PAP Test Procedure

By Nancy Bowers

(Pap Smear, Pap Screening, Papanicolaou Test)

Procedure overview

What is a Pap test?

A Pap test, named after Dr. George Papanicolaou who designed the test, is a screening test to collect and microscopically examine cells taken from the cervix, the lower, narrow part of the uterus (womb) located between the bladder and the rectum. The cervix forms a canal that opens into the vagina, which leads to the outside of the body. With a Pap test, cells can be collected from the vagina as well as the cervix.

Who should have Pap tests?

Women should seek expert medical advice about when they should begin screening, how often they should be screened, and when they can discontinue cervical screenings, especially if they are at higher than average risk of cervical cancer due to factors such as HIV infection.

According to the American College of Obstetricians and Gynecologists (the College), general guidelines include:

  • Cervical cancer screening should begin at age 21. In the past, women were advised to have their first test at age 21, or three years after having sexual intercourse for the first time, whichever happened first.

  • Cervical cancer is very rare in women younger than 21. That’s because the immune system of adolescent women naturally fights the virus that causes cervical cell changes. The College found that early Pap testing can lead to unnecessary procedures to remove suspicious cells—before the woman’s body can heal itself. These procedures increase the risk of having premature babies.

  • Most women younger than 30 can now be tested for cervical cancer every other year instead of annually. Women older than 30 can be tested once every three years if they have had three consecutive Pap tests with normal results. Research shows this testing schedule prevents cervical cancer just as well as annual Pap tests.

  • Women at high risk for cervical cancer may need more frequent screenings than the new standard guidelines suggest. This includes those who have a weak immune system or who have been treated for abnormal cervical cells in the past. Ask your care provider how often you should be tested.

  • Women 65 to 70 years of age who have had at least three normal Pap tests in a row, are sexually inactive, and have had no abnormal Pap tests in the past may decide, on consultation with their health care provider, to stop cervical cancer screening.

  • Women who have had a total hysterectomy (removal of the uterus and cervix) do not need to undergo cervical cancer screening, unless the surgery was done as a treatment for cervical precancer or cancer.

Other related procedures that may be used to diagnose cervical conditions include colposcopy, cervical biopsy, and loop electrosurgical excision procedure (LEEP). Please see these procedures for additional information.

What are female pelvic organs?

The organs and structures of the female pelvis are:

  • Endometrium. The lining of the uterus

  • Uterus (also called the womb). The uterus is a hollow, pear-shaped organ located in a woman's lower abdomen, between the bladder and the rectum. The uterus sheds its lining each month during menstruation, unless a fertilized egg (ovum) becomes implanted and pregnancy follows.

  • Ovaries. Two female reproductive organs located in the pelvis in which egg cells (ova) develop and are stored, and where the female sex hormones estrogen and progesterone are produced

  • Cervix. The lower, narrow part of the uterus located between the bladder and the rectum, forming a canal that opens into the vagina, which leads to the outside of the body

  • Vagina (also called the birth canal). The passageway through which fluid passes out of the body during menstrual periods. The vagina connects the cervix and the vulva (the external genitalia).

  • Vulva. The external portion of the female genital organs

Reasons for the procedure

A Pap test, along with a pelvic examination, is an important part of a woman's routine health care because it may detect abnormalities that can lead to invasive cancer. Most cancers of the cervix can be detected early if women have Pap tests and pelvic examinations regularly. As with many types of cancer, cancer of the cervix is more likely to be successfully treated if it is detected early.

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