Pap Smear

  • Medical Author:
    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.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    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.

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Who should have a Pap smear?

Guidelines have been developed for cervical cancer screening that address the frequency with which women should have Pap smears. The US Preventive Services Task Force (USPSTF) and the American Cancer Society (ACS) both recommend that all women receive cervical cancer screening every 3 years between the ages of 21 and 65. A Pap smear is the typical screening procedure, but when a Pap smear is combined with a test for human papillomavirus (HPV, the known cause of cervical cancers), screening every 5 years is acceptable for women aged 30 and above.

Pregnancy does not prevent a woman from having a Pap smear, therefore, Pap smears can be safely done during pregnancy.

Pap smear testing is not indicated for women who have had a hysterectomy (with removal of the cervix) for benign conditions. Women who have had a hysterectomy in which the cervix is not removed, called subtotal hysterectomy, should continue screening following the same guidelines as women who have not had a hysterectomy.

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.) A woman may experience a small amount of spotting (light vaginal bleeding) immediately after a Pap smear, but heavy or excessive bleeding is not normal.

What kind of doctor performs a Pap test?

Pap testing is performed by obstetrician-gynecologists (OB-GYNs) or by primary care physicians including family practitioners, internal medicine specialists, or pediatricians. Pap smears can also be performed by other specially trained health-care professionals including physician assistants, nurse practitioners, or nurse midwives.

How is a Pap smear done?

With the woman positioned on her back, the health-care professional 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 small brush or swab is inserted into the opening of the cervix and twirled around to collect a sample of cells.
  • A second sample is also collected on the surface of the cervix as part of the Pap smear
  • The samples are placed in a solution from which cells are isolated and used to produce slides 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 professional 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).

Medically Reviewed by a Doctor on 1/6/2016
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