Everything you need to know about pap tests and pap smears

A Pap smear or Pap test screens for precancerous changes to cervical cells. The cervix is the gateway to your uterus, in a donut shape.

Cervical cell testing is done using (most commonly) the Papanicolaou (Pap) test. The Pap test is performed by a doctor who collects cells from the cervix using a scraping tool and a tiny brush. The cells are later examined under a microscope for changes. The scraping can cause a small amount of bleeding

The test is called a ‘smear’ because the sample is smeared onto a glass slide to be examined under a microscope in the lab. Doesn’t sound great, but that’s what it’s called.​1,2​

There are two sorts of Pap tests – the conventional Pap test and the liquid-based Pap test.

We now have a blood test that is widely used’to test for HPV, decreasing the need for Pap tests as frequently – if you have HPV, you get a Pap test; if you are negative for HPV, there is less need.

Who gets tested with a Pap test and why

A Pap test should be done once you become sexually active since HPV – the virus that causes cervical cancer – can be spread via body fluids and skin contact.

But during a Pap test, most people are screened for sexually transmitted infections and vulvovaginal health (a visual check by the doctor), which helps protect the population.

Read more about HPV

What happens during a Pap test

It’s best if the testing is done when you don’t have your period and haven’t used any douches or vaginal creams for at least 24 hours prior to your test.

You will visit the doctor’s office (or wherever your testing happens to be) and be taken to a private area.

You will be asked to remove your lower layers of clothing – shoes, underwear, trousers/skirt – and climb up on the table that should be covered with a fresh disposable paper sheet or material (for hygiene).

The doctor usually covers your view with a piece of material or paper so you actually can’t see yourself or what they are doing. This is mostly just to keep you separate from what’s going on since it’s not the most fun thing you’ll ever do. You don’t have to have it there if you don’t want it.

The doctor will lube up a speculum and a nice doctor will warm the speculum under a hot tap to warm it first. A speculum is a tool that holds the walls of your vagina apart since their natural inclination is to close.

The test doesn’t really hurt, but it can feel uncomfortable since the cells are being scraped off. The cervix isn’t that dense with nerve endings, so it’s not like other areas being scraped. In fact, sometimes it just feels like pressure.

The key is to really try to relax – your vaginal muscles can be really tight when you are tense, so just make a concerted effort to relax at least your vaginal muscles to make it less uncomfortable. Talk to your doctor about your nerves so they can reassure you.

A spatula (sort of like a tongue depressor) is used to remove cells from the surface and opening of the cervix, and then a small-bristled brush (like a mini bottlebrush) is inserted through the cervical entrance to get the cells from inside the neck of the cervix.​3​

Later in the lab, abnormal cells are hunted down via the microscope, with most often none being found. Abnormal cells have a rating system – CIN cervical intraepithelial neoplasia I, II, III or IV, with IV being cancerous, and the rest being on the spectrum from slightly abnormal to very much precancerous.​4​

How often you should get a Pap smear

Depending on the availability of the HPV blood test and cervical cancer (HPV) vaccines, these guidelines are likely to change in the future.

Between ages 21 – 30, testing is most often done every three years, however, if you have had an abnormal result at any point, that could be shifted up to every six months or every year.​5,6​

The reason for this is that the virus does spontaneously disappear, and it may clear up on its own.

After age 30, testing is done every three years, or every five years if both a Pap test and human papillomavirus (HPV) test are done.​7​

After age 65, testing is no longer required if test results have been normal for at least three years in a row, and there was no abnormal result in the past 10 years.

There are exceptions: if you get a new sexual partner(s), you should keep getting tested, because you can catch HPV at any age.

Male testing and testing on those without a cervix

Soon it is hoped that men will be able to be tested for HPV via blood tests, since currently men are not screened, yet they can still have it.​8​

Anal, penile and vulvar/vaginal cancers are thought to also be caused by HPV, so this is an excellent adjunct to current testing. Everyone can still get cancers caused by HPV (anal, genital), so it might be worth asking your doctor how you can get tested.

Early sexual activity and sexual abuse

If you became sexually active in your younger teenage years, you should be tested earlier – age is not an indicator of when HPV can strike, but when you can get infected with the virus i.e. earlier on.

Anyone who was sexually abused as a child or teenager should keep this in mind – your abuser or attacker may have passed on the virus to you.

Women who need more frequent Pap tests

Smokers

Smoking is known to be a factor that makes HPV infection do bad things faster. If you smoke and have HPV, the chances of you developing abnormal cells increase significantly.​9​

This information isn’t to scare you, but if you do smoke and are sexually active, it’s really important that you get regular checks, even more often than others.

HIV, immunosuppressant drugs, weakened immune system

If you have HIV, are on drugs that suppress your immune system or have a weak immune system, you may need to be tested more frequently.​10​

The cervical cancer vaccine

Pap tests are an effective way to test for and prevent cervical cancer, however, there are several vaccines now being made mandatory in many countries to reduce the incidence of cervical cancer.​11​

What to do if you are freaked out by Pap tests

There are some things to know about getting regular Pap tests.

  1. You don’t have to do anything you don’t want to, and nobody is going to make you. It is 100 per cent your choice to get a Pap test or not.
  2. Consider the benefits of being screened for ‘silent’ cancers of your reproductive organs, including the major benefit of not dying of preventable cancer or going through serious cancer treatments.
  3. Cancer of your reproductive organs doesn’t really hurt, because they don’t have that many nerve endings, so you can’t tell if something is wrong until it’s too late. You will probably feel fine.
  4. You can be spreading HPV to other people and not know. This could result in someone else catching HPV, if they too do not get regularly tested.
  5. There is a chance that you don’t have HPV, but estimates are that eight out of ten people have HPV at some point in their lives.
  6. People who have HPV don’t necessarily have abnormal cells or develop cancer.
  7. Don’t be scared of knowing. Not knowing can cause you more anxiety.
  8. You probably don’t have cervical cancer or abnormal changes!
  9. Early detection means effective treatments.
  10. It is our strong recommendation that you get tested however often is appropriate for your circumstance.

References

  1. 1.
    Sachan PL, Singh M, Patel ML, Sachan R. A Study on Cervical Cancer Screening Using Pap Smear Test and Clinical Correlation. Asia-Pacific Journal of Oncology Nursing. Published online July 2018:337-341. doi:10.4103/apjon.apjon_15_18
  2. 2.
    Ashtarian H, Mirzabeigi E, Mahmoodi E, Khezeli M. Knowledge about Cervical Cancer and Pap Smear and the Factors Influencing the Pap test Screening among Women. Int J Community Based Nurs Midwifery. 2017;5(2):188-195. https://www.ncbi.nlm.nih.gov/pubmed/28409172
  3. 3.
    Kamal M. Pap Smear Collection and Preparation: Key Points. Cytojournal. Published online March 29, 2022:24. doi:10.25259/cmas_03_05_2021
  4. 4.
    Díaz-Rosario LA, Kabawat SE. Performance of a Fluid-Based, Thin-Layer Papanicolaou Smear Method in the Clinical Setting of an Independent Laboratory and an Outpatient Screening Population in New England. Archives of Pathology & Laboratory Medicine. Published online September 1, 1999:817-821. doi:10.5858/1999-123-0817-poafbt
  5. 5.
    Chiang YC, Chen YY, Hsieh SF, et al. Screening frequency and histologic type influence the efficacy of cervical cancer screening: A nationwide cohort study. Taiwanese Journal of Obstetrics and Gynecology. Published online August 2017:442-448. doi:10.1016/j.tjog.2017.01.010
  6. 6.
    Sirovich BE, Welch HG. The frequency of Pap smear screening in the United States. J Gen Intern Med. Published online March 2004:243-250. doi:10.1111/j.1525-1497.2004.21107.x
  7. 7.
    MacLaughlin KL, Jacobson RM, Radecki Breitkopf C, et al. Trends Over Time in Pap and Pap-HPV Cotesting for Cervical Cancer Screening. Journal of Women’s Health. Published online February 2019:244-249. doi:10.1089/jwh.2018.7380
  8. 8.
    Vives A, Cosentino M, Palou J. Evaluación del virus del papiloma humano en varones: primera revisión exhaustiva de la literatura. Actas Urológicas Españolas. Published online March 2020:86-93. doi:10.1016/j.acuro.2019.08.010
  9. 9.
    MacLaughlan SD, Lachance JA, Gjelsvik A. Correlation Between Smoking Status and Cervical Cancer Screening. Journal of Lower Genital Tract Disease. Published online April 2011:114-119. doi:10.1097/lgt.0b013e3181f58d0d
  10. 10.
    Moscicki AB, Flowers L, Huchko MJ, et al. Guidelines for Cervical Cancer Screening in Immunosuppressed Women Without HIV Infection. J Low Genit Tract Dis. Published online April 2019:87-101. doi:10.1097/lgt.0000000000000468
  11. 11.
    Patel C, Brotherton JM, Pillsbury A, et al. The impact of 10 years of human papillomavirus (HPV) vaccination in Australia: what additional disease burden will a nonavalent vaccine prevent? Eurosurveillance. Published online October 11, 2018. doi:10.2807/1560-7917.es.2018.23.41.1700737


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Jessica Lloyd - Vulvovaginal Specialist Naturopathic Practitioner, BHSc(N)

Jessica is a degree-qualified naturopath (BHSc) specialising in vulvovaginal health and disease, based in Melbourne, Australia.

Jessica is the owner and lead naturopath of My Vagina, and is a member of the:

  • International Society for the Study of Vulvovaginal Disease (ISSVD)
  • International Society for the Study of Women's Sexual Health (ISSWSH)
  • National Vulvodynia Association (NVA) Australia
  • New Zealand Vulvovaginal Society (ANZVS)
  • Australian Traditional Medicine Society (ATMS)
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