Common Pap smear questions and answers

Sometimes, it just seems like the little joys of womanhood are beyond number. Not only do we get to have periods every month or so, every few years, we also get to have our nether regions cranked open and a little brush scraped around in there.

That particular bit of fun is called a pap smear, and if you haven’t yet had the pleasure — or it’s just been awhile — here’s some information about what the test is for, who should get it, how it’s done, and the possible results.

obgyn checkup

Here are some common pap test Q&As, adapted from information from the Office on Women’s Health.
What is a Pap test?

A Pap test (Pap smear, Papanicolaou test or cytology) checks the cervix — the lower part of the uterus — for abnormal cell changes. Cell changes can develop on the cervix, which, if caught early, the chance of successful treatment of cervical cancer is very high. Pap tests can also find abnormal cervical cells before they turn into cancer cells. Treating these abnormal cells can help prevent most cases of cervical cancer from developing, so getting tested is one of the best things you can do to prevent cervical cancer.

How is a Pap smear done?

pap smear disposable cervical cytology brushesYour doctor can do a Pap test during a pelvic exam. It is a simple and quick test. You will lie down on an exam table. Your doctor will put an instrument called a speculum into your vagina (clear plastic versions are shown below) and will open it to see your cervix.

He or she will then use a special stick or brush (see some examples at right) to take a few cells from the surface of and inside the cervix. The cells are placed on a glass slide and sent to a lab for testing.

A Pap test may be mildly uncomfortable, but should not be painful, though you may have some spotting afterwards.

How often do you need to get a Pap test?

The general guidelines were updated in 2012, but the frequency really depends on your age and health history, so consult with your healthcare provider. Most women can follow these guidelines:

  • If you are between ages 21 and 29, you should get a Pap test every 3 years.
  • If you are between ages 30 and 64, you should get a Pap test and human papillomavirus (HPV) test together every 5 years or a Pap test alone every 3 years.
  • If you are 65 or older, ask your doctor if you can stop having Pap tests.

Some women may need more frequent Pap tests. You should talk to your doctor about getting a test more often if:

  • You have a weakened immune system because of organ transplant, chemotherapy, or steroid use.
  • Your mother was exposed to diethylstilbestrol (DES) while pregnant.
  • You have had treatment for abnormal Pap results or cervical cancer in the past.
  • You are HIV-positive. Women who are living with HIV, the virus that causes AIDS, are at a higher risk of cervical cancer and other cervical diseases. The US Centers for Disease Control and Prevention (CDC) recommends that all HIV-positive women get an initial Pap test, and get re-tested 6 months later. If both tests are normal, HIV-positive women can get yearly Pap tests in the future.
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Do all women need Pap smear?

disposable plastic vaginal speculumMost women ages 21 to 65 should get Pap smears as part of routine health care. Even if you are not currently sexually active, you should still have a Pap test. Women who have gone through menopause (when a woman’s periods stop) and are younger than 65 still need regular Pap tests.

Women who do not have a cervix (usually because of a hysterectomy), and who also do not have a history of cervical cancer or abnormal Pap results, do not need Pap tests.

Women ages 65 and older who have had three normal Pap tests in a row and no abnormal test results in the last 10 years do not need Pap tests.

Who does not need a regular test?

The only women who do not need regular cervical tests are:

  • Women ages 65 and older who have had three normal Pap tests in a row and no abnormal test results in the last 10 years, and have been told by their doctors that they don’t need to be tested anymore.
  • Women who do not have a cervix (usually because of a hysterectomy) and who do not have a history of cervical cancer or abnormal Pap results.

All women should speak to a doctor before you stop getting regular pap smears.

Do you still need Pap smear after a hysterectomy?

It depends on the type of hysterectomy (surgery to remove the uterus) you had and your health history. Women who have had a hysterectomy should talk with their doctor about whether they need routine Pap tests.

  • If you no longer have a cervix because you had a hysterectomy for reasons other than cancer, you do not need Pap tests.
  • If you had a hysterectomy because of abnormal cervical cells or cervical cancer, you should have a yearly Pap test until you have three normal tests.
  • If you had your uterus removed but you still have a cervix (this type of hysterectomy is not common), you need regular Pap tests until you are 65 and have had three normal Pap tests in a row with no abnormal results in the last 10 years.
How can you prepare for a Pap smear?

Some things can cause incorrect Pap test results.

For two days before the, test do not:

  • Use tampons
  • Use vaginal creams, suppositories, or medicines
  • Use vaginal deodorant sprays or powders
  • Have sex
  • Douche

Doctors suggest you schedule a Pap test when you do not have your period, so the best time to be tested is 10 to 20 days after the first day of your period.

When will you get the results of your Pap test?

Usually it takes one to three weeks to get Pap test results. Most of the time, test results are normal. If the test shows that something might be wrong, your doctor will contact you to schedule more tests. There are many reasons for abnormal Pap test results. Abnormal Pap test results do not always mean you have cancer.

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Micrograph low grade squamous intraepithelial lesion Pap test

What does your test result mean?

Your Pap test will come back as either normal, unclear or abnormal.

Normal: A normal result means that no cell changes were found on your cervix. This is good news, but you still need to get Pap tests in the future. New cell changes can still form on your cervix.

Unclear: It is common for test results to come back unclear. Your doctor may use other words to describe this result, like equivocal, inconclusive or ASC-US. These all mean the same thing: that your cervical cells look like they could be abnormal. It could be related to life changes like pregnancy, menopause or an infection, or the HPV test can help find out if your cell changes are related to HPV.

If your Pap smear was “abnormal” — what happens now?

It can be scary to hear that your Pap test results are “abnormal.” But abnormal Pap test results usually do not mean you have cancer. Most often there is a small problem with the cervix, which often can be caused by HPV. The changes may be minor (low-grade) or serious (high-grade).

Most of the time, minor changes go back to normal on their own, but more serious changes can turn into cancer if they are not removed. The more serious changes are often called “precancer” because they are not yet cancer, but they can turn into cancer over time. It is important to make sure these changes do not get worse. Treating abnormal cells that don’t go away on their own can prevent almost all cases of cervical cancer. If you have abnormal results, talk with your doctor about what they mean. Your doctor should answer any questions you have and explain anything you don’t understand. Treatment for abnormal cells is often done in a doctor’s office during a routine appointment.

If results of the Pap smear are unclear or show a small change in the cells of the cervix, your doctor may repeat the test immediately, in 6 months, or a year, or he or she may run more tests.

If the test finds more serious changes in the cells of the cervix, the doctor will suggest more tests. Results of these tests will help your healthcare provider decide on the best treatment.

What does a “false positive” result mean?

Pap tests are not always perfect. False positive and false negative results can happen, which can be upsetting and confusing.

  • False positive. A false positive Pap test occurs when a woman is told she has abnormal cervical cells, but the cells are not actually abnormal or cancerous. If your doctor says your Pap results were a false positive, there is no problem.
  • False negative. A false negative Pap smear is when a woman is told her cells are normal, but there is a problem with the cervical cells that was missed. False negatives delay the discovery and treatment of unhealthy cells of the cervix. But having regular Pap tests boosts your chances of finding any problems. Cervical cancers usually take many years to develop. If abnormal cells are missed at one time, they will probably be found on your next Pap test.
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How can you reduce your chances of getting cervical cancer?

You can reduce your chances of getting cervical cancer in several ways:

  • Get regular Pap tests. Regular Pap smears help your doctor find and treat any abnormal cells before they turn into cancer.
  • Get an HPV vaccine (if you are 26 or younger). Most cases of cervical cancer are caused by a type of HPV that is passed from per­son to person through genital contact. Most women never know they have HPV. It usually stays hidden. While it sometimes goes away on its own, it can cause changes in the cells of the cervix. Pap tests usually find these changes. To learn more, read this fact sheet on HPV vaccines and young women.
  • Be monogamous. Having sex with just one partner can also lower your risk. Be faithful to each other. That means that you only have sex with each other and no one else.
  • Use condoms. The best way to prevent any sexually transmitted infection (STI), including HPV, the cause of most cases of cervical cancer, is to not have vaginal, oral, or anal sex. If you do have sex, use condoms. Condoms lower your risk of getting HPV and other STIs. Although HPV can also occur in female and male genital areas that are not protected by condoms, research shows that condom use is linked to lower cervical cancer rates. Protect yourself with a condom every time you have vaginal, anal or oral sex.
How can you get a free or low-cost Pap test?

Pap tests are covered under the Affordable Care Act, the health care law passed in 2010. Most insurance plans now cover Pap tests at no cost to you.

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