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Pap Tests

The Papanicolaou test, or Pap smear, checks for changes in the cells of the cervix (the lower part of the uterus that connects to the vagina) that could indicate cervical cancer. The procedure involves collecting and analyzing a sample of a woman's cervical cells. When women have regular Pap tests, dysplasia (cell changes that could lead to cancer) can be detected and treated to prevent cervical cancer.

Cervical cancer and HPV

Cervical cancer is caused by the human papilloma virus (HPV), a very common sexually transmitted infection (STI). Most sexually active people will become infected with HPV sometime in their life. Genital HPV usually goes away on its own, without causing any health problems. However, for a small number of women, HPV can persist and lead to cell changes that can eventually became cervical cancer if left untreated.

Pap test timeline

All women should begin getting Pap tests at age 21. Pap tests are recommended every other year until age 30, then every two to three years for most women with no history of abnormal Pap tests. Women who have had one or more abnormal Pap tests may be tested more often.

Before a Pap test

To ensure the most accurate results on a Pap test, follow these rules:

  • Do not have sexual intercourse or insert anything into the vagina, including tampons, for 48 hours before the appointment.
  • Do not douche or use any lubricants, spermicides, or medication in the vagina for 48 hours before the appointment.

Test procedure

A clinician will insert a plastic or metal instrument (called a speculum) into the vagina to see the cervix. A small wooden or plastic spatula and a small brush are used to gently scrape some cells from the surface of the cervix and from inside the cervical canal. This procedure may cause minor discomfort, sometimes described as a pinching, scratching, or slight cramping sensation.

After being collected, the cells are preserved and sent to a laboratory for analysis. If no abnormal cells are found, the Pap test report will be “normal” or “negative.”

Interpreting abnormal results

Most women with abnormal Pap test results will fall into one of two categories: atypical cells of undetermined significance (ASC-US) or low-grade intraepithelial lesion (LSIL). In most of these instances, inflammation is caused by HPV infection and any cell changes will be temporary. Some women in the ASC-US category may have other minor infections, such as a yeast infection or bacterial vaginosis, as the cause. Women whose Pap tests are reported as high-grade intraepithelial lesion (HSIL) are at greater risk for developing cervical cancer and may require treatment.

Regardless of the cause, it is important to evaluate abnormal Pap tests. Depending on the type and severity of the cell changes, the clinician may want to repeat the Pap test, do a test for HPV, or perform another examination called colposcopy. Colposcopy is a test that uses a special light microscope to view the cervix and determine the areas of inflammation or abnormality. The clinician may take a small tissue sample of these areas to confirm the Pap smear result and to determine whether treatment is needed. l

HPV Prevention

Consider the following methods to reduce the risk of contracting HPV:

  • Minimize the number of sexual partners you have, and choose a partner who has had a low number of sexual partners. The more sexual partners a person has over their lifetime, the more likely they are to acquire HPV from one of them.
  • Use condoms. Although condoms do not completely eliminate the risk of HPV transmission, they greatly reduce the risk of HPV infection and subsequent cervical cancer.
  • Don’t smoke. Women who smoke have a higher risk of persistent HPV infection and dysplasia. Quitting smoking decreases the risk of cervical cancer (as well as other types of cancers, lung diseases, and circulatory diseases).
  • Get vaccinated. Women can be protected from HPV by a new 3-shot vaccine series approved in 2006. Ask a clinician about the HPV vaccine.

More information

To learn more about HPV and associated risks, visit the following web sites:

[document HU446 : updated 07/2011]