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Pap Test—What to Expect

November 18, 2010

A Pap test, also called a Pap smear, detects cervical cancer and can also find early changes in the cells of a woman’s cervix that, if left untreated, could turn into cancer. If a doctor treats these irregular cells, the patient has an almost 100% chance of being cured. The Pap test can be used to determine the cause of pelvic problems. It is most often used as a routine screening test for cervical cancer in women who have no symptoms. The test is typically done at the same time as a gynecologic checkup.

Over the years, slight changes to the original Pap test have been made, but the basics are the same: a doctor will gather a sample of cells from the cervix and look at them under a microscope. A pathologist, a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease, can spot those cells that look different from normal cells—called atypical cells—and those that are cancerous. The vast majority of Pap tests that find a problem are related to such early, cellular changes, rather than cervical cancer.

The medical team
A Pap test is typically performed by a gynecologist, a medical doctor who specializes in treating diseases of the female reproductive organs. Pap tests are also sometimes performed by other health-care professionals, including physician assistants, and nurse practitioners. The tests are performed in a doctor’s office. If your gynecologist is a man, a female assistant or nurse will be in the room during the Pap test.

The doctor or clinician who performs the test will send the sample to be reviewed by a pathologist. If the results of the Pap test indicate cancer, an oncologist (a doctor who specializes in cancer) will treat the woman with cervical cancer.

Questions to ask your doctor before the Pap test
Before having a Pap test, consider asking your doctor the following questions:

  • Who will perform my Pap test?
  • When will I get the test results?
  • Who will explain the results to me?
  • What if the test results are abnormal or unclear?
  • What further tests will be necessary if the test results indicate cancer?
  • After this test, when should I have my next Pap test?
  • If I’ve had the HPV vaccine, do I still need regular Pap tests?

Preparing for the procedure
To ensure that the Pap test results are as clear as possible, do not have sexual intercourse for two to three days before the test. Also, do not use tampons, birth-control foams, vaginal medicines, douches, or vaginal creams or powders for two to three days before the test; these products may wash away abnormal cells.

The best time to schedule your Pap test is at least five days after the end of your menstrual period. A Pap test can be done during your menstrual period, but it is better to schedule the test at another time.

During the procedure
A Pap test is performed during a pelvic examination in a private room in your health-care professional’s office. It takes only a few minutes. The test can be uncomfortable, but it is not usually painful. Emptying your bladder before the examination, and taking deep breaths and relaxing your muscles during the procedure, may make it more comfortable.

When you arrive for your examination, your health-care professional may ask you some basic questions related to the test, including:

  • Are you pregnant?
  • Do you use birth control?
  • What medications have you recently taken?
  • Do you smoke?
  • When was your last menstrual period, and how long did it last?
  • Do you have any problems or symptoms, including itching, redness, or sores?
  • Have you had surgery or other procedures to your reproductive organs?
  • Have you ever had abnormal results from a previous Pap test?

When you are ready for your examination, you will remove your clothes below the waist and lie on your back on an examination table. You will be given a sheet to cover your waist and legs. You will raise your feet and put your heels in stirrups at the end of the table, allowing your knees to relax to the sides. You can keep your socks on to keep your feet warm.

Next, the health-care professional performing the examination will gently insert a lubricated plastic or metal instrument, called a speculum, into your vagina. This tool slowly spreads apart the vagina walls. This may cause some slight discomfort.

After a visual inspection of the cervix, which is the part of the uterus that opens to the vagina, the health-care professional will use a cotton swab, a spatula, or a cervical brush to gather cells from two places on the cervix: the ectocervix (the part of the cervix closest to the vagina) and the endocervix (the part next to the body of the uterus). This area is called the transition zone, and it is where cervical cancers develop. As the cells are collected, you may feel pulling or pressure.

The health-care professional will smear the cells directly onto a glass microscope slide or put the cells into a container and send the sample to a pathologist for evaluation.

Once the Pap test is complete, your health-care professional will complete the pelvic examination. He or she will put two lubricated, gloved fingers inside your vagina, and use his or her other hand to feel from the outside for any lumps or tenderness in other reproductive organs, including your fallopian tubes, ovaries, and uterus.

After the procedure
You may have a small amount of vaginal bleeding after your Pap test. Excessive bleeding should be reported to your doctor. You can resume your normal activities immediately after the test.

Even though the Pap test is an excellent medical tool, it is not perfect. As such, sometimes the results are normal even when there are abnormal cervical cells present; this is called a “false negative” test result. That is why regular screening—at least every three years—is important. Research shows that almost all cervical abnormalities can be found with regular screening and treated before they become cancerous.

Source: American Society of Clinical Oncology (ASCO)


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