How is a Pap test performed?

While no woman looks forward to a pelvic examination, the Papanicolaou (Pap) test itself is fairly straightforward. It should generally cause only minimal discomfort. With the patient's legs in stirrups, the doctor places a speculum into the vagina in order to see the cervix well, usually with the aid of a headlamp or speculum light. Then, the doctor places a thin plastic or wooden spatula against the cervix and sweeps in a circular fashion, also sampling any fluid at the top the vagina that may have pooled there. A thin brush is also placed into the cervical os (center opening) to obtain a slightly deeper sample of cells from that area. These samples are then placed onto microscope slides, which are sent to the laboratory and examined by a specially trained technician and/ or computer. The evaluation of the specimens is supervised by a medical doctor called a pathologist, who's specially trained to determine whether cancer cells are present or absent. Most samples will be negative, some will contain definite cancer cells, while others will have cells that are indeterminate or suspicious and require further evaluation.

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 lubricated 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 cervix brush), 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.