A speculum holds open the vagina during the pap test and pelvic exam
Patients who need a pap test
Annual pap tests, or smears, in sexually active women or those over 18 detects cervical cancer in the earliest stages. Since it tests the opening of the cervix and not the uterus, a hysterectomy does not preclude a woman from annual pap tests. Most post menopausal women no longer need pap smears, but they still require gynecological exams each year.
Preparation
Ideally, a pap test needs to be done 10 to 20 days into the woman's menstrual cycle. Douching and vaginally applied products should be avoided for 2 days prior to the test to avoid tainting the results. The patient relates her most recent medical history to the doctor, focusing on the date of her last gynecological exam, pap test and any abnormalities in her menstrual cycle.
The patient removes her clothes and changes into a gown. Lying on the examination table on her back, she spreads her legs to allow the gynecologist to do a visual exam of the pelvic area. The doctor then lubricates and inserts a speculum to spread open the vagina. This allows the doctor to use both hands for the pap smear collection and the pelvic exam. A brief visual inspection of the genital area precedes sample collection for the pap test.
Sample collection
To clear away any mucus, the doctor might rub a cotton swab around the cervix. The gynecologist uses cervical brushes to gently collect cells from just inside and on the outside of the opening of the cervix. The cells from just around the inside of the opening are the endocervical sample, and those from the outside are called the ectocervical sample. These brushes are rubbed onto two separate glass slides for an evaluation under a microscope.
Test results
Within 2 to 3 weeks, the patient receives the results from her pap test. Tests examine for cell changes and read normal or abnormal, with abnormal results broken down by the type of cell change found. Normal test results only require scheduling a routine pap test for the following year, but abnormal results warrant further care and consultation with a doctor.
Changes in cells do not mean that the patient has cervical cancer, but it indicates that changes in the cells could later develop into cancer. A sexually transmitted disease, the human papillomavirus (HPV) often causes these changes and can lead to cervical cancer. Severe changes in the cells could indicate that cervical cancer is present either around the cervix or already spread. Abnormal results should be discussed with the patient's gynecologist to determine the best course of action.
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