What a Pap smear is
A Pap smear, also called a Pap test, checks cells from the cervix, the opening of the uterus at the top of the vagina. It looks for early changes that could turn into cancer over many years if left alone. It is a screening test, meant for women who feel well. It does not diagnose cancer by itself. Because the changes cause no symptoms in the early years, a test is the only way to find them.
Nearly all cervical cancer is linked to long-lasting infection with high-risk types of human papillomavirus, or HPV. This virus is very common and passes through sexual contact. Most infections clear without treatment. A few persist and slowly change the cells. Screening finds these changes at a stage when they can be treated simply. Cervical cancer is among the most common cancers in Indian women, yet it is largely preventable.
Screening tests and how often
| Test | What it looks for | Typical gap if normal |
|---|---|---|
| Pap smear | Abnormal cells | About every 3 years |
| HPV test | High-risk virus types | About every 5 years or longer |
| Co-testing | Cells and virus together | About every 5 years |
| VIA | Visible changes after dilute vinegar | About every 5 years |
Guidelines differ on the exact starting age and gap. Many doctors begin Pap tests from the age of 21 or 25 in women who have been sexually active. The World Health Organization prefers HPV testing from the age of 30. India's national programme offers VIA to women aged 30 to 65 at government health centres. Your doctor decides the right test and schedule for you based on age, past results and health. Women with HIV or weak immunity need earlier and more frequent screening.
Screening is still needed if you have had the HPV vaccine, are in a single long-term relationship or have reached menopause. It usually stops at around 65 if earlier results were normal.
How to prepare
- Pick a date when you are not on your period. Mid-cycle is ideal.
- For two days before, avoid sex, douching, vaginal creams, pessaries and tampons.
- Tell the doctor if you are pregnant, have unusual discharge or are using any hormonal treatment.
- Note the first day of your last period.
- Wear clothes that are easy to remove from the waist down.
- If you are anxious or have had a painful examination before, say so at the start.
The test can be combined with a routine gynecological check-up.
What happens during the test
- You lie on the examination couch with knees bent. A sheet covers you, and you can ask for a female attendant.
- The doctor or nurse gently inserts a speculum into the vagina to see the cervix. You may feel pressure.
- A soft brush or small spatula is rotated on the cervix to collect cells. This takes a few seconds.
- The sample is put on a glass slide or in a liquid bottle and sent to the laboratory. The same sample can sometimes be used for an HPV test.
- The speculum is removed and you can dress and go home.
The whole thing takes about five minutes. It can feel uncomfortable but should not be very painful. Slow breathing and relaxing your thighs helps. Slight spotting for a day is common. Reports usually come in a few days to two weeks.
Understanding your result
Normal or negative
No abnormal cells were seen. Go back for the next test at the gap your doctor advises.
Unsatisfactory sample
There were too few cells, or blood or infection hid them. A repeat test is needed after some weeks.
Abnormal result
An abnormal report rarely means cancer. Terms such as ASC-US, LSIL or HSIL describe mild to more marked cell changes. Mild changes often settle without treatment and may only need a repeat test or an HPV test. For more marked changes, or a positive test for high-risk HPV types, the doctor may advise colposcopy and biopsy, where the cervix is viewed under magnification and a tiny sample is taken. Abnormal areas can then be treated before they become cancer. Do not skip the follow-up, even if you feel fine.
Sometimes the report mentions infection or inflammation. This is usually unrelated to cancer and may just need treatment or a repeat test, as your doctor advises. Keep a copy of every report so that the next doctor can compare results.
Lowering your risk
HPV vaccination offers strong protection against the virus types that cause most cervical cancers. It works best when given before any sexual contact, and is commonly recommended for girls from 9 to 14 years. Older teenagers and young adults may also benefit, so ask your doctor. The vaccine is given as injections in the upper arm, and the number of doses depends on age and the product used. Condoms lower the chance of HPV infection but do not remove it completely. Not using tobacco also helps. Costs of tests and vaccines vary by city, hospital and case.
When to see a gynecologist without waiting
Screening is for women with no symptoms. If you notice any of the following, do not wait for your next routine test:
- Bleeding after sex
- Bleeding between periods
- Any bleeding after menopause
- Discharge that is foul-smelling, watery or blood-stained
- Pain during sex or ongoing pelvic pain
- Unexplained weight loss with lower back or leg pain
These signs usually have less serious causes such as infection or polyps, but they need an examination.
This page is general information for readers in India. It is not medical advice. Speak to a qualified gynecologist about your own health.