Pap Tests

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What is a Pap test (cervical cytology)?

The Pap test (cervical cytology), sometimes called a Pap smear, is a medical test used to find changes in the cells of the cervix. The cervix is the entrance to the uterus, at the top of your vagina. This test is usually done during your routine pelvic exam.

Why is it important for me to have a regular Pap test?

The Pap test detects cervical changes that might develop into cancer over many years. These changes have no specific symptoms. The Pap test is not 100% effective in finding changes though newer versions of the test have fewer errors. Having regular tests is the way to make sure that abnormal cervical changes (cervical dysplasia) are detected early.

Who should have a Pap test?

You should have regular Pap tests beginning at the age of 25 if you are sexually active (see the new Guideline for Cervical Cancer Screening, January 2013). Any woman who has ever been sexually active, including lesbians and queer women, should have the test, even if you are not sexually active right now.* 

Women without symptoms of cervical cancer from age 25-69 who are, or have been, sexually active are recommended to have the test every three years. 

After age 70 you may stop being tested, but only after three (3) negative Pap tests in a row over a period of 10 years. But if you are 70 and over and have never had a test, then you need to have one.

You should be particularly sure to have routine Pap tests if:

  • You have already been treated for cervical abnormalities or cancer;
  • You have undergone a partial hysterectomy (removal of the uterus without removing the cervix); or 
  • You or your mother took DES during pregnancy. DES (Diethylstilbestrol) is a drug that was given to millions of pregnant women between 1941 and 1971 to help prevent miscarriages. It was, in fact, found not to prevent miscarriage and, further, led to problems in the reproductive organs of many of the offspring of women who took the drug.

 *Please note that these new recommendations do NOT apply to women who have never been sexually active, have had a full hysterectomy for a benign (i.e. non-cancerous) disease, who have had previous abnormal Pap test results, and/or have a weakened immune system. If any of these situations apply to you, ask your health care provider about when you should have a Pap test. For more information, see the new Canadian Cervical Cancer Screening Guideline FAQ: Should you be screened for Cervical Cancer? (PDF version)

What happens during a Pap test?

A doctor, nurse practitioner or midwife does the test. If the person doing the test is a man, you may request that a woman be present as well. Throughout the test, your health care provider should explain each of her actions to you. You undress and wear a gown, lie on an examination table and place your feet in stirrups. If you ask to have the top part of the exam table raised up slightly, you can see the doctor or nurse practitioner as she works. She puts on medical exam gloves and warms the instrument, called a speculum, under warm water before carefully inserting into your vagina.  The speculum is gently opened so that the cervix can be seen well.  Some practitioners might offer you a mirror so that you can see your cervix if you would like. 

With the cervix in view, a sample of cells is collected using a cotton swab or a small brush.  A test for HPV (Human papillomavirus) is also done at the same time in some provinces.  A Pap test does not check for sexually transmitted infections.  If you would like to test for gonorrhea and chlamydia, this can be done at the same time as the pelvic exam using a cotton swab to collect cells from the vagina and cervix.  All of the cell samples collected will be sent to a laboratory for analysis by technicians (cytologists). 

Getting through the exam

Pap tests should not hurt but they can be unpleasant.  In all, the test lasts just a few minutes.  Some women experience spotting afterwards, but this is normal and should not cause alarm. Taking long, slow breaths during the pelvic exam can help you relax the muscles inside your vagina. Inform the doctor, nurse or midwife if this is your first exam.  If you are too uncomfortable at any time, ask them to stop.

If you are a survivor of sexual abuse or assault you may have difficulty with the exam.  You do not have to disclose that you have this history.  However, if you are ready to disclose, it may be helpful for the doctor or nurse to know.  For more information about what survivors can do to prepare themselves for pelvic exams please visit Getting Through Medical Examinations: A Resource for Women Survivors of Abuse and their Health Care Providers.

You can also ask a friend or relative to be with you during the exam.

What should I do to ensure that the Pap test is reliable?

To ensure that a good sample is collected:

  • Do not use vaginal douches and/or contraceptive jelly or cream 48 hours before the test;
  • Limit sexual activity 24 hours before the test by not having vaginal intercourse or inserting anything in your vagina; and
  • Schedule your appointment for when you are mid-cycle, not during your period. Avoid scheduling an appointment while using a treatment for a yeast infection, e.g. Canesten or other yeast infection treatments.

I've had the test, what happens next?

Written test results are sent to your health care provider within a few weeks after the Pap test.  Most results are normal, but approximately one in ten tests will detect abnormal cells. Your health care provider will let you know if abnormalities are detected.  She will explain the results to you and what you will need to do next.

You will not be contacted if the results are normal.

Continue to see your doctor or nurse practitioner for a Pap test every three years if you are between the ages of 25-69, and have ever been sexually active, even if the tests are normal, so that any cervical changes can be noticed. You can also see your midwife for your routine Pap test with your next pregnancy if it has been within three years.

If you are 24 or younger, the new guidelines do not recommend routine screening, even if you are sexually active.  If you are 70 or older with three (3) successive negative Pap tests, the new guidelines suggest that routine screening may stop. 

Where can I go for more information?

This FAQ may provide medical information, but is not meant to be a substitute for medical advice. When you have questions about your health, it is always advisable to ask a health care practitioner.

Revised September 2013.