Papanicolaou test; Pap smear; Cervical cancer screening - Pap test; Cervical intraepithelial neoplasia - Pap; CIN - Pap; Precancerous changes of the cervix - Pap; Cervical cancer - Pap; Squamous intraepithelial lesion - Pap; LSIL - Pap; HSIL - Pap; Low-grade Pap; High-grade Pap; Carcinoma in situ - Pap; CIS - Pap; ASCUS - Pap; Atypical glandular cells - Pap; AGUS - Pap; Atypical squamous cells - Pap; HPV - Pap; Human papilloma virus - Pap cervix - Pap; Colposcopy - Pap
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.
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.
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.
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.
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.
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. 157: cervical cancer screening and prevention. Obstet Gynecol. 2016;127(1):e1-e20. PMID: 26695583 pubmed.ncbi.nlm.nih.gov/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.
Fontham ETH, Wolf AMD, Church TR, Etzioni R, Flowers CR, Herzig A, Guerra CE, Oeffinger KC, Shih YT, Walter LC, Kim JJ, Andrews KS, DeSantis CE, Fedewa SA, Manassaram-Baptiste D, Saslow D, Wender RC, Smith RA. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA Cancer J Clin. 2020;70(5):321-346. PMID: 32729638 pubmed.ncbi.nlm.nih.gov/32729638/.
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.
Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, Huh WK, Kim JJ, Moscicki AB, Nayar R, Saraiya M, Sawaya GF, Wentzensen N, Schiffman M; 2019 ASCCP Risk-Based Management Consensus Guidelines Committee. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. J Low Genit Tract Dis. 2020;24(2):102-131. PMID: 32243307 pubmed.ncbi.nlm.nih.gov/32243307/.
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.
US Preventive Services Task Force website. Final recommendation statement. Cervical cancer: screening. www.uspreventiveservicestaskforce.org/uspstf/recommendation/cervical-cancer-screening. Updated August 21, 2018. Accessed June 3, 2021.BACK TO TOP
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. Internal review and update on 06/03/2021 by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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