Pap Smear (cont.)
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Pap smear facts
- What is a Pap smear?
- Who should have a Pap smear?
- Which women are at increased risk for having an abnormal Pap smear?
- How is a Pap smear done?
- What are the risks of having a Pap smear?
- How is a Pap smear read (analyzed)?
- What information is included on a Pap smear report?
- Why is a woman's menstrual status important for the Pap smear?
- Why is a woman's past Pap smear history pertinent?
- When might a Pap smear not be adequate for interpretation?
- How is the final Pap smear diagnosis made?
- What are the possible recommendations for follow-up after a Pap smear?
- What treatments are available if a Pap smear is abnormal?
- What is the follow-up after treatment for an abnormal Pap smear?
- What is the current status of human papilloma virus (HPV) testing?
- When should women start and stop having Pap smears, and how often should Pap smears be performed?
- What is the current status of the newer Pap smear technologies?
- With Pap smears so available, why are women still dying of cervical cancer?
- Historical note: Dr. Pap
- Find a local Obstetrician-Gynecologist in your town
How is a Pap smear done?
A woman should have a Pap smear when she is not menstruating. The best time for screening is between 10 and 20 days after the first day of her menstrual period. For about two days before testing, a woman should avoid douching or using spermicidal foams, creams, or jellies or vaginal medicines (except as directed by a physician). These agents may wash away or hide any abnormal cervical cells.
A Pap smear can be done in a doctor's office, a clinic, or a hospital by either a physician or other specially trained health care professional, such as a physician assistant, a nurse practitioner, or a nurse midwife.
- With the woman positioned on her back, the clinician will often first examine the outside of the patient's genital and rectal areas, including the urethra (the opening where urine leaves the body), to assure that they look normal.
- A speculum is then inserted into the vaginal area (the birth canal). (A speculum is an instrument that allows the vagina and the cervix to be viewed and examined.)
- A cotton swab is sometimes used to clear away mucus that might interfere with an optimal sample.
- A small brush called a cervical brush is then inserted into the opening of the cervix (the cervical os) and twirled around to collect a sample of cells. Because this sample comes from inside the cervix, is called the endocervical sample ("endo" meaning inside).
- A second sample is also collected as part of the Pap smear and is called the ectocervical sample ("ecto" meaning outside).
- These cells are collected from a scraping of the area surrounding, but not entering, the cervical os.
- Both the endocervical and the ectocervical samples are gently smeared on a glass slide and a fixative (a preservative) is used to prepare the cells on the slide for laboratory evaluation.
A bimanual (both hands) pelvic exam usually follows the collection of the two samples for the Pap smear. The bimanual examination involves the physician or health care practitioner inserting two fingers of one hand inside the vaginal canal while feeling the ovaries and uterus with the other hand on top of the abdomen (belly).
The results of the Pap smear are usually available within one to two weeks. At the end of Pap smear testing, each woman should ask how she should expect to be informed about the results of her Pap smear. If a woman has not learned of her results after a month, she should contact her health care practitioner's office.
What are the risks of having a Pap smear?
There are absolutely no known medical risks associated with Pap smear screening. (However, there are medical risks from not having a Pap smear.)
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