Pap Test Information

ExitCare ImageA Pap test is a medical test done to evaluate cells that are on the surface of the cervix. The cervix is the lower portion of the uterus and upper portion of the vagina. This test is done in a clinic office and can detect certain infections, abnormal cervical cells, or cervical cancer. For some women, the cervical region has the potential to form cancer. With consistent evaluations, cervical cancer is a rare and preventable kind of cancer.

DIFFERENT WAYS TO PERFORM A PAP TEST

There are 2 ways a Pap test may be done. The main difference between the 2 ways has to do with what instruments are used to get a cell sample and how the cells are tested. In both tests, a warm metal or plastic instrument (speculum) is placed in the vagina. The speculum allows the caregiver to see the inside of the vagina and to look at the cervix. The caregiver will use either a wooden spatula or plastic brush to collect cervical cells. If a wooden spatula was used, the cervical cells are placed on a glass slide and sent to the lab to be examined. If a plastic brush was used, the cervical cells are retrieved and both the plastic brush and cells are placed in a container with fluid, and the cells are examined. In addition, the fluid in the container can also be checked for human papillomavirus (HPV) and other infections, such as gonorrhea and chlamydia.

RISK FACTORS FOR CERVICAL CANCER

Risk factors for cervical cancer are things that increase your chance of getting cervical cancer. These things include:

  • Having had an abnormal Pap test or cancer of the vagina or vulva and avoiding proper medical follow up and care.

  • Becoming sexually active before age 18.

  • Smoking.

  • Having a weakened immune system. HIV or other immunodeficiency disorders weaken the immune system.  

  • Having had a sexually transmitted infection (STI), such as chlamydia, gonorrhea, or HPV.  

  • Having a sexual partner who has a history of direct or indirect contact with cervical cancer.  

  • Not using condoms with new sexual partners.  

  • Being the daughter of a woman who took diethylstilbestrol (DES) during pregnancy.

HOW TO PREPARE FOR A PAP TEST

  • Schedule your Pap test for a time when you are not likely to be on your period, or ask if it is okay to be on your period during the Pap test. Depending on the method of Pap test collection, your caregiver may not be able to perform the test if you are on your period or if your period is very heavy.

  • Avoid douching before the Pap test. This may lessen the number of cells that are being evaluated.

  • Refrain from intercourse the day before your Pap test, or as directed by your caregiver.

If you have never had a Pap test, ask your caregiver how it is done. He or she may take extra time to show and explain the speculum and collecting system used during the test.

HOW OFTEN SHOULD YOU HAVE PAP TESTS?

How often you should get a Pap test depends on your age and health history. Talk to your caregiver about how often you should get tested.

PAP RECOMMENDATIONS BASED ON AGE

The recommendations below are the same for women who have or have not gotten the vaccine for HPV. Some women may need screenings more often if they are at high risk for cervical cancer.

  • The first Pap test should be done at age 21.

  • Between ages 21 and 29, have a Pap test every 2 or 3 years.

  • If you are 30 years old and your last 3 Pap tests have been normal, Pap tests are needed no more often than every 3 years. This should be approved by your caregiver.

  • If you are 65 years old or older, ask your caregiver if you can stop having Pap tests.

PAP TEST RECOMMENDATIONS BASED ON HEALTH HISTORY

Confirm the recommendations below with your caregiver. It is recommended that:

  • You have your first Pap test before the age of 21 if you are sexually active or are immunocompromised (HIV, lupus, or taking transplant medicines).

  • You have more frequent Pap tests if you have a weakened immune system due to HIV, lupus, or you are taking transplant medicines; if your mother was exposed to DES while pregnant with you; or if you have cervical intraepithelial neoplasia (CIN) 2 or 3.

  • You have a Pap test and screenings for cancer for at least 20 years after treatment for cervical cancer or a condition that could lead to cancer. Talk to your caregiver if a new problem develops soon after your last Pap test.

YOU DO NOT NEED REGULAR PAP TESTS IF:

  • You had a hysterectomy for a problem that was not a cancer or a condition that could lead to cancer. However, even if you no longer need a Pap test, a regular exam is a good idea to make sure other serious problems are not starting.

  • If you are between ages 65 and 70, and you have had normal Pap tests for 10 years, you no longer need Pap tests. However, even if you no longer need a Pap test, a regular exam is a good idea to make sure other serious problems are not starting.

If Pap tests have been discontinued, risk factors (such as a new sexual partner) need to be re-evaluated to determine if screening should be resumed.

RESULTS OF YOUR PAP TEST

A healthy Pap test shows no abnormal cells or evidence of infection. However, inflammation of the cervix (cervicitis) is a common Pap test result but is of no significance.

The presence of abnormally growing cells on the surface of the cervix may be reported as an abnormal Pap test. If a Pap test is abnormal, it is most often a result of a previous exposure to HPV. HPV may infect the cells of the cervix and cause dysplasia. Dysplasia is where the cells no longer look normal. If a person has been diagnosed with high-grade dysplasia or severe dysplasia, they are at higher risk of developing cervical cancer. A woman diagnosed with low-grade dysplasia should still be seen by her caregiver. Low-grade dysplasia still has a small risk of developing into cancer. Your caregiver will determine what follow-up care is needed or when you should have your next Pap test.  

If you have had an abnormal Pap test:  

  • You may be asked to have a colposcopy. This is a test in which the cervix is viewed with a lighted microscope.  

  • A cervical tissue sample (biopsy) may also be needed. This involves taking a small tissue sample from the cervix.