Pap Smear for Cervical Cancer Screening: What to Expect & FAQs

When asked why they've never had cervical cancer screening, 39.4% of Singaporean women said they felt healthy and didn't think it was necessary. If that reasoning sounds familiar, here's what's important to know: Cervical cancer develops silently over 10-20 years, often without any symptoms until it's advanced. By the time you feel unwell, it may be too late for simple treatment.

That's exactly why the Pap smear exists—to catch problems before they become cancer, when treatment is straightforward and highly effective. Despite being the sixth most common cancer among women in Singapore, cervical cancer is one of the most preventable through regular screening. Knowing what a Pap test involves and why it's recommended can help you take this important step for your health.

What is a Pap smear?

Also known as the Pap test or cytology, the Pap smear is a screening test to reveal abnormal cellular changes in the cervix. Persistent infection with high-risk types of human papillomavirus (HPV) often causes such changes. These changes could indicate the presence of cervical cancer or precancerous conditions. The test involves collecting the cell samples from the cervix during the pelvic exam to be sent for analysis.

Why is a Pap smear being done?

The main purposes are:

• Early detection of cervical cancer:

  • The test can identify cancer in its earliest, most treatable stages, often before any symptoms appear.

• Finding precancerous changes:

  • More importantly, it can detect abnormal cells that might become cancerous if left untreated. This allows for early intervention to prevent cancer from developing.

• Screening for HPV:

  • The Pap test is often combined with HPV testing, since HPV is the primary cause of cervical cancer.

When should you get your first Pap test?

In Singapore, cervical cancer screening is recommended for all women aged 25 and above who have ever been sexually active. You can start with your first Pap test from age 25, even if you feel completely healthy. Detecting abnormal cells early can prevent cervical cancer from developing later on.

If you’ve never had sexual intercourse, your risk of HPV infection is very low, but it’s still best to discuss your individual situation with your doctor.

How often do you need a Pap smear?

The frequency of screening depends on both your age and the type of test being performed.

• Ages 25 to 29:
  • A Pap test once every 3 years is recommended, as mentioned earlier.
• Ages 30 to 69:
  • Switch to an HPV test once every 5 years. This test detects the virus that can cause cervical cancer, allowing earlier and more accurate detection.

If you’ve had abnormal results, treatment for cervical abnormalities, or have a weakened immune system, your doctor may advise more frequent screening. Women over 69 years old who have had consistently normal results may be able to stop regular screening after consulting their doctor.

For personalised guidance on your cervical screening schedule and what’s right for your age or health history, consider speaking with a women’s health specialist. You may contact Thomson Medical to arrange a consultation for personalised guidance

How is a Pap smear done?

A Pap test involves the following steps:

• Positioning: You’ll be asked to lie on the examination bed. A speculum is gently inserted into your vagina to widen it and allow your doctor to view the cervix.
• Cell collection: Using a soft brush or spatula, your doctor will collect cells from the cervix. These will be sent to a laboratory for analysis to check for any abnormalities.
• Speculum removal: The speculum is then carefully removed from your vagina.

The test is quick, simple, and usually causes only mild discomfort. You might experience light spotting or discharge afterward, but you can return to your normal activities right away.

How to prepare for your Pap smear?

Preparing for a Pap smear is a straightforward process. Here are detailed steps on how to prepare for it:

• Choose the right timing:

  • If you’re still menstruating, schedule your appointment about two weeks after the start of your period or up to a week before your next period begins. This helps ensure the clearest and cleanest sample.

  • If you’ve reached menopause, you may schedule your Pap smear at any time.

• Avoid certain products:

  • For 48 hours before the test, avoid using vaginal creams, foams, or douches, as they may interfere with the test results.

• Skip sexual activity:

  • Refrain from sexual intercourse for at least 48 hours before the test. Semen, lubricants, and certain products can affect the Pap smear results.

• Inform your healthcare provider:

  • Inform your healthcare provider about any concerns, symptoms, or changes in your reproductive health. They can address your specific needs and provide appropriate care. 

• Reschedule if sick:

  • If you have an active infection or are feeling unwell, consider rescheduling your Pap smear. Infections can affect the accuracy of the test. 

• Comfortable clothing:

  • Wear comfortable clothing to your appointment, as you may need to undress from the waist down.

• Relaxation techniques:

  • Practice relaxation techniques if you feel anxious. Deep breathing or meditation can help ease tension.

• Ask questions:

  • Ask your healthcare provider any questions you may have about the procedure. Understanding the process can help alleviate concerns.

Who does not need a Pap smear?

Most women benefit from regular Pap tests, but there are a few exceptions where screening may no longer be necessary. You may not need a Pap smear if:

• You have had a total hysterectomy (removal of the uterus and cervix) for non-cancerous reasons, such as fibroids or heavy bleeding, and have no history of cervical cancer or pre-cancer.

• You are over 65 and have had consistently normal results over the past 10 years. Your doctor may advise that further screening is no longer needed.

• You have never been sexually active. While the risk of cervical cancer is very low, you should discuss your personal risk factors with your doctor.

• You have specific medical conditions or have undergone treatments that make Pap test unnecessary and your healthcare provider can confirm based on your health history.

Always check with your doctor before stopping cervical cancer screening. They can guide you based on your age, medical history, and risk factors.

Can an HPV test be done with a Pap smear?

Yes, in many cases, an HPV test is done at the same time as a Pap smear — this is known as co-testing. Both tests use the same sample of cervical cells, so you don’t need to undergo two separate procedures.

The Pap smear checks for abnormal cervical cells, while the HPV test looks for high-risk types of human papillomavirus (HPV) that can cause these changes.

Co-testing provides a more complete picture of your cervical health and helps detect early warning signs more accurately. Your doctor will advise whether you need both tests, depending on your age, past results, and overall risk profile.

What do Pap smear results mean?

Your Pap smear results help your doctor understand if the cells on your cervix are healthy or if there are any early changes that need attention.Results usually fall into two broad categories:

• Normal (negative) result:

  • This result means that no abnormal cells were found. Your cervix is healthy, and you can continue routine screening as recommended by your doctor.

  • Most women will have normal results; in Singapore, around 90% of Pap smears come back normal.

• Abnormal result:

  • An abnormal Pap smear doesn’t necessarily mean you have cervical cancer. It simply means that some cervical cells look different from normal under the microscope.

  • These changes are often caused by HPV, a common infection that most women clear naturally. Depending on the level of change, your doctor may suggest:

    • Repeating the test after a few months

    • HPV testing to check for high-risk strains

    • Colposcopy, a closer examination of the cervix

Sometimes, the test may not collect enough cells or the sample may be unclear.This is called an “unsatisfactory” or “inadequate” result and does not mean anything is wrong. In this case, the test simply needs to be repeated.

If you’ve recently received your Pap smear or HPV test results and are unsure what they mean, consider speaking with a women’s health specialist. You may contact Thomson Medical to arrange a consultation for personalised guidance, further evaluation, and clarity on your next steps.

FAQ

Can you get a Pap smear earlier than 25?

Routine Pap smears are generally not recommended before age 25 in Singapore. The national screening guidelines advise starting at 25 for women who have ever been sexually active. If you have specific risk factors or concerns, discuss early screening with your doctor.

Where can you get HPV vaccine in Singapore?

Do I still need Pap smears if I have had the HPV vaccine?

Yes, the HPV vaccine doesn't cover all cancer-causing HPV types, so regular screenings are still essential.

Can I do a Pap smear during pregnancy?

Yes, Pap smears can be safely conducted during pregnancy.

Is a Pap smear painful?

Most women experience only mild discomfort during the test. If you feel significant pain, talk to your healthcare provider so they can make the process more comfortable.

Can cervical cancer be prevented with Pap smear?

Regular Pap smears can detect precancerous changes, allowing for early intervention and prevention of cervical cancer.

Do you still need a Pap smear after menopause?

According to MOH, a woman may discontinue screening at 69 years if her Pap smear at that age is negative and she has had two prior consecutive negative smears within the last 10 years. Speak with your doctor about your personal screening plan.

Do you need a pap smear if not sexually active?

Pap smears are generally recommended for sexually active individuals, but guidelines may vary. Consult with your healthcare provider to determine individual screening needs.

How much bleeding is normal after a Pap smear?

Some spotting or light bleeding is normal after a Pap smear. If bleeding is excessive or persists, contact a healthcare provider for guidance.

Disclaimer: The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations and tailored advice, please consult a specialist at Thomson Medical. Request for an appointment with Thomson Medical today.