Pap Smear (Papanicolaou Smear)
Papanicolaou smear (Pap smear, cervical smear) is a safe, noninvasive cytological
examination for early detection of cervical cancer. During the 1900s, cervical cancer was one of the
leading cause of death among women. It was until the year 1928, where a greek physician George
Nicholas Papanicolaou was able to discover the difference between normal and malignant cervical
cells by viewing the samples microscopically, hence Pap smear was invented.
For women ages 30 and above, this procedure can be done in conjunction with a test on Human
papillomavirus (HPV), the most common sexually transmitted disease and primary causative agent
for cervical cancer. The American Cancer Society recommends a Pap smear at least once every three
years for women ages 21 to 29 who are not in a high-risk category and who have had negative
results and who have had negative results from three previous Pap tests. While a Pap test and an
HPV test is recommended every five years for women ages 30 to 65 years old. If a Pap smear is
positive or suggests malignancy, a cervical biopsy can confirm the diagnosis.
Indications of Pap Smear
Pap smear is indicated for the following reasons:
Identify the presence of sexually transmitted disease such as human papillomavirus (HPV),
herpes, chlamydia, cytomegalovirus, Actinomyces spp., Trichomonas vaginalis, and Candida
spp.
Detect primary and metastatic neoplasms
Evaluate abnormal cervical changes (cervical dysplasia)
, Detect condyloma, vaginal adenosis, and endometriosis
Assess hormonal function
Evaluate the patient’s response to chemotherapy and radiation therapy
Interfering Factors
Delay in fixing a specimen, allows the cells to dry therefore destroying the effectiveness of
the stain and makes cytologic interpretation difficult
Improper collection site may cause rejection of the specimen. Samples for
hormonal evaluation are taken from the vagina while samples for cancer screening are
obtained from the vaginal fornix
Use of lubricating jelly on the speculum that may affect the viability of some organisms
Specimen collection during normal menstruation since blood can contaminate the sample
Douching, using tampons, or having sexual intercourse within 24 hours before the exam can
wash away cellular deposits
Existing vaginal infections that may interfere with hormonal cytology
Pap Smear Procedure
Pap smear is performed by a practitioner and takes approximately about 5 to 10 minutes. The step-
by-step procedure is as follows:
1. The patient is positioned.
The client is assisted in a supine, dorsal lithotomy position with feet in stirrups.
2. A speculum is inserted.
The practitioner puts on gloves and inserts an unlubricated plastic or metal speculum into
the vagina and is opened gently to spread apart the vagina to access the cervix. The
speculum may be moistened with saline solution or warm water to make insertion easier.
3. Cervical and vaginal specimens collection.
After positioning the speculum, specimen from the vagina and cervix are taken. A cytobrush
is inserted inside the cervix and rolls it firmly into the endocervical canal. The brush is then
rotated one turn and removed. A plastic or wooden spatula is utilized to scrape the outer
opening of the cervix and vaginal wall.
4. Collection technique (Using the conventional collection).
The specimen from the brush and spatula is wiped on the slide and fixed immediately by
immersing the slide in equal parts of 95% ethanol or by using a spray fixative.
5. Collection technique (Using the ThinPrep collection).
The brush and spatula are immediately immersed in a ThinPrep solution with a swirling
motion to release the material. The brush and spatula are then removed from the solution
and the bottle lid is replaced and secured.
6. Label the specimen
The slides are properly labeled with the patient’s name, age, initials of the health care
provider collecting the specimen, date, and time of collection.
7. Specimens are sent to the laboratory
The specimens are transported to the laboratory for cytologic analysis.
Papanicolaou smear (Pap smear, cervical smear) is a safe, noninvasive cytological
examination for early detection of cervical cancer. During the 1900s, cervical cancer was one of the
leading cause of death among women. It was until the year 1928, where a greek physician George
Nicholas Papanicolaou was able to discover the difference between normal and malignant cervical
cells by viewing the samples microscopically, hence Pap smear was invented.
For women ages 30 and above, this procedure can be done in conjunction with a test on Human
papillomavirus (HPV), the most common sexually transmitted disease and primary causative agent
for cervical cancer. The American Cancer Society recommends a Pap smear at least once every three
years for women ages 21 to 29 who are not in a high-risk category and who have had negative
results and who have had negative results from three previous Pap tests. While a Pap test and an
HPV test is recommended every five years for women ages 30 to 65 years old. If a Pap smear is
positive or suggests malignancy, a cervical biopsy can confirm the diagnosis.
Indications of Pap Smear
Pap smear is indicated for the following reasons:
Identify the presence of sexually transmitted disease such as human papillomavirus (HPV),
herpes, chlamydia, cytomegalovirus, Actinomyces spp., Trichomonas vaginalis, and Candida
spp.
Detect primary and metastatic neoplasms
Evaluate abnormal cervical changes (cervical dysplasia)
, Detect condyloma, vaginal adenosis, and endometriosis
Assess hormonal function
Evaluate the patient’s response to chemotherapy and radiation therapy
Interfering Factors
Delay in fixing a specimen, allows the cells to dry therefore destroying the effectiveness of
the stain and makes cytologic interpretation difficult
Improper collection site may cause rejection of the specimen. Samples for
hormonal evaluation are taken from the vagina while samples for cancer screening are
obtained from the vaginal fornix
Use of lubricating jelly on the speculum that may affect the viability of some organisms
Specimen collection during normal menstruation since blood can contaminate the sample
Douching, using tampons, or having sexual intercourse within 24 hours before the exam can
wash away cellular deposits
Existing vaginal infections that may interfere with hormonal cytology
Pap Smear Procedure
Pap smear is performed by a practitioner and takes approximately about 5 to 10 minutes. The step-
by-step procedure is as follows:
1. The patient is positioned.
The client is assisted in a supine, dorsal lithotomy position with feet in stirrups.
2. A speculum is inserted.
The practitioner puts on gloves and inserts an unlubricated plastic or metal speculum into
the vagina and is opened gently to spread apart the vagina to access the cervix. The
speculum may be moistened with saline solution or warm water to make insertion easier.
3. Cervical and vaginal specimens collection.
After positioning the speculum, specimen from the vagina and cervix are taken. A cytobrush
is inserted inside the cervix and rolls it firmly into the endocervical canal. The brush is then
rotated one turn and removed. A plastic or wooden spatula is utilized to scrape the outer
opening of the cervix and vaginal wall.
4. Collection technique (Using the conventional collection).
The specimen from the brush and spatula is wiped on the slide and fixed immediately by
immersing the slide in equal parts of 95% ethanol or by using a spray fixative.
5. Collection technique (Using the ThinPrep collection).
The brush and spatula are immediately immersed in a ThinPrep solution with a swirling
motion to release the material. The brush and spatula are then removed from the solution
and the bottle lid is replaced and secured.
6. Label the specimen
The slides are properly labeled with the patient’s name, age, initials of the health care
provider collecting the specimen, date, and time of collection.
7. Specimens are sent to the laboratory
The specimens are transported to the laboratory for cytologic analysis.
