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The Pap smear is done as part of a gynecological exam. You will lie on a table and place your feet in stirrups to position your pelvis for examination. The health care provider will insert an instrument (speculum) into your vagina and open it slightly to see inside the vaginal canal.

The health care provider will take a sample of cells from outside and inside the canal of the cervix by gently scraping the outside of the cervix with a wooden or plastic spatula, then inserting a small brush that looks like a pipe cleaner into the canal.

The cells are placed on a glass slide, or put in a bottle containing a preservative, and then sent to the lab for examination.


The Pap smear procedure is not complicated or painful. The only risk is not detecting cervical cancer in time to treat and cure it.

Pap Smear Preparation

The best time to have a Pap smear is when the woman is not menstruating. A woman could ask for a female doctor if that would make her feel more comfortable.

For 2 days before the test, avoid the following because these might hide any abnormal cells:
  • Intercourse
  • Douches
  • Vaginal medications (except as directed by your doctor)
  • Vaginal contraceptives such as birth control foams, creams, or jellies

During The Procedure

A Pap smear is usually part of a pelvic exam and accompanied by a breast exam performed by the health care provider.

It should only take about 1 minute to perform a Pap smear during this overall exam :

  • The woman will lie on the examination table (see Multimedia File 1) on her back with her knees up and bent and her feet in stirrups (rests). While she is lying on an examination table, her health care provider will use a small metal or plastic instrument called a speculum to open the vagina so that the walls of the vagina and cervix can be seen clearly.
  • A sample of mucus and cells will be obtained from the cervix (see Multimedia File 2) (the part of the uterus that extends into the vagina) and endocervix (the opening of the cervix) using a wooden scraper or a small cervical brush or broom.
  • The sample of cells is evenly applied to a glass slide and sprayed with a fixative. This sample is sent to the lab for close and careful examination under a microscope. If the doctor is using a new kind of Pap smear called a ThinPrep test, the sample is rinsed into a vial and sent to a lab for slide preparation and examination.
  • A cytologist (a specialist trained to look at the cells and interpret a Pap smear) reviews both types of tests.
  • Some discomfort during the test may occur. Most women feel nothing at all or feel pressure. Staying relaxed will help stop any discomfort. The woman should breathe slowly and concentrate on relaxing her stomach and legs.
  • A Pap smear should not be painful. If experiencing pain during the test, the woman should tell her doctor.

After The Procedure

The test found cells of a different size and shape :

  • An abnormal Pap smear result does not always indicate cancer. Cells sometimes appear abnormal but are not cancerous. The woman will have to return to the clinic for follow-up care.
  • Remember that abnormal conditions do not always become cancerous, and some conditions are more of a threat than others.
  • An infection of the cervix may cause a positive test result. A yeast, trichomonas, chlamydial, or gonorrheal infection can cause the cervical cells to appear inflamed. After the infection is treated, the Pap smear result usually returns to normal.
  • Human papillomavirus (HPV) can also cause a test result to be positive. This virus may exist on the cervix or in the vagina and causes genital warts. Many types of HPV have been identified, and some are associated with cervical cancer. If the woman has HPV, she has a higher risk of developing cervical cancer.
  • The smear result may be positive because it shows changes that may become cervical cancer.
  • If a woman has an abnormal Pap smear result, a repeat test should be done every 4-6 months for 2 years until 3 consecutive negative tests have been obtained.
  • If the Pap smear result is positive because of an infection, the underlying cause should be treated. The test should then be repeated in 2-3 months, because cancer of the cervix can be hidden by an infection. A check-up with a doctor is necessary.
  • Although the Pap smear is the best method of detecting cervical cancer early, it is not perfect. Because even the best labs can miss some cell changes, a woman should have the test performed yearly, as the American Cancer Society recommends.

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