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Pap Smear (cont.)

What Happens During the Pap Smear Procedure?

A Pap smear is usually part of a pelvic exam and accompanied by a breast exam performed by the health care professional. It should only take about one minute to perform a Pap smear during this overall exam.

  • The woman will lie on the examination table (see Multimedia File 1) on her back with her knees up and bent and her feet in stirrups (rests). While she is lying on an examination table, her health care professional will use a small metal or plastic instrument called a speculum to open the vagina so that the walls of the vagina and cervix can be seen clearly.
  • A sample of mucus and cells will be obtained from the cervix (see Multimedia File 2) (the part of the uterus that extends into the vagina) and endocervix (the opening of the cervix) using a wooden scraper or a small cervical brush or broom.
  • Formerly, a sample of cells was evenly applied to a glass slide and sprayed with a fixative. This sample was sent to the lab for close and careful examination under a microscope. Currently almost all providers are using a new kind of Pap smear called a ThinPrep test, the sample is rinsed into a vial and sent to a lab for slide preparation and examination.
  • A cytologist (a specialist trained to look at the cells and interpret a Pap smear) reviews both types of tests.
  • Some discomfort during the test may occur. Most women feel nothing at all or feel pressure. Staying relaxed will help stop any discomfort. The woman should breathe slowly and concentrate on relaxing her stomach and legs.
  • A Pap smear should not be painful. If a woman has pain during the test, she should tell her doctor.

What Happens After the Pap Smear Procedure?

The health care professional will send a letter with test results. If there is a problem, the woman's health care professional may contact her. For peace of mind, she can also call the medical office to get the results. Before leaving after the exam, she can ask how long it takes the office to receive the lab report.

A negative or normal test finding means that the cervix looks healthy. All the cells are of a healthy size and shape.

A positive or abnormal test finding means that something unusual is in the sample. The test found cells of a different size and shape.

An abnormal Pap smear result does not always indicate cancer. Cells sometimes appear abnormal but are not cancerous. The woman will have to return to the doctor for follow-up care.

  • An infection of the cervix may cause an abnormal test result. Yeast, trichomonas, chlamydia, or gonorrhea infection can cause the cervical cells to appear inflamed. After the infection is treated, the Pap smear result usually returns to normal.
  • If the Pap smear result is positive because of an infection, the underlying cause should be treated. The test should then be repeated in 2-3 months, because cancer of the cervix can be hidden by an infection. A check-up with a doctor is necessary.

Most laboratories in the United States use a standard set of terms called the Bethesda System to report, or interpret, test results. Under the Bethesda System, Pap smear samples that have no cell abnormalities are reported as "negative for intraepithelial lesion or malignancy" (meaning the woman does not have cancer).

Samples with cell abnormalities fall into the following categories (as outlined by the National Cancer Institute):

  • ASC (atypical squamous cells): Squamous cells are the thin, flat cells that form the surface of the cervix. The Bethesda System divides this category into the following two groups:
    • ASC-US (atypical squamous cells of undetermined significance): The squamous cells do not appear completely normal, but doctors are uncertain what the cell changes mean. Sometimes the changes are related to HPV infection. ACSUS isconsidered a mild abnormality.
    • ASC-H (atypical squamous cells cannot exclude a high-grade squamous intraepithelial lesion): The cells do not appear normal, but doctors are uncertain what the cell changes mean. ASC-H may be at higher risk of being precancerous.
  • AGC (atypical glandular cells): Glandular cells are mucus-producing cells found in the endocervical canal (opening in the center of the cervix) or in the lining of the uterus. The glandular cells do not appear normal, but doctors are uncertain what the cell changes mean.
  • AIS (endocervical adenocarcinoma in situ): Precancerous cells found in the glandular tissue.
  • LSIL (low-grade squamous intraepithelial lesion): Low-grade means there are early changes in the size and shape of cells. The word lesion refers to an area of abnormal tissue. Intraepithelial refers to the layer of cells that forms the surface of the cervix. LSILs are considered mild abnormalities caused by HPV infection.
  • HSIL (high-grade squamous intraepithelial lesion): High-grade means that there are more marked changes in the size and shape of the abnormal (precancerous) cells, meaning the cells look very different from normal cells. HSILs are more severe abnormalities and have a higher likelihood of progressing to invasive cancer.
Medically Reviewed by a Doctor on 11/21/2017

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