Pap test or Pap smear

Everything you need to know about the Pap test for cervical cancer screening

What is a Pap test? If you regularly go for cervical cancer screening, you‘ve probably heard the term before. If you still don’t know exactly what happens during a Pap smear and what exactly it examines, you are not alone. This article will answer the most important questions about the Pap test.

Frauenärztin nimmt Pap-Abstrich

Table of contents

What does the Pap test examine?

The Pap test is part of cervical cancer screening and is intended to detect possible cervical changes at an early stage. To do this, the gynecologist swabs the cervix with a kind of brush to take a sample of the mucosal cells. This is why the Pap test is also called a Pap smear.

The mucosal cells from the cervix and uterus are then examined under a microscope in a laboratory. The aim of this examination is to detect cell changes as early as possible. Cell changes are relatively common, especially in young women. In most cases, they disappear completely. However, in some cases, they can also develop into precancerous lesions and ultimately into cervical cancer.

The Pap test can therefore help prevent cancer, because it can provide indications of cervical cancer before it develops. The earlier cervical cancer is detected, the more successful its treatment.

When is a Pap smear taken?

Women have a Pap test during their regular cancer screening with their gynecologist. The doctor will examine whether there are any abnormal or altered cells on the cervix.

The gynecologist takes a smear from the cervix using a special brush. The collected cells are then examined under a microscope for changes.

Cervical cancer screening in Germany regulates how often a woman can have a Pap smear. The costs are covered by health insurance companies.

My Pap test is abnormal! What does that mean?

Most women don’t hear from their gynecologist after their cancer screening – no news usually means good news. However, if the gynecologist calls, it may be that the Pap smear or Pap test result is abnormal.

Important to know: An abnormal Pap smear is not a diagnosis of cervical cancer. Pap findings are divided into different groups or levels which describe the type of abnormality.

Incidentally, the term “positive Pap test” is often used colloquially. However, this term is not correct, because the individual stages have very different meanings.

What does my Pap test result mean?

Findings Meanings
Pap 0 The cell smear is insufficient to make a diagnosis.
Pap I All cells are normal.
Pap II-a The smear is normal, but there have been abnormalities in the past.
Pap II There are minor cell changes, but cancer is not suspected.
Pap IIID 1 Altered cells have been found, but the risk of cancer development is low.
Pap IIID 2 Altered cells have been found and there is a risk that these will develop into cancer.
Pap III Altered cells have been found, but these cannot be clearly assessed. However, cancer cells have not yet been found.
Pap IV Severely altered cells have been found. There may already be severe tissue changes that could develop into cancer.
Pap V Malignant cells have been found. Cancer could be present.

Is a cell change bad?

A cell change occurs when the affected cell differs in form and function from a normal cell. For example, this can happen due to an infection with human papillomaviruses.

Slight cell changes are normal and not at all serious.  In most cases, they disappear completely. However, cell changes can also be precursors to malignant changes.

As already described, cervical cancer can develop from precursors. Such precursors, also known as dysplasia, can be detected during a Pap test.

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How does the Pap smear work?

The Pap test examines cell material from the cervix and uterus under a microscope. The analysis is carried out by specialized medical personnel (cytologists).

The doctor removes cell material through a cervical smear, i.e. a smear from the cervix. This procedure is familiar to most women who have  been to the gynecologist. The woman will lie down on the examination chair and a so-called speculum will be inserted into the vagina. The speculum will slightly widen the vagina to make the examination easier. The gynecologist then inserts a kind of brush and strokes it along the cervix to collect cells for examination.  This process should be relatively painless.

The doctor will send the swab sample to a laboratory. There, the sample is spread on a glass plate, also known as a microscope slide, stained with a special agent and examined under a microscope. A cytologist will determine whether cells are normal or whether there are cell changes. In this context, cell changes are also called dysplasia.

Limits of the Pap test

Although the Pap test is an important part of cervical cancer screening, it also has its limitations.

It can happen that altered cells are overlooked under the microscope. This is why it is so important to go for regular cervical cancer screening.

On the other hand, in three to four out of 100 cases, healthy cells are mistakenly classified as malignant. A nerve-wracking time then begins for the women affected until further examinations give the all-clear.

What is the difference between the Pap test and the HPV test?

Both the Pap smear and the HPV test are used in the regular cervical cancer screening program. However, the two tests answer different questions.

HPV test:

A swab sample is examined for human papillomavirus (HPV).

Is there an HPV infection, which in rare cases can cause cervical cancer?

Pap test:

A swab sample from the cervix is examined under a microscope.

Are there any cell changes?

Where does the term Pap come from?

The Pap test owes its name to its developer, the Greek pathologist George Nicolas Papanicolaou. He used the microscopic method for the early detection of cervical cancer as early as 1928.

With the introduction of the Pap test, cervical cancer could be treated early and mortality from this type of cancer fell significantly.


The Pap test is part of cervical cancer screening: a swab sample from the cervix is examined under a microscope for cell changes. In the best case scenario, cervical cancer can be detected in its preliminary stages.

It is important to note that an abnormal Pap test is not a cancer diagnosis. The results of the Pap test are divided into different Pap test levels which indicate the degree of cell changes. But don’t worry, cell changes are relatively normal, can heal on their own and do not necessarily mean cancer. Further examinations may be necessary depending on Pap test results.

Order GynTect®

Contact us, to get GynTect®

On request, you will receive a free smear test kit, which is accompanied by a treatment contract. Only when we have received the swab sample together with the signed examination request in the laboratory do you undertake to pay the costs of 150 euros.

Do you have any further questions? Please use the contact options provided.

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  1. Titelbild: Image Point Fr/Shutterstock
  2. Schema Gebärmutter und Gebärmutterhals: Pepermpron/Shutterstock
  3. Pap-Abstrich unter dem Mikroskop: Komsan Loonprom/Shutterstock