Content Map Terms

Pap Test

British Columbia Specific Information

A Pap test, also known as a Papanicolaou test or pap smear, is a test used to determine if there are abnormal cells in the cervix. If abnormal cells are found, steps can be taken to try to prevent them from developing into cervical cancer. Cervical cancer is a disease in which the cells of the cervix become abnormal and start to grow uncontrollably, forming tumors. In Canada, a Pap test is the most effective and recommended screening test for cervical cancer. In B.C., it is recommended women aged 25-69 be screened every 3 years. To learn more about the cervical cancer screening program in B.C., including guidelines on who should be tested, visit BC Cancer Agency - Cervix Screening.

Approximately 70 per cent of all cervical cancer is caused by the human papillomavirus (HPV) types 16 and 18. The HPV vaccines, Cervarix® (HPV2) and Gardasil® (HPV4), protect against infection from certain types of human papillomaviruses (HPV). Health Canada approves the HPV vaccine Gardasil® (HPV4) for use in women and men. Health Canada also approves the HPV vaccine Cervarix® (HPV2) for use in women; however it is not currently approved for use in men.

Some groups are eligible to receive the vaccine for free. Those not eligible to receive the vaccine for free may purchase it from a pharmacy or doctor’s office. For information about the vaccine, including who is eligible to receive it for free, see HealthLinkBC File #101b Human Papillomavirus (HPV) Vaccine.

For more information about HPV see HealthLinkBC File #101a Human Papillomavirus (HPV) Infection and Genital Warts. For information on other HPV vaccine programs in B.C., visit ImmunizeBC - HPV (Human Papillomavirus).

Test Overview

A Pap test is done to look for changes in the cells of the cervix. During a Pap test, a small sample of cells from the surface of the cervix is collected by your doctor. The sample is then spread on a slide (Pap smear) or mixed in a liquid fixative (liquid-based cytology) and sent to a lab for examination under a microscope. The cells are examined for abnormalities that may point to abnormal cell changes, such as dysplasia or cervical cancer.

The recommended Pap test schedule is based on your age and on things that increase your risk. Talk to your doctor about how often to have this test.

A high-risk type of the human papillomavirus (HPV) causes most cases of cervical cancer. Girls and women ages 9 to 45 can get the series of HPV shots to prevent infection with the types of HPV that are most likely to cause cervical cancer. HPV vaccine recommendations and cost coverage vary from province to province.

If your Pap test shows an abnormal result, see the topic Abnormal Pap Test.

Why It Is Done

A Pap test is done to look for changes in the cells of the cervix. Finding these changes and treating them when needed will greatly lower your chance of getting cervical cancer.

How To Prepare

Before a Pap test:

    • Try to schedule the test when you are not having your period, since blood can interfere with the results of the test. If your bleeding is light, you may still be able to have a Pap test.
    • Do not use douches, tampons, vaginal medicines, contraceptive (spermicidal) creams, foams or gels, sprays, or powders for 48 hours before having a Pap test.
    • Some doctors recommend avoiding sex for 24 hours before a Pap test.

At the beginning of your visit, tell your doctor:

  • If you are or might be pregnant.
  • If you have any reproductive or urinary tract symptoms such as itching, redness, sores, swelling, or an unusual odour or increased vaginal discharge. If you have been performing regular vaginal self-examinations, discuss any changes you have noticed with your doctor. To learn more, see the topic Vaginal Self-Examination (VSE).
  • If you are using birth control.
  • If this is your first Pap test.
  • The first day of your last menstrual period and how long your period lasted.
  • If you have had surgery or other procedures such as radiation therapy to the vagina, cervix, uterus, or vulva.

If you have had problems with pelvic examinations in the past or have experienced sexual assault (rape) or sexual abuse, talk to your doctor about your concerns or fears before the examination.

No other special preparations are needed before having a Pap test. For your own comfort, you may want to empty your bladder before the examination.

Tell your doctor whether you have had an abnormal Pap test in the past.

Talk to your doctor about any concerns you have about the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form .

How It Is Done

You will need to take off your clothes below the waist and drape a paper or cloth covering around your waist. You will then lie on your back on an examination table with your feet raised and supported by footrests. This allows the doctor to examine your external genital area, vagina, and cervix. You may want to wear socks to keep your feet warm while they are in the footrests.

The doctor will insert a speculum into your vagina. The speculum gently spreads apart the vaginal walls, allowing the inside of the vagina and the cervix to be examined.

Your doctor will collect several samples of cells from your cervix using a cotton swab, brush (cytobrush or cytobroom), or a small spatula. Cells are collected from the visible part of the cervix as well as from its opening (endocervical canal). In women who do not have a cervix, cells from the vagina are collected if a Pap test is needed. The cells are smeared on a slide or mixed in a liquid fixative and sent to a lab for examination under a microscope.

How It Feels

You will feel more comfortable during your Pap test if you and the doctor are relaxed. Breathing deeply and having a light conversation with your doctor may help you relax. Holding your breath or tensing your muscles will increase your discomfort.

You may feel some discomfort when the speculum is inserted, especially if your vagina is irritated, tender, or narrow. You may also feel pulling or pressure when the sample of cervical cells is being collected.

Risks

There is very little chance of a problem from having a Pap test. You may have a small amount of vaginal bleeding for 1-2 days after this test. And you may want to use a pad or panty liner to protect your clothes from any spotting.

Results

A Pap test is done to look for changes in the cells of the cervix . Results are usually available in 2 to 8 weeks. Ask your doctor when you can expect the results.

Classification systems

In Canada, the Bethesda system (TBS) is the most widely used system for reporting Pap test results. It provides information about the quality of the cell sample and the types of cell changes found.

Normal

The sample contained enough cells and no abnormal cells were found.

Normal Pap test results do not completely rule out the presence of abnormal cells (dysplasia) or cervical cancer.

Abnormal

The sample did not contain enough cells, or abnormal cells were found. To learn more about abnormal Pap test results, see the topic Abnormal Pap Test.

What Affects the Test

Pap test results may be affected by:

    • Menstrual blood on the slide. This can make it harder to examine the cervical cells.
    • A vaginal infection.
    • The use of douches or vaginal creams or preparations within 48 hours of the examination.
    • Not enough cells in the sample.

What To Think About

References

Other Works Consulted

  • American College of Obstetricians and Gynecologists (2012). Screening for cervical cancer. ACOG Practice Bulletin No. 131. Obstetrics and Gynecology, 120(5): 1222–1238.
  • Centers for Disease Control and Prevention (2012). Genital HPV infection. Available online: http://www.cdc.gov/std/HPV/STDFact-HPV.htm.
  • Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.
  • Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.
  • U.S. Preventive Services Task Force (2012). Screening for cervical cancer: Summary of recommendations. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspscerv.htm.

Credits

Adaptation Date: 9/23/2021

Adapted By: HealthLink BC

Adaptation Reviewed By: HealthLink BC