What Is a Pap Smear?
A pap smear (or pap test) is a screening for cervical cancer. It involves taking cells from the cervix and vagina and examining them under a microscope. The test is looking for cervical dysplasia鈥攃ells that are not yet cancerous but have the potential to be. Early discovery and treatment of cervical dysplasia can prevent more serious problems later.
Many kinds of providers can do a pap smear, including:
- primary care doctors,
- internal medicine specialists,
- gynecologists, and
- advanced practice providers (physician assistants, nurse practitioners, and nurse midwives).
How Often Do You Need a Pap Smear?
Starting at age 21, women should get a pap smear every three to five years. Every woman is different, and your health history may influence how often you should have a pap smear. Your provider may recommend that you have a pap smear more frequently or less frequently if you:
- had an abnormal pap smear result in the past,
- had a hysterectomy, or
- have a weakened immune system due to a condition such as human immunodeficiency virus (HIV), a prior transplant, or a disease requiring immunosuppressive treatment, such as systemic lupus erythmatosis, inflammatory bowel disease, or rheumatologic disease.
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What to Expect During a Pap Smear
A pap test takes place during a pelvic exam at your doctor鈥檚 office. If you are having your period on the day of your pap test, that鈥檚 okay. It won鈥檛 affect your test results.
Before your pap test, you will be asked to remove all your clothing from the waist down and lie on your back on the exam table. You鈥檒l place your feet in stirrups, and your provider will sit at the end of the table facing you.
During the pap test, your provider will:
- Insert an instrument called a speculum into your vagina to hold the walls of the vagina open.
- Adjust the speculum to get a good view of your cervix. You may feel pressure, but it shouldn鈥檛 be painful.
- Insert a long swab and advance it to your cervix, using it to collect a sample of cells, and
- Withdraw the swab.
Afterward, you will be able to resume your normal activities. Some people have light spotting after a pap smear, but this is not a cause for concern.
Pap Smear Results
Your pap smear test results should be available on MyChart within a few days to a week. A pap test can be normal, unclear, or abnormal.
- Normal means that there is no sign of cell changes on your cervix.
- Unclear means that the cells look like they could be abnormal.
- Abnormal means that the test detected cell changes on your cervix. This usually doesn鈥檛 mean you have cervical cancer, but your provider may recommend further testing just to be sure.
Follow-Up Testing after an Abnormal Pap Test
If your pap smear results are abnormal, the lab report will indicate suspicion for either mild, moderate, or severe dysplasia. Your provider will talk to you about next steps, which will depend on many factors, including the extent of the cervical dysplasia suspected, your age, and cancer risk.
Your provider may refer you to a gynecologist for more testing and treatment, if needed, or have you follow-up for a repeat pap smear in 6鈥12 months.
Gynecologists at U of U Health have extensive training and experience with two types of follow-up testing procedures: colposcopy and loop electrosurgical excision procedure (LEEP).
Colposcopy
A colposcopy is typically done if a pap smear test is abnormal and the doctor wants to investigate further. It involves using a magnifying instrument called a colposcope to look at the vagina and cervix. This procedure usually happens in the doctor鈥檚 office and takes 10 to 20 minutes.
A colposcopy is similar to a pap smear in that you are lying down on an exam table with your feet in stirrups. The doctor shines a bright light to see your vagina and cervix in more detail. If any tissue looks suspicious, the doctor can obtain a sample of the tissue for testing. The doctor also can treat the abnormal tissue by freezing it. This is called 鈥渃ryotherapy鈥 and involves using cold energy to destroy abnormal cells.
Loop Electrosurgical Excision Procedure (LEEP)
A LEEP may be done as a follow-up test if a colposcopy suggests that a person has moderate or severe dysplasia. Sometimes, it is done instead of a colposcopy, if the doctor believes the patient may have severe dysplasia or cancer. This procedure can take place in the doctor鈥檚 office or a U of U Health hospital or same-day surgery center.
A LEEP allows the doctor to get a larger cell sample and provide treatment at the same time. LEEP uses a wire loop heated by an electric current to cut away abnormal cells and tissue. The doctor will send the abnormal cells and tissue to the lab for testing.
Human Papillomavirus (HPV) Testing
Cervical cancer is closely linked to a sexually transmitted disease called human papillomavirus (HPV). In fact, HPV is the primary cause of cervical cancer. That鈥檚 why experts recommend women start having HPV screenings every three to five years after the age of 30. This screening is administered like the pap test, but instead of looking at cells, it is looking for strains of HPV that could cause cancer.
This screening can be done at the same time as a pap smear, or separately鈥攄epending on your age and risk factors.
An HPV test result can be negative (you don鈥檛 have the HPV type linked to cervical cancer) or positive (you do have the HPV type linked to cervical cancer). A positive result could be a warning sign, and your provider may recommend additional testing to learn more.
Making An Appointment
Women鈥檚 health specialists at U of U Health provide women's wellness exams, screenings, preventive care, and specialized treatment for patients at every stage of life. To make an appointment with one of our OB/GYNs, family medicine specialists, nurse-midwives, or fertility specialists, call 801-213-2995.
