# Papanicolaou (Pap) Smear

## Overview

This module describes how to perform a Papanicolaou smear, better known as a Pap smear, a test used for cervical cancer screening.

## Indications

## Contraindications

## Patient information and consent

Always verify your patient’s identity and obtain informed consent before proceeding.

### How do I explain this procedure?

“A Pap smear is a test for cervical cancer, or for changes to the cervix that put you at risk of developing cancer later. Although the thought of it might make you feel uncomfortable, every woman should have Pap smears regularly as a part of looking after yourself.”

### What can my patient expect?

“I will use a speculum, a tool that allows me to see your cervix. The speculum may feel very cold. Once the speculum is in place, the procedure will go very quickly. I will use a spatula to scrape some cells from your cervix to send to the lab. This is usually not painful, but it can be slightly uncomfortable. There should not be bleeding after the test. The results will come back in a month’s time. I will call you with the results.”

### What is my patient’s role?

“If you have a full bladder, it is best to void before the procedure. Take deep breaths and try not to tense or squeeze your legs; when you are relaxed, it’s less uncomfortable. Tell me if it is painful at any point, or if you wish me to stop.”

## Preparation

Prepare a trolley with equipment. Ensure a female chaperone is present.

### Documentation

### Equipment

## Site & Positioning

The patient should be positioned reclining or supine, with their heels drawn up to their buttocks and knees apart. This procedure requires strong, focused lighting.

## Procedure

Follow medical asepsis with non-sterile gloves.

## Troubleshooting

The patient’s vaginal walls bulge between the speculum valves and I can’t see past them.

Cut the fingers off a small glove and slip the palm section over the speculum valves. Once inserted and opened, the glove will stretch to form a sleeve, holding back the vaginal walls and allowing you to see past them.

My patient is very anxious and is struggling to relax enough for me to pass the speculum.

Ask the patient to cough or strain while inserting the speculum. Warming the speculum valves in your hand before insertion can also help. Make sure that you provide lots of reassurance and are sensitive to the patient’s emotional state during the procedure.

My patient’s results have returned and I want to arrange follow-up.

Report shows 'Inadequate': Repeat the smear.

Report shows

LSIL

LSIL

Low-grade squamous intraepithelial lesion

or

ASCUS

ASCUS

Atypical Squamous Cells of Undetermined Significance

: Repeat smear in 6-12 months. If normal, do another smear in 12 months. If the same or worse, refer for colposcopy.

Report shows

DSIL

DSIL

High-grade Squamous Intraepithelial Lesion

or

AGUS

AGUS

Atypical Glandular Cells of Undetermined Significance

: refer for colposcopy.

## Risks

## References