Pap Smear — Cervical Cytology Screening | Palmotićeva

What is a Pap smear?

The Pap smear (Papanicolaou test) is a painless cervical cytology screening designed for early detection of precancerous and cancerous cell changes. Named after the Greek-American pathologist Georgios Papanicolaou who developed this screening method in 1928, the Pap test remains the most important preventive examination in gynecology — thanks to it, the incidence of cervical cancer has been dramatically reduced worldwide.

Why is a Pap smear important?

Cervical cancer develops gradually — from initial cellular changes to invasive carcinoma, the process can take 10–15 years. The Pap test detects these changes at their earliest stage, when treatment is straightforward and fully curable.

• Early detection of dysplasia — precancerous changes that can be completely cured
• Cervical cancer prevention — up to 80% reduction in incidence with regular screening
• HPV infection detection — cellular changes caused by human papillomavirus
• Infection monitoring — vaginitis, cervicitis, fungal and bacterial infections
• Post-treatment follow-up — monitoring after conization or dysplasia treatment

How is a Pap smear performed?

The procedure is completely painless and takes only 2–3 minutes. The gynecologist collects a sample of cells from the surface of the cervix (ecto- and endocervix) using a specialized brush or spatula. The sample is fixed on a glass slide and sent to a cytology laboratory for analysis.

• The patient is positioned in a gynecological examination chair
• The doctor inserts a speculum to visualize the cervix
• A gentle sweep collects cells from the cervix
• The sample is fixed and sent for microscopic analysis
• Results are available within 5–7 business days

When should you have a Pap smear?

A regular annual Pap test is recommended for all women aged 21 to 65. It is especially important if:

• You have not had a cervical cytology test for more than a year
• You have tested positive for HPV
• A previous Pap test showed abnormal cells
• You experience irregular bleeding or post-coital bleeding
• You are planning pregnancy — preconception screening
• You have undergone dysplasia treatment or conization

How to prepare for a Pap smear

• Schedule outside of menstruation — ideally days 10–20 of the cycle
• Avoid sexual intercourse 24–48 hours before the test
• Do not use vaginal preparations (creams, suppositories, douches) 48 hours prior
• No vaginal douching on the day of the test
• No special diet or lab work is required

Interpreting Pap smear results

Results are classified using two systems — the traditional Papanicolaou classification and the modern Bethesda system:

• Papanicolaou I (negative) — normal cells, no changes
• Papanicolaou II — inflammatory changes, usually due to infection → treatment + follow-up
• Papanicolaou III (dysplasia) — abnormal cells, requires colposcopy and possible biopsy
• Papanicolaou IV — suspected carcinoma in situ → urgent further diagnostics
• Papanicolaou V — malignant cytology → urgent oncological work-up

Under the Bethesda system, results are further categorized as:

• NILM — negative for intraepithelial lesion or malignancy
• ASC-US — atypical squamous cells of undetermined significance → HPV testing
• LSIL — low-grade squamous intraepithelial lesion (mild dysplasia, CIN I)
• HSIL — high-grade squamous intraepithelial lesion (moderate/severe dysplasia, CIN II–III)
• AGC — atypical glandular cells → requires further evaluation

What if the Pap smear is abnormal?

An abnormal Pap test does not mean cancer — most commonly it indicates inflammation or mild dysplasia that responds well to treatment. Depending on the findings, your gynecologist may recommend:

• Repeat Pap test in 3–6 months
• Colposcopy — magnified cervical examination with biopsy
• Conization — surgical removal of affected tissue
• HPV genotyping — identification of the specific HPV type

Read more:
Colposcopy — cervical examination
Gynecological examination
Cervical conization
HPV infection and condylomata