cancer screening typically done as part of a well-woman exam. The Pap test is screening for cervical cancer believed to be spread by the human papillomavirus (HPV) through sexual contact. Frequently the Pap smear is done along with HPV screening. During the Pap smear portion of the test, cells are sampled from the cervix to look for abnormalities. HPV screening looks for specific strains of the virus that are considered high risk for the development of cervical cancer. As a routine screening test, the Pap smear is considered preventative care and is usually covered under most insurance plans.
The Pap smear does not screen for other forms of cancer, such as uterine or ovarian cancer. The Pap does not look for endometriosis or screen for sexually transmitted diseases. However, screening for some sexually transmitted diseases can be done during the same exam.
What to expect during the exam
The provider will have a conversation with the patient regarding their reproductive health. Common topics discussed may include:
Abnormal vaginal bleeding
Risk of sexually transmitted infections
Unusual pelvic pain
Pain with sex
These topics help the provider understand the patient's health and health risks and are used to guide potential testing and treatments.
For the exam, the patient is undressed from the waist down and covered with a sheet for modesty. The patient is asked to lie on the exam table and put their feet in holders known as stirrups. The stirrups are wide apart so that the provider can easily see the genitals for the exam. The provider will first examine the external genitals, lymph nodes, and anal region.
Then an instrument called a speculum is inserted into the vagina. The speculum moves the walls of the vagina apart so the cervix can be seen for testing. Moving the vaginal walls also allows the provider to look at the inside of the vagina for any potential problems like abnormal discharge, growths, or signs of infection.
The provider then inserts a small brush through the vagina into the opening of the cervix and gently removes a small sample of cells. Some women may experience light bleeding or spotting after this test. The sample of cells is put in a fluid to transport to a lab where the cells will get looked at under a microscope. This same sample is used to look for high-risk HPV.
For the last part of the exam, the provider removes the speculum so they can do a bi-manual exam. The bi-manual exam involves the provider inserting two fingers into the patient’s vagina and pressing down on the patient’s abdomen with the other hand. This two-handed exam allows the provider to feel for any abnormalities with the uterus and ovaries. They can also evaluate any pelvic pain with this exam.
Frequency of screening
All people born with a cervix should get routine cervical cancer screening with a Pap smear. The recommended start for testing used to be at the time the patient became sexually active. Due to improved testing and knowledge about cancer risk, screening now does not start until age 21 regardless of when sexual activity begins. The frequency of screening varies based on age and prior screening results. For most women and people born with a cervix, screening stops at age 65.
Under age 21
No screening is recommended
Ages 21 to 29
Pap smear only every 3 years
Ages 30 to 65
Multiple options are available for screening:
After age 65
No screening is recommended when risk is low and there is adequate prior screening
Hysterectomy with cervix removed
No screening is recommended unless there is a history of cervical cancer or the patient is at high risk