The Pap smear is a gynecological exam used to evaluate the cells of the cervix, being able to identify uterine changes and diseases, such as inflammation, HPV infection and cancer.
Despite being recommended mainly for women who have already started sexual activity, the Pap smear, also called a preventive exam, can be carried out by virgin women from the age of 21.
This exam is quick, does not require much preparation, is carried out in the gynecologist’s office and does not hurt, however the woman may feel a little discomfort or pressure inside the vagina while the doctor scrapes the cells from the uterus. The collected sample is sent to the laboratory for analysis, with the result released within 10 days.
What is it for
The Pap smear may be indicated for:
- Assess the health of the cervix;
- Investigate vaginal infections, such as candidiasis or bacterial vaginosis Gardnerella vaginalis;
- Identify and diagnose sexually transmitted infections, such as trichomoniasis, chlamydia, gonorrhea, syphilis or HPV;
- Check for signs of cervical cancer;
- Assess the presence of Nabothian cysts, which are small nodules that can be formed due to the accumulation of fluid released by glands present in the cervix.
The Pap smear can also be done by virgin women after the age of 21, using special material and only according to the doctor’s instructions, with the aim of evaluating the cervix and identifying possible changes.
Pap smear preparation
Preparing for the Pap smear is simple and includes avoiding intimate relations even with the use of a condom, avoiding using showers for intimate hygiene and avoiding the use of medications or vaginal contraceptives in the 2 days before the exam.
Furthermore, the woman cannot be menstruating either, as the presence of blood can alter the test results.
See when it is necessary to do other tests to evaluate the cervix.
How the exam is carried out
The Pap smear is simple, quick and carried out in the gynecologist’s office.
During the examination, the woman is placed in a gynecological position and a medical device is inserted into the vaginal canal to visualize the cervix. Then, the doctor uses a spatula or brush to collect a small sample of cells that will be sent for analysis in the laboratory. In addition, two slides are made from the material collected during the examination and sent to the microbiology laboratory to identify the presence of microorganisms.
The exam does not hurt, however discomfort or pressure may be felt inside the uterus during the exam, however the sensation passes soon after removing the spatula and the medical device. See more details on how the Pap smear is done.
When to take a pap smear
The Pap test is indicated for women from the beginning of sexual activity until the age of 65, however it is prioritized for women between 25 and 65 years of age. This exam must be carried out annually, however, if the result is negative for 2 years in a row, the exam can be carried out every 3 years. This recommendation exists due to the slow evolution of cervical cancer, allowing pre-cancerous and cancerous lesions to be identified early and treatment can then be started.
In the case of women over the age of 64 who have never had a Pap smear, the recommendation is that two exams be carried out with an interval of 1 to 3 years between exams. In the case of women with lesions indicative of cervical cancer, Pap smear monitoring is carried out every six months. Cervical cancer is caused by the Human Papillomavirus, HPV, which must be identified and monitored, if detected, to prevent the development of cancer. Find out how to identify HPV infection and how it is treated.
Pap smear during pregnancy
The Pap smear can be done during pregnancy up to the fourth month at the latest, and is preferably carried out during the first prenatal consultation, if the woman has not done it recently. Furthermore, the exam is safe for the baby, as it does not reach the inside of the uterus or the fetus.
How to understand the results
The results of the Pap smear are released by the laboratory according to the characteristics of the cells observed under the microscope, which may be:
- Classe I: the cervix is normal and healthy;
- Class II: presence of benign changes in cells, which are normally caused by vaginal inflammation;
- Class III: includes CIN 1, 2 or 3 or LSIL, which means that there are changes in the cells of the cervix and the doctor may prescribe new tests to look for the cause of the problem, which could be HPV;
- Class IV; CIN 3 or HSIL, which indicate a probable onset of cervical cancer;
- Classe V: presence of cervical cancer.
- Unsatisfactory sample: the material collected was not adequate and the examination could not be carried out.
Depending on the result, the gynecologist will tell you whether further tests are necessary and what treatment is appropriate. In cases of HPV infection or changes in the cells, the examination must be repeated after 6 months, and in case of suspected cancer, a colposcopy must be performed, which is a more detailed gynecological examination in which the doctor evaluates the vulva, the vagina and cervix. Understand what colposcopy is and how it is performed.
Bibliography
- SMITH, Elizabeth R. et al. New Biological Research and Understanding of Papanicolaou’s Test. Diagn Cytopathol. Vol 46. 6 ed; 507-515, 2018
- MINISTRY OF HEALTH. Cytopathology Technician. 2012. Available at: <http://bvsms.saude.gov.br/bvs/publicacoes/tecnico_citopatologia_caderno_referencia_1.pdf>. Accessed on February 25, 2020
