The smear at the gynecologist is a routine examination and is used for cancer prevention and the detection of sexually transmitted diseases such as HPV. Everything about the process and what happens if the Pap test is abnormal.
- The smear at the gynecologist is painless and an important routine examination.
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What is examined with the smear at the gynecologist?
With a gynecological smear, the doctor can examine various secretions, cells, bacteria and fungi in the genital area of women. For this purpose, a cell sample is taken from the cervical canal and cervix and the material is then examined for signs of inflammation or malignant changes.
It is also called a cytological smear, cervical smear, or Pap test. As a Pap test (named after the Greek doctor and pathologist George Papanicolaou) it is one of the routine examinations in gynecological practice and is primarily used for the early detection of cervical cancer and its preliminary stages.
Pap test is important for cancer prevention
The Pap test is a routine examination at the gynecologist and is mainly used to prevent cancer. Since the introduction of the Pap test as regular screening, it has been possible to detect an early stage of the disease in many women in good time, thus averting the negative consequences of a late diagnosis, such as major surgery.
If the test is carried out regularly, inflamed tissue or cancer cells can be detected before women even notice any symptoms. Pathogens such as chlamydial bacteria can also be detected in the cell smear.
How often does health insurance pay for the Pap smear?
Statutory health insurance pays women between 20 and 34 years of age one preventive check-up for cervical cancer every year.
For women aged 35 and over, the Pap test has only been covered by health insurers every three years since 2020, but then the smear is also checked for HPV viruses.
This is what the gynecologist does with the smear
A gynecological smear must be done very carefully, otherwise it can give incorrect results. The examination is therefore usually carried out by a gynecologist.
Special preparation for the smear at the gynecologist is not necessary. However, the Pap test should not be performed during menstruation. This should be considered when making an appointment. For the smear, the person to be examined undresses from the navel down and goes to the gynecological examination chair.
For the collection of secretions or cells, the vagina is painlessly unfolded with an inserted metal spatula (speculum). The doctor then inserts a sterile spatula, a cotton swab or a small brush, rubs it over the surface of the mucous membrane, and thus takes the necessary sample material.
The gynecological smear is usually found uncomfortable, but it is not painful and only takes a few minutes. Complications are not to be expected. Occasionally, light spotting may occur after the examination.
Microbiological examination in the laboratory
After the doctor has removed the cell material, it is smeared on a slide and viewed under a microscope after (or without) staining. The first possible changes can sometimes already be recognized. The practice then sends the sample to a laboratory, where the tissue is examined and the actual Pap test is carried out.
In the laboratory, the test material taken from the vagina is analyzed for signs of inflammation or malignant changes. For this purpose, the samples are colored in order to make changes and abnormal cells more visible and to be able to assess them.
Evaluation of findings: What the result of the Pap test says
The Pap test is divided into different groups of findings, so-called Pap groups. The following table shows how the results of the laboratory findings are classified according to the Munich nomenclature III, which has been in effect since 2015, and which further diagnostic steps are necessary.
| Finding | meaning | Further measures and recommendations |
| Pap 0 | The material cannot be evaluated | New smear necessary |
| Pap I | Normal cell structure | unnecessary |
| Pap II | Slight inflammation recognizable | unnecessary |
| Pap III | Cell material cannot be assessed | Possibly tissue examination |
| Pap IIID | Suspected slight to moderate changes in the cells | Detailed gynecological examination (colposcopy) and cell smear after three months |
| Pap IVa | Suspected severe cell changes, possibly early tumor | Detailed gynecological examination (colposcopy) and tissue examination |
| Pap IVb | Severe cell changes or early-stage tumor suspected. The onset of cancer cannot be ruled out. | Detailed gynecological examination (colposcopy) and tissue examination |
| Pap V | Malignant tumor cells can be detected. | Detailed gynecological examination (colposcopy) and tissue examination |
The accuracy of the Pap test is given as around 80 to 90 percent. It may happen that the sample from the first smear is insufficient to be able to make an accurate statement. If the result is suspicious, the smear is repeated. The suspicion of malignant cell changes is checked by taking tissue (endometrial biopsy).
HPV test detects cancerous pathogens
A gynecological smear can also be used to obtain sample material for an HPV test. Human papillomaviruses (HP viruses or HPV for short) can be involved in the development of cervical cancer. The HPV test is therefore suitable for detecting an infection with the virus. However, the HPV test has so far only been part of the three-yearly cancer screening program for women aged 35 and over without any suspicion of infection.
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