Pap Smear

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Also known as: PAP Test
Formal name: Papanicolaou Smear; Cervical Smear; Cervical/vaginal Cytology
Related tests: HPV; Trichomonas

At a Glance

Why Get Tested?

To screen for cervical cancer and certain vaginal or uterine infections

When to Get Tested?

For women over the age of 21, once every 3 to 5 years depending on your age, risk factors, use of other screening tests, and your doctor's advice

Sample Required?

Cells from the cervical area

Test Preparation Needed?

You may be instructed not to douche or tub bathe for 24 hours before the Pap smear is to be performed. You may also be asked to refrain from sexual intercourse for 24 to 48 hours before the test. Do not use any vaginal creams or foams for 48 hours prior to the exam and do not schedule the test during your menstrual period.

The Test Sample

What is being tested?

Thumbnail diagram of the cervix

A Pap smear is a test used to detect abnormal or potentially abnormal cells from the vagina and uterine cervix. Various bacterial, fungal, and viral infections of the uterus may also be detected using this test.

Pap smears, when performed routinely, have been a great help in the detection and treatment of areas of pre-cancerous cells, which help to prevent cervical cancer from developing. In addition, the test can help detect cervical cancer in the early stages, when it is most treatable. The Pap smear is also used to monitor any abnormalities or unusual findings. In many cases, these findings are part of the body's repair process and often resolve themselves without any further treatment.

How is the sample collected for testing?

The conventional method consists of sampling cells from the cervical area. The sample is obtained using a type of wooden "spatula," cotton swab, or brush. Relatively new liquid-based methods are available that are modifications of the conventional Pap smear. The specimen is collected as noted above but is not placed directly onto a glass slide. Rather, it is put into a special liquid preservative. This cell suspension is processed onto a glass slide, stained, and examined.

NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.

Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.

Is any test preparation needed to ensure the quality of the sample?

You may be instructed not to douche or tub bathe for 24 hours before the Pap smear is to be performed. You may also be asked to refrain from sexual intercourse for 24 to 48 hours before the test. Do not use any vaginal creams or foams for 48 hours prior to the exam and do not schedule the test during your menstrual period.

The Test

Common Questions

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Article Sources

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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.

Sources Used in Current Review

American Cancer Society. Cervical Cancer Overview. Available online at http://www.cancer.org/Cancer/CervicalCancer/OverviewGuide/cervical-cancer-overview-key-statistics through http://www.cancer.org. Last reviewed February 8, 2012. Accessed April 17, 2012.

World Health Organization. Sexual and Reproductive Health: Cancer of the Cervix. Available online at http://www.who.int/reproductivehealth/topics/cancers/en/ through http://www.who.int.  Accessed March 23, 2012.

Press release. FDA Approves New Indication for Gardasil to Prevent Genital Warts in Men and Boys. Available online at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm187003.htm through http://www.fda.gov. Issued October 16, 2009. Accessd March 23, 2009.

U.S. Preventive Services Task Force. Screening for Cervical Cancer. Release Date: March 2012. Available online at http://www.uspreventiveservicestaskforce.org/uspstf/uspscerv.htm. Accessed March 2012. 

Moyer, VA on behalf of the U.S. Preventive Services Task Force. Screening for Cervical Cancer: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine, March 6, 2012, 156(5). Available online at http://www.annals.org/content/early/2012/03/14/0003-4819-156-12-201206190-00424.full through http://www.annals.org. Accessed March 2012.

American Cancer Society. New Screening Guidelines for Cervical Cancer. Article date: March 14, 2012. Available online at http://www.cancer.org/Cancer/news/News/new-screening-guidelines-for-cervical-cancer through http://www.cancer.org. Accessed March 2012. 

American College of Obstetricians and Gynecologists (ACOG). Cervical cytology screening. Washington (DC): American College of Obstetricians and Gynecologists (ACOG); 2009 Dec. 12. (ACOG practice bulletin; no. 109). Available online at http://www.guideline.gov/content.aspx?id=15274#Section420 through http://www.guideline.gov. Accessed March 23, 2012.

National Cancer Institute.Fact Sheet. HPV and Cancer. Available online at http://www.cancer.gov/cancertopics/factsheet/Risk/HPV through http://www.cancer.gov. Accessed March 23, 2012.

National Cancer Institute. Treatment Options by Stage. Available online at http://www.cancer.gov/cancertopics/pdq/treatment/cervical/Patient/page5 through http://www.cancer.gov. Accessed March 23, 2012.

Reuters. Wait longer between Pap tests, doctors say. October 22, 2012. Available online at http://www.reuters.com/article/2012/10/22/health-cancer-papsmear-idUSL3E8LM84D20121022 through http://www.reuters.com. Accessed November 2012.

ACOG. Ob-Gyns Recommend Women Wait 3 to 5 Years Between Pap Tests. October 22, 2012. Available online at http://www.acog.org/About_ACOG/News_Room/News_Releases/2012/Ob-Gyns_Recommend_Women_Wait_3_to_5_Years_Between_Pap_Tests through http://www.acog.org. Accessed November 2012.

Sources Used in Previous Reviews

Thomas, Clayton L., Editor (1997). Taber’s Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].

Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby’s Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO.

Robert Krum, MD. Director of Cytology, Kaiser Permanente; Adjunct Assistant Professor of Pathology, Oregon Health & Science University.

Communication from Kenneth Sims, M.D. based on Dr. John Bishops' topic "Pap Smear" in Evaluating Abnormal Test Results, http://UPCMD.com developed by the University Pathology Consortium, LLC.

Cindy Steele, SCT(ASCP (IAC). Cytopathology Supervisor, SUNY Upstate Medical University, Syracuse, NY.

Teri Somrak, JD, CT (ASCP). Director of Educational Planning, ASCP.

(2004 Copyright). Human Papilloma Virus (HPV). American Cancer Society [On-line information]. Available online through http://www.cancer.org.

Bren, L. (2004 January February). Cervical Cancer Screening. FDA Consumer Magazine [On-line article]. Available online at http://www.fda.gov/fdac/features/2004/104_cancer.html through http://www.fda.gov.

(2004 Copyright). Human Papillomavirus (HPV). ARUP's Guide to Clinical Laboratory Testing [On-line testing information]. Available online at http://www.arup-lab.com/guides/clt/tests/clt_302a.jsp#3465668 through http://www.arup-lab.com.

(2004 May 4). Revised Cervical Cancer Screening Guidelines Require Reeducation of Women and Physicians. ACOG [On-line news release]. Available online at http://www.acog.org/from_home/publications/press_releases/nr05-04-04-1.cfm through http://www.acog.org.

(2004 Copyright). The High-Risk HPV Test: A Breakthrough in Cervical Cancer Screening. The HPVtest.com [On-line information from Digene Corportaion]. Available online at http://www.thehpvtest.com/factsheet.html through http://www.thehpvtest.com.

Pagana K, Pagana T. (2006). Mosby's Manual of Diagnostic and Laboratory Tests. 3rd edition. St. Louis: Mosby Elsevier. Pages 690-693.

(December 2009). ACOG Practice Bulletin, Clinical Management Guidelines for Obstetricians-Gynecologists, No. 109, Cervical Cytology Screening. PDF available for download at http://journals.lww.com/greenjournal/documents/PB109_Cervical_Cytology_Screening.pdf through http://journals.lww.com. Accessed December 2009.

(Updated 2009 January 22). Frequently Asked Questions, Pap Test. Womenshealth.gov [On-line information]. Available online at http://womenshealth.gov/faq/pap-test.cfm through http://womenshealth.gov. Accessed February 2009.

(Updated 2009 January 7). Making Progress against Cervical Cancer. CDC [On-line information]. Available online at http://www.cdc.gov/Features/CervicalCancer/ through http://www.cdc.gov. Accessed February 2009.

(Reviewed 2009 February 2). Pap Test. National Cancer Institute Fact Sheet [On-line information]. Available online at http://www.cancer.gov/cancertopics/factsheet/Detection/Pap-test through http://www.coancer.gov. Accessed February 2009.

(2005 January 28). Understanding Cervical Changes: A Health Guide for Women. National Cancer Institute Fact Sheet [On-line information]. Available online at http://www.cancer.gov/cancertopics/understandingcervicalchanges through http://www.cancer.gov. Accessed February 2009.

(Updated 2008 April). Pap Smear, What is a Pap Smear? Familydoctor.org [On-line information]. Available online at http://familydoctor.org/online/famdocen/home/women/reproductive/gynecologic/138.html through http://familydoctor.org. Accessed February 2009.

Dr. D. Van Niekirk, Director, Cervical Cancer Screening Laboratory, British Columbia Cancer Agency, Vancouver, BC, Canada.