1. What is a Pap smear?
A Pap smear (also known as the Pap test) is a medical procedure in which a sample of cells from a woman's cervix (the end of the uterus that extends into the vagina) is collected and spread (smeared) on a microscope slide. The cells are examined under a microscope in order to look for pre-malignant (before-cancer) or malignant (cancer) changes.

2. Who should have a Pap smear?
Pregnancy does not prevent a woman from having a Pap smear. Pap smears can be safely done during pregnancy.
Pap smear testing is not indicated for women who have had a hysterectomy (with removal of the cervix) for benign conditions. Women who have had a hysterectomy in which the cervix is not removed, called subtotal hysterectomy, should continue screening following the same guidelines as women who have not had a hysterectomy.

3. What is the sample checked for?
The cells on the slide are checked for signs that they're changing from normal to abnormal. Cells go through a series of changes before they turn into cancer. A Pap smear can show if your cells are going through these changes long before you actually have cancer. If caught and treated early, cervical cancer is not life-threatening. This is why getting regular Pap smears is so important.

4. How is a Pap smear done?
A woman should have a Pap smear when she is not menstruating. The best time for screening is between 10 and 20 days after the first day of her menstrual period. For about two days before testing, a woman should avoid douching or using spermicidal foams, creams, or jellies or vaginal medicines (except as directed by a physician). These agents may wash away or hide any abnormal cervical cells.

5. A Pap smear can be done in a doctor's office, a clinic, or a hospital by either a physician or other specially trained health care professional, such as a physician assistant, anurse practitioner, or a nurse midwife.
With the woman positioned on her back, the clinician will often first examine the outside of the patient's genital and rectal areas, including the urethra (the opening where urine leaves the body), to assure that they look normal. 

6. A speculum is then inserted into the vaginal area (the birth canal)
A speculum is then inserted into the vaginal area (the birth canal). (A speculum is an instrument that allows the vagina and the cervix to be viewed and examined.)
A cotton swab is sometimes used to clear away mucus that might interfere with an optimal sample.
A small brush called a cervical brush is then inserted into the opening of the cervix (the cervical os) and twirled around to collect a sample of cells. Because this sample comes from inside the cervix, is called the endocervical sample ("endo" meaning inside). 

7. A second sample is also collected as part of the Pap smear and is called the ectocervical sample ("ecto" meaning outside). 
These cells are collected from a scraping of the area surrounding, but not entering, the cervical os. 
Both the endocervical and the ectocervical samples are gently smeared on a glass slide and a fixative (a preservative) is used to prepare the cells on the slide for laboratory evaluation.

8. What do the results mean?
A normal Pap smear means that all the cells in your cervix are normal and healthy.  An abnormal Pap smear can be a sign of a number of changes in the cells on your cervix:
Inflammation (irritation). This can be caused by an infection of the cervix, including a yeast infection, infection with the human papillomavirus (HPV) the herpes virus or many other infections.
Abnormal cells. These changes are called cervical dysplasia. The cells are not cancer cells, but may be precancerous (which means they could eventually turn into cancer).
More serious signs of cancer. These changes affect the top layers of the cervix but don't go beyond the cervix.
More advanced cancer.

9. What abnormal results mean
The Pap smear is a screening test. Abnormal values are based on the test results. The current system divides the results into three main areas:
ASCUS or AGUS (atypical cells of uncertain significance)
LSIL (low-grade dysplasia) or HSIL (high-grade dysplasia)
Possibly cancerous (malignant)
When a Pap smear shows abnormalities, further testing or follow-up is needed. The next step depends on the results of the Pap smear, your previous history of Pap smears, and risk factors you may have for cervical cancer.

10. If the Pap smear shows minor cell changes or abnormalities, a colposcopy-directed biopsy probably will NOT be done right away unless there is a reason to believe you may be in a high-risk category.
With an ASCUS result, an HPV test is done to check for the presence of the HPV virus types most likely to cause cancer. If the HPV test is negative, then colposcopy will not be needed.
For minor cell changes, doctors usually recommend having a repeat Pap smear in 6 months. With a negative HPV test result, it's acceptable to have the repeat Pap done in 1 year.

11. Which women are at increased risk for having an abnormal Pap smear?
A number of risk factors have been identified for the development of cervical cancer and precancerous changes in the cervix.
HPV: The principal risk factor is infection with the genital wart virus, also called the human papillomavirus (HPV), although most women with HPV infection do not get cervical cancer. About 95%-100% of cervical cancers are related to HPV infection. Some women are more likely to have abnormal Pap smears than other women. 

12. Smoking:
 One common risk factor forpremalignant and malignant changes in the cervix is smoking. Although smoking is associated with many different cancers, many women do not realize that smoking is strongly linked to cervical cancer. Smoking increased the risk of cervical cancer about two to four fold.

13. Weakened immune system: Women whose immune systems are weakened or have become weakened by medications (for example, those taken after an organ transplant) also have a higher risk of precancerous changes in the cervix. 
Medications: Women whose mothers took the drug diethylstilbestrol (DES) during pregnancy also are at increased risk.

14. Other risk factors: Other risk factors for precancerous changes in the cervix and an abnormal Pap testing include having multiple sexual partners and becoming sexually active at a young age.
What the risks are
There are no risks involved.
Special considerations

15. The following drugs may affect Pap smears:
Colchicine
Compounds in cigarettes
Estrogen
Podophyllin
Progestins
Silver nitrate