Editing Pap test (section)

==Medical uses==
{| class="wikitable" style="float:right; width:40em; border:solid 1px #999; margin:0 0 1em 1em;"
|-
! colspan="3" style="background:#cee;"| Summary of reasons for testing
|-
! patient's characteristic
! indication
! rationale
|-
| under age 21, regardless of sexual history
| no test
| more harms than benefits<ref name="AAFPfive">{{Cite journal |author1 = American Academy of Family Physicians |author1-link = American Academy of Family Physicians |title = Five Things Physicians and Patients Should Question |journal = Choosing Wisely: An Initiative of the ABIM Foundation |url = http://www.aafp.org/dam/AAFP/documents/about_us/initiatives/choosing-wisely-five-questions.pdf |access-date = August 14, 2012  |archive-url = https://web.archive.org/web/20171111204956/http://www.aafp.org/dam/AAFP/documents/about_us/initiatives/choosing-wisely-five-questions.pdf |archive-date = November 11, 2017 |url-status = dead }}</ref>
|-
| age 20–25 until age 50–60
| test every 3–5 years if results normal
| broad recommendation<ref name=Arbyn10 />
|-
| over age 65; history of normal tests
| no further testing
| recommendation of [[United States Preventive Services Task Force|USPSTF]], [[American Congress of Obstetricians and Gynecologists|ACOG]], [[American Cancer Society|ACS]] and [[American Society for Clinical Pathology|ASCP]];<ref name=Saslow2012 /><ref name="stopscreening"/><ref name="agebenefit"/>
|-
| had total [[hysterectomy]] for non-cancer disease&nbsp;– [[cervix]] removed
| no further testing
| harms of screening after hysterectomy outweigh the benefits<ref name="AAFPfive"/>
|-
| had partial hysterectomy&nbsp;– cervix remains
| continue testing as normal
|
|-
| has received [[HPV vaccine]]
| continue testing as normal
| vaccine does not cover all cancer-causing types of HPV<ref name=Arbyn10 />
|-
| history of [[endometrial cancer]], with history of hysterectomy
| discontinue routine testing<ref name="SGOfive">{{Cite journal|author1 = Society of Gynecologic Oncology |author1-link = Society of Gynecologic Oncology |date = February 2014 |title = Five Things Physicians and Patients Should Question |journal = Choosing Wisely: An Initiative of the ABIM Foundation |url = http://www.choosingwisely.org/doctor-patient-lists/society-of-gynecologic-oncology/ |access-date = 19 February 2013}}, which cites
* {{cite journal |vauthors=Salani R, Backes FJ, Fung MF, Holschneider CH, Parker LP, Bristow RE, Goff BA | title = Posttreatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncologists recommendations | journal = American Journal of Obstetrics and Gynecology | volume = 204 | issue = 6 | pages = 466–78 | year = 2011 | pmid = 21752752 | doi = 10.1016/j.ajog.2011.03.008 | doi-access = free }}
* {{cite journal |vauthors=Salani R, Nagel CI, Drennen E, Bristow RE | title = Recurrence patterns and surveillance for patients with early stage endometrial cancer | journal = Gynecologic Oncology | volume = 123 | issue = 2 | pages = 205–7 | year = 2011 | pmid = 21820709 | doi = 10.1016/j.ygyno.2011.07.014 }}
* {{cite journal |vauthors=Bristow RE, Purinton SC, Santillan A, Diaz-Montes TP, Gardner GJ, Giuntoli RL | title = Cost-effectiveness of routine vaginal cytology for endometrial cancer surveillance | journal = Gynecologic Oncology | volume = 103 | issue = 2 | pages = 709–13 | year = 2006 | pmid = 16797686 | doi = 10.1016/j.ygyno.2006.05.013 }}</ref>
| test no longer effective and likely to give false positive<ref name="SGOfive"/>
|-
|}
Screening guidelines vary from country to country. In general, screening starts about the age of 20 or 25 and continues until about the age of 50 or 60.<ref name="stopscreening">{{cite journal |last= Strander |first=B | title = At what age should cervical screening stop? | journal = Br Med J | volume = 338 | pages = 1022–23 | year = 2009 | pmid = 19395422 | doi = 10.1136/bmj.b809 | s2cid = 37206485 }}</ref> Screening is typically recommended every three to five years, as long as results are normal.<ref name=Arbyn10 />

[[American Congress of Obstetricians and Gynecologists]] (ACOG) and others recommend starting screening at age 21.<ref name=Saslow2012>{{cite journal |last1=Saslow |first1=Debbie |last2=Solomon |first2=Diane |last3=Lawson |first3=Herschel W. |last4=Killackey |first4=Maureen |last5=Kulasingam |first5=Shalini L. |last6=Cain |first6=Joanna M. |last7=Garcia |first7=Francisco A. R. |last8=Moriarty |first8=Ann T. |last9=Waxman |first9=Alan G. |last10=Wilbur |first10=David C. |last11=Wentzensen |first11=Nicolas |last12=Downs |first12=Levi S. |last13=Spitzer |first13=Mark |last14=Moscicki |first14=Anna-Barbara |last15=Franco |first15=Eduardo L. |last16=Stoler |first16=Mark H. |last17=Schiffman |first17=Mark |last18=Castle |first18=Philip E. |last19=Myers |first19=Evan R. |title=American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology Screening Guidelines for the Prevention and Early Detection of Cervical Cancer |journal=Journal of Lower Genital Tract Disease |date=July 2012 |volume=16 |issue=3 |pages=175–204 |doi=10.1097/LGT.0b013e31824ca9d5 |pmid=22418039 |pmc=3915715}}</ref><ref name=ACOG2009>{{cite journal | title = ACOG Committee on Gynecologic Practice; Routine Pelvic Examination and Cervical Cytology Screening, Opinion #413 | journal = Obstetrics and Gynecology | volume = 113 | issue = 5 | pages = 1190–1193 | year = 2009 | pmid = 19384150 | doi = 10.1097/AOG.0b013e3181a6d022 | author1 = ACOG Committee on Gynecological Practice | doi-access = free }}</ref> Many other countries wait until age 25 or later to start screening. For instance, some parts of Great Britain start screening at age 25. ACOG's general recommendation is that people with female reproductive organs age 30–65 have an annual [[well-woman examination]], that they not get annual Pap tests, and that they do get Pap tests at three to five year intervals.<ref name="ACOGfive">{{Cite journal|author1 =  American Congress of Obstetricians and Gynecologists |author1-link = American Congress of Obstetricians and Gynecologists |title = Five Things Physicians and Patients Should Question |journal = Choosing Wisely: An Initiative of the ABIM Foundation |url = http://www.choosingwisely.org/doctor-patient-lists/american-college-of-obstetricians-and-gynecologists/ |access-date = August 1, 2013}}, which cites
* {{cite journal |vauthors=Boulware LE, Marinopoulos S, Phillips KA, Hwang CW, Maynor K, Merenstein D, Wilson RF, Barnes GJ, Bass EB, Powe NR, Daumit GL | title = Systematic review: The value of the periodic health evaluation | journal = Annals of Internal Medicine | volume = 146 | issue = 4 | pages = 289–300 | year = 2007 | pmid = 17310053 | doi=10.7326/0003-4819-146-4-200702200-00008| s2cid = 1683342 | doi-access = free }}
* {{cite journal |vauthors=Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J, Garcia FA, Moriarty AT, Waxman AG, Wilbur DC, Wentzensen N, Downs LS, Spitzer M, Moscicki AB, Franco EL, Stoler MH, Schiffman M, Castle PE, Myers ER | title = American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer | journal = CA Cancer J Clin | volume = 62 | issue = 3 | pages = 147–72 | year = 2012 | pmid = 22422631 | pmc = 3801360 | doi = 10.3322/caac.21139 }}
* {{cite journal | title = Committee Opinion No. 534 | journal = Obstetrics & Gynecology | volume = 120 | issue = 2, Part 1 | pages = 421–424 | year = 2012 | pmid = 22825111 | doi = 10.1097/AOG.0b013e3182680517 | author1 = Committee on Gynecologic Practice }}
* {{cite journal | title = ACOG Practice Bulletin Number 131: Screening for cervical cancer | journal = Obstetrics and Gynecology | volume = 120 | issue = 5 | pages = 1222–1238 | year = 2012 | pmid = 23090560 | doi = 10.1097/AOG.0b013e318277c92a | author1 = Committee on Practice Bulletins—Gynecology }}</ref>

HPV is passed through skin to skin contact; sex does not have to occur, although it is a common way for it to spread.<ref>{{Cite web|url=https://www.cancer.org/cancer/cervical-cancer/prevention-and-early-detection/can-cervical-cancer-be-prevented.html|title=Can Cervical Cancer Be Prevented?|website=www.cancer.org|language=en|access-date=2018-11-07}}</ref> It takes an average of a year, but can take up to four years, for a person's immune system to clear the initial infection. Screening during this period may show this immune reaction and repair as mild abnormalities, which are usually not associated with cervical cancer, but could cause the patient stress and result in further tests and possible treatment. Cervical cancer usually takes time to develop, so delaying the start of screening a few years poses little risk of missing a potentially precancerous lesion. For instance, screening people under age 25 does not decrease cancer rates under age 30.<ref>{{cite journal|author1=Sasieni, P |author2=Castanon, A |author3=Cuzick, J |author4=Snow, J | title = Effectiveness of Cervical Screening with Age: Population based Case-Control Study of Prospectively Recorded Data | journal = BMJ | volume = 339| pages = 2968–2974 | year = 2009 | doi=10.1136/bmj.b2968|pmid=19638651 |pmc=2718082 }}</ref>

HPV can be transmitted in sex between females, so those who have only had sex with other females should be screened, although they are at somewhat lower risk for cervical cancer.<ref name=Marrazzo2001>{{cite journal |vauthors=Marrazzo JM, Koutsky LA, Kiviat NB, Kuypers JM, Stine K | title = Papanicolaou test screening and prevalence of genital human papillomavirus among women who have sex with women | journal = American Journal of Public Health | volume = 91 | issue = 6 | pages = 947–952 | year = 2001 | pmid = 11392939 | pmc = 1446473 | doi = 10.2105/AJPH.91.6.947 }}</ref>

Guidelines on frequency of screening vary—typically every three to five years for those who have not had previous abnormal smears.<ref name=Arbyn10 /> Some older recommendations suggested screening as frequently as every one to two years, however there is little evidence to support such frequent screening; annual screening has little benefit but leads to greatly increased cost and many unnecessary procedures and treatments.<ref name=Saslow2012 /> It has been acknowledged since before 1980 that most people can be screened less often.<ref>{{cite journal| quote = ACS and others have recommended, since before 1980, that conventional cytology can be safely performed up to every three years for most women. | author = Smith, RA| title = American Cancer Society Guideline for the Early Detection of Cervical Neoplasia and Cancer | journal = CA: A Cancer Journal for Clinicians| volume = 52 | issue = 1 | pages = 8–22 | year = 2002 | doi = 10.3322/canjclin.52.6.342| pmid = 12469763| s2cid = 19919545|display-authors=etal| doi-access = free}}</ref> In some guidelines, frequency depends on age; for instance in Great Britain, screening is recommended every three years for women under 50, and every five years for those over.<ref>{{cite web |title=Cervical screening: programme overview |url=https://www.gov.uk/guidance/cervical-screening-programme-overview |website=Gov.UK |publisher=Public Health England |access-date=21 June 2023}}</ref>

Screening should stop at about age 65 unless there is a history of abnormal test result or disease. There is probably no benefit in screening people aged 60 or over whose previous tests have been negative.<ref name="agebenefit">{{cite journal |vauthors=Sasieni P, Adams J, Cuzick J | title = Benefit of cervical screening at different ages: evidence from the UK audit of screening histories | journal = Br J Cancer | volume = 89 | issue = 1 | pages = 88–93 | year = 2003 | pmid = 12838306 | pmc = 2394236 | doi = 10.1038/sj.bjc.6600974 }}</ref> If a woman's last three Pap results were normal, she can discontinue testing at age 65, according to the USPSTF, ACOG, ACS, and ASCP;<ref name=Saslow2012 /> England's NHS says 64. There is no need to continue screening after a complete hysterectomy for benign disease.

Pap smear screening is still recommended for those who have been [[HPV vaccine|vaccinated against HPV]]<ref name=Arbyn10 /> since the vaccines do not cover all HPV types that can cause cervical cancer. Also, the vaccine does not protect against HPV exposure before vaccination.<ref>{{cite web |title=HPV Vaccination Recommendations |url=https://www.cdc.gov/vaccines/vpd/hpv/hcp/recommendations.html |website=Centers for Disease Prevention and Control |date=22 May 2023 |access-date=21 June 2023}}</ref>

Those with a history of [[endometrial cancer]] should discontinue routine Pap tests after hysterectomy.<ref name="SGOfive"/><ref>{{Cite journal|last=Salani|first=R|date=2017|title=An update on post-treatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncology (SGO) recommendations|url=https://www.sgo.org/wp-content/uploads/2017/06/Salani-paper.pdf |archive-url=https://web.archive.org/web/20190702163850/https://www.sgo.org/wp-content/uploads/2017/06/Salani-paper.pdf |archive-date=2019-07-02 |url-status=live|journal=Gynecologic Oncology|volume=146|issue=1|pages=3–10|doi=10.1016/j.ygyno.2017.03.022|pmid=28372871}}</ref> Further tests are unlikely to detect recurrence of cancer but do bring the risk of giving false positive results, which would lead to unnecessary further testing.<ref name="SGOfive"/>

More frequent Pap smears may be needed to follow up after an abnormal Pap smear, after treatment for abnormal Pap or biopsy results, or after treatment of cancer (cervical, anal, etc.).<ref>{{Cite web |date=2022-10-13 |title=HPV and Pap Test Results: Next Steps after an Abnormal Test - NCI |url=https://www.cancer.gov/types/cervical/screening/abnormal-hpv-pap-test-results |access-date=2024-02-25 |website=www.cancer.gov |language=en}}</ref>

===Effectiveness===
The Pap test, when combined with a regular program of screening and appropriate follow-up, can reduce cervical cancer deaths by up to 80%.<ref name=Arbyn10>{{cite journal |vauthors=Arbyn M, Anttila A, Jordan J, Ronco G, Schenck U, Segnan N, Wiener H, Herbert A, von Karsa L | title = European Guidelines for Quality Assurance in Cervical Cancer Screening. Second Edition—Summary Document | journal = Annals of Oncology | volume = 21 | issue = 3 | pages = 448–458 | year = 2010 | pmid = 20176693 | pmc = 2826099 | doi = 10.1093/annonc/mdp471 }}</ref>

Failure of prevention of cancer by the Pap test can occur for many reasons, including not getting regular screening, lack of appropriate follow-up of abnormal results, and sampling and interpretation errors.<ref name=DeMay>{{cite book| author = DeMay, M. | year = 2007 | title = Practical principles of cytopathology. Revised edition. | isbn = 978-0-89189-549-7| publisher = American Society for Clinical Pathology Press| location = Chicago, IL}}</ref> In the US, over half of all invasive cancers occur in females who have never had a Pap smear; an additional 10 to 20% of cancers occur in those who have not had a Pap smear in the preceding five years.{{citation needed|date=August 2024}} About one-quarter of US cervical cancers were in people who had an abnormal Pap smear but did not get appropriate follow-up (patient did not return for care, or clinician did not perform recommended tests or treatment).{{citation needed|date=May 2021}}

[[Adenocarcinoma]] of the cervix has not been shown to be prevented by Pap smears.<ref name=DeMay /> In the UK, which has a Pap smear screening program, adenocarcinoma accounts for about 15% of all cervical cancers.<ref>{{cite web | title=Cancer Research UK website | url=http://info.cancerresearchuk.org/cancerstats/types/cervix/incidence/ | access-date=2009-01-03 | url-status=dead | archive-url=https://web.archive.org/web/20090116222837/http://info.cancerresearchuk.org/cancerstats/types/cervix/incidence/ | archive-date=2009-01-16 }}</ref>

Estimates of the effectiveness of the United Kingdom's call and recall system vary widely, but it may prevent about 700 deaths per year in the UK.<ref name="pmid12714468">{{cite journal |vauthors=Raffle AE, Alden B, Quinn M, Babb PJ, Brett MT | title = Outcomes of screening to prevent cancer: analysis of cumulative incidence of cervical abnormality and modelling of cases and deaths prevented | journal = BMJ | volume = 326 | issue = 7395 | page = 901 | year = 2003 | pmid = 12714468 | pmc = 153831 | doi = 10.1136/bmj.326.7395.901 }}</ref>

Multiple studies have performed sensitivity and specificity analyses on Pap smears. Sensitivity analysis captures the ability of Pap smears to correctly identify women with cervical cancer. Various studies have revealed the sensitivity of Pap smears to be between 47.19 - 55.5%.<ref name=":0">{{Cite journal |date=December 2007 |title=Specificity, sensitivity and cost |url=https://www.nature.com/articles/nrc2287 |journal=Nature Reviews Cancer |language=en |volume=7 |issue=12 |pages=893 |doi=10.1038/nrc2287 |s2cid=43571578 |issn=1474-1768|url-access=subscription }}</ref><ref name=":1">{{Cite journal |last1=Najib |first1=Fatemeh sadat |last2=Hashemi |first2=Masooumeh |last3=Shiravani |first3=Zahra |last4=Poordast |first4=Tahereh |last5=Sharifi |first5=Sanam |last6=Askary |first6=Elham |date=September 2020 |title=Diagnostic Accuracy of Cervical Pap Smear and Colposcopy in Detecting Premalignant and Malignant Lesions of Cervix |journal=Indian Journal of Surgical Oncology |volume=11 |issue=3 |pages=453–458 |doi=10.1007/s13193-020-01118-2 |issn=0975-7651 |pmc=7501362 |pmid=33013127}}</ref><ref name=":2">{{Cite journal |last1=Nkwabong |first1=Elie |last2=Laure Bessi Badjan |first2=Ingrid |last3=Sando |first3=Zacharie |date=January 2019 |title=Pap smear accuracy for the diagnosis of cervical precancerous lesions |journal=Tropical Doctor |language=en |volume=49 |issue=1 |pages=34–39 |doi=10.1177/0049475518798532 |pmid=30222058 |s2cid=52280945 |issn=0049-4755|doi-access=free }}</ref> Specificity analysis captures the ability of Pap smears to correctly identify women without cervical cancer. Various studies have revealed the specificity of Pap smears to be between 64.79 - 96.8%.<ref name=":0" /><ref name=":1" /><ref name=":2" /> While Pap smears may not be entirely accurate, they remain one of the most effective cervical cancer prevention tools. Pap smears may be supplemented with HPV DNA testing.{{citation needed|date=October 2022}}

===Results===
In screening a general or low-risk population, most Pap results are normal.

In the United States, about 2–3 million abnormal Pap smear results are found each year.<ref name="emedicine">{{cite web |title=Pap Smear |url=http://www.emedicinehealth.com/pap_smear/article_em.htm |access-date=2008-12-27}}</ref> Most abnormal results are mildly abnormal ([[Bethesda system|ASC-US]] (typically 2–5% of Pap results) or low-grade squamous intraepithelial lesion ([[Bethesda System#LSIL|LSIL]]) (about 2% of results)), indicating HPV infection.{{citation needed|date=January 2009}} Although most low-grade cervical dysplasias spontaneously regress without ever leading to [[cervical cancer]], dysplasia can serve as an indication that increased vigilance is needed.

In a typical scenario, about 0.5% of Pap results are high-grade SIL ([[Bethesda System#HSIL|HSIL]]), and less than 0.5% of results indicate cancer; 0.2 to 0.8% of results indicate Atypical Glandular Cells of Undetermined Significance (AGC-NOS).{{citation needed|date=January 2009}}

As liquid-based preparations (LBPs) become a common medium for testing, atypical result rates have increased. The median rate for all preparations with low-grade squamous intraepithelial lesions using LBPs was 2.9% in 2006, compared with a 2003 median rate of 2.1%. Rates for high-grade squamous intraepithelial lesions (median, 0.5%) and atypical squamous cells have changed little.<ref>{{cite journal |vauthors=Eversole GM, Moriarty AT, Schwartz MR, Clayton AC, Souers R, Fatheree LA, Chmara BA, Tench WD, Henry MR, Wilbur DC |year=2010 |title=Practices of participants in the college of american pathologists interlaboratory comparison program in cervicovaginal cytology, 2006 |url=https://meridian.allenpress.com/aplm/article/134/3/331/460995/Practices-of-Participants-in-the-College-of |journal=Archives of Pathology & Laboratory Medicine |volume=134 |issue=3 |pages=331–5 |doi=10.5858/134.3.331 |pmid=20196659|url-access=subscription }}</ref>

Abnormal results are reported according to the [[Bethesda system]].<ref>{{Cite journal|last1=Nayar|first1=Ritu|last2=Solomon|first2=Diane|date=2004-01-01|title=Second edition of 'The Bethesda System for reporting cervical cytology' - Atlas, website, and Bethesda interobserver reproducibility project|journal=CytoJournal|language=en|volume=1|issue=1|page=4|doi=10.1186/1742-6413-1-4|pmc=526759|pmid=15504231 |doi-access=free }}</ref> They include:<ref name="emedicine" />

* Atypical squamous cells (ASC)
** Atypical squamous cells of undetermined significance (ASC-US)
** Atypical squamous cells&nbsp;– cannot exclude HSIL (ASC-H)
* Squamous intraepithelial lesion (SIL)
** Low-grade squamous intraepithelial lesion (LGSIL or LSIL)
** High-grade squamous intraepithelial lesion (HGSIL or HSIL)
* [[Squamous cell carcinoma]]
* Glandular epithelial cell abnormalities
** Atypical glandular cells not otherwise specified (AGC or AGC-NOS)

Endocervical and endometrial abnormalities can also be detected, as can a number of infectious processes, including [[Candida albicans|yeast]], [[herpes simplex virus]] and [[trichomoniasis]]. However it is not very sensitive at detecting these infections, so absence of detection on a Pap does not mean absence of the infection.<ref>{{Cite journal |last=González Pedraza Avilés |first=A. |last2=Ortiz Zaragoza |first2=C. |last3=Topete Barrera |first3=L. |last4=Mota Vázquez |first4=R. |last5=Ponce Rosas |first5=R. |date=2001-03-15 |title=[Is the Papanicolaou smear useful as aid for diagnosing some sexually transmitted infections?] |url=https://pubmed.ncbi.nlm.nih.gov/11262330 |journal=Atencion Primaria |volume=27 |issue=4 |pages=222–226 |doi=10.1016/S0212-6567(01)78800-2 |issn=0212-6567 |pmc=7684047 |pmid=11262330}}</ref>

<gallery class="center">
Image:Normal PAP (Cervical) Smear.jpg|[[Micrograph]] of a normal pap smear
Image:Low-grade sil and endocx.jpg|[[Micrograph]] of a Pap test showing a low-grade intraepithelial lesion (LSIL) and benign [[endocervix|endocervical]] mucosa. [[Pap stain]].
Image:Trichomonas pap test.jpg|[[Micrograph]] of a Pap test showing [[trichomoniasis]]. Trichomonas organism seen in the upper right. [[Pap stain]].
Image:Herpes simplex virus pap test.jpg|[[Micrograph]] of a Pap test showing changes of [[herpes simplex virus]]. [[Pap stain]].
Image:Adenocarcinoma on pap test 1.jpg|Endocervical [[adenocarcinoma]] on a pap test.
Image:Candida pap 1.jpg|[[Candida (genus)|Candida]] organisms on a pap test.
Image:Herpes_simplex_virus_pap_test.jpg|Viral cytopathic effect consistent with [[herpes simplex virus]] on a pap test.
Image:Pap test normal.jpg|Normal squamous epithelial cells in [[premenopausal]] women
Image:Pap test atropy.JPG|Atrophic squamous cells in [[postmenopausal]] women
Image:Pap test endocervical cells.JPG|Normal [[Canal of the cervix|endocervical cells]] should be present into the slide, as a proof of a good quality sampling
Image:Pap test citolysis.JPG|The cytoplasms of squamous [[Epithelium|epithelial cells]] melted out; many [[Vaginal flora|Döderlein]] bacilli can be seen.
Image:Pap test trichomonas.JPG|Infestation by [[Trichomonas vaginalis]]
Image:Pap test abnormal.JPG|An obviously atypical cell can be seen
</gallery>

===Pregnancy===
Pap tests can usually be performed during pregnancy up to at least 24 weeks of [[Gestational age (obstetrics)|gestational age]].<ref name=victoria>[http://www.papscreen.org.au/forwomen/whoshouldhavepaptests/pregnantwomen PapScreen Victoria > Pregnant women] {{Webarchive|url=https://web.archive.org/web/20140201225635/http://www.papscreen.org.au/forwomen/whoshouldhavepaptests/pregnantwomen |date=2014-02-01 }} from Cancer Council Victoria 2014</ref> Pap tests during pregnancy have not been associated with increased risk of [[miscarriage]].<ref name="victoria" /> An inflammatory component is commonly seen on Pap smears from pregnant women<ref>[http://deepblue.lib.umich.edu/bitstream/handle/2027.42/35304/1_ftp.pdf?sequence=1] {{cite journal |author=Michael CW |year=1999 |title=The Papanicolaou Smear and the Obstetric Patient: A Simple Test with Great Benefits |journal=Diagnostic Cytopathology |volume=21 |issue=1 |pages=1–3 |doi=10.1002/(SICI)1097-0339(199907)21:1<1::AID-DC1>3.0.CO;2-0 |pmid=10405797 |s2cid=1367319 |hdl-access=free |hdl=2027.42/35304}}</ref> and does not appear to be a risk for subsequent [[preterm birth]].<ref>{{cite journal |vauthors=Lanouette JM, Puder KS, Berry SM, Bryant DR, Dombrowski MP | title = Is inflammation on Papanicolaou smear a risk factor for preterm delivery? | journal = Fetal Diagnosis and Therapy | volume = 12 | issue = 4 | pages = 244–247 | year = 1997 | pmid = 9354886 | doi=10.1159/000264477}}</ref>

After childbirth, it is recommended to wait 12 weeks before taking a Pap test because inflammation of the cervix caused by the birth interferes with test interpretation.<ref>{{cite web |url=http://www.papscreen.org.au/forwomen/whoshouldhavepaptests/pregnantwomen |title=Pregnant women |author=<!--Staff writer(s); no by-line.--> |website=papscreen.org |publisher=[[Cancer Council Victoria]] |access-date=2015-01-16 |archive-url=https://web.archive.org/web/20150108193521/http://www.papscreen.org.au/forwomen/whoshouldhavepaptests/pregnantwomen |archive-date=2015-01-08 |url-status=dead }}</ref>

=== In transgender individuals ===
Transgender men are also typically at risk for HPV due to retention of the uterine cervix in the majority of individuals in this subgroup.<ref>{{Cite book |last=Grant |first=Jaime M. |title=National Transgender Discrimination Survey report on health and health care : findings of a study by the National Center for Transgender Equality and the National Gay and Lesbian Task Force |date=2010 |publisher=National Center for Transgender Equality |oclc=707939280}}</ref><ref name=":4">{{Cite web |last= |date=2018-06-27 |title=Should trans men have cervical screening tests? |url=https://www.nhs.uk/common-health-questions/sexual-health/should-trans-men-have-cervical-screening-tests/ |access-date=2023-08-10 |website=[[NHS]] |language=en}}</ref> As such, professional guidelines recommend that transgender men be screened routinely for cervical cancer using methods such as Pap smear, identical to the recommendations for cisgender women.<ref>{{Cite journal |date=December 2011 |title=Committee Opinion No. 512: Health Care for Transgender Individuals |url=https://journals.lww.com/00006250-201112000-00051 |journal=Obstetrics & Gynecology |language=en |volume=118 |issue=6 |pages=1454–1458 |doi=10.1097/AOG.0b013e31823ed1c1 |pmid=22105293 |issn=0029-7844|doi-access=free }}</ref>

However, transgender men have lower rates of cervical cancer screening than cisgender women.<ref>{{Cite journal |last1=Peitzmeier |first1=Sarah M. |last2=Khullar |first2=Karishma |last3=Reisner |first3=Sari L. |last4=Potter |first4=Jennifer |date=December 2014 |title=Pap Test Use Is Lower Among Female-to-Male Patients Than Non-Transgender Women |url=https://linkinghub.elsevier.com/retrieve/pii/S0749379714003985 |journal=American Journal of Preventive Medicine |language=en |volume=47 |issue=6 |pages=808–812 |doi=10.1016/j.amepre.2014.07.031 |pmid=25455121|url-access=subscription }}</ref> Many transgender men report barriers to receiving gender-affirming healthcare,<ref>{{Cite book |last=Grant |first=Jaime M. |title=Injustice at every turn : a report of the National Transgender Discrimination Survey |date=2011 |publisher=National Center for Transgender Equality |oclc=777348181}}</ref><ref>{{Cite journal |last1=Snelgrove |first1=John W |last2=Jasudavisius |first2=Amanda M |last3=Rowe |first3=Bradley W |last4=Head |first4=Evan M |last5=Bauer |first5=Greta R |date=December 2012 |title="Completely out-at-sea" with "two-gender medicine": A qualitative analysis of physician-side barriers to providing healthcare for transgender patients |journal=BMC Health Services Research |language=en |volume=12 |issue=1 |pages=110 |doi=10.1186/1472-6963-12-110 |issn=1472-6963 |pmc=3464167 |pmid=22559234 |doi-access=free }}</ref> including lack of insurance coverage and stigma/discrimination<ref>{{Cite journal |last1=Poteat |first1=Tonia |last2=German |first2=Danielle |last3=Kerrigan |first3=Deanna |date=May 2013 |title=Managing uncertainty: A grounded theory of stigma in transgender health care encounters |url=https://linkinghub.elsevier.com/retrieve/pii/S0277953613001019 |journal=Social Science & Medicine |language=en |volume=84 |pages=22–29 |doi=10.1016/j.socscimed.2013.02.019|pmid=23517700 |s2cid=5339596 |url-access=subscription }}</ref><ref>{{Cite journal |last1=Reisner |first1=Sari L. |last2=Gamarel |first2=Kristi E. |last3=Dunham |first3=Emilia |last4=Hopwood |first4=Ruben |last5=Hwahng |first5=Sel |date=September 2013 |title=Female-to-Male Transmasculine Adult Health: A Mixed-Methods Community-Based Needs Assessment |url=http://journals.sagepub.com/doi/10.1177/1078390313500693 |journal=Journal of the American Psychiatric Nurses Association |language=en |volume=19 |issue=5 |pages=293–303 |doi=10.1177/1078390313500693 |pmid=23963876 |s2cid=3285779 |issn=1078-3903|url-access=subscription }}</ref> during clinical encounters, and may encounter provider misconceptions regarding risk in this population for cervical cancer. Pap smears may be presented to patients as non-gendered screening procedures for cancer rather than one specific for examination of the female reproductive organs. Pap smears may trigger gender dysphoria in patients and gender-neutral language can be used when explaining the pathogenesis of cancer due to infection, emphasizing the pervasiveness of HPV infection regardless of gender.<ref>{{Cite journal |last1=Potter |first1=Jennifer |last2=Peitzmeier |first2=Sarah M. |last3=Bernstein |first3=Ida |last4=Reisner |first4=Sari L. |last5=Alizaga |first5=Natalie M. |last6=Agénor |first6=Madina |last7=Pardee |first7=Dana J. |date=2015-07-10 |title=Cervical Cancer Screening for Patients on the Female-to-Male Spectrum: a Narrative Review and Guide for Clinicians |journal=Journal of General Internal Medicine |volume=30 |issue=12 |pages=1857–1864 |doi=10.1007/s11606-015-3462-8 |pmid=26160483 |pmc=4636588 |issn=0884-8734}}</ref>

Transgender women who have not had [[Vaginoplasty|vaginoplasties]] are not at risk of developing cervical cancer because they do not have cervices. Transgender women who have had vaginoplasties and have a neo-cervix or neo-vagina have a small chance of developing cancer, according to the Canadian Cancer Society.<ref>{{Cite web |title=As a trans woman, do I need to get screened for cervical cancer |url=https://cancer.ca/en/cancer-information/find-cancer-early/screening-in-lgbtq-communities/as-a-trans-woman-do-i-need-to-get-screened-for-cervical-cancer |publisher=Canadian Cancer Society}}</ref> Surgeons typically use penile skin to create the new vagina and cervix, which can contract HPV and lead to [[penile cancer]], although it is considerably rarer than cervical cancer.<ref name=":5">{{Cite web |date=2019-10-10 |title=I'm trans or non-binary, does this affect my cancer screening? |url=https://www.cancerresearchuk.org/about-cancer/cancer-symptoms/spot-cancer-early/screening/trans-and-non-binary-cancer-screening |access-date=2023-08-10 |website=Cancer Research UK |language=en}}</ref> Because the risk of this kind of cancer is so low, cervical cancer screening is not routinely offered for those with a neo-cervix.<ref>{{Cite web |date=2020-09-04 |title=Cervical screening for trans men and/or non-binary people |url=https://www.jostrust.org.uk/information/cervical-screening/trans-non-binary |access-date=2023-08-10 |website=Jo's Cervical Cancer Trust |language=en |author1=Anonymous }}</ref><ref name=":4" /><ref>{{Cite web |date=2023-03-17 |title=Tweet misleads on cervical cancer guidance for trans women |url=https://apnews.com/article/fact-check-cervical-cancer-trans-testing-249098855574 |access-date=2023-08-10 |website=AP News |language=en}}</ref><ref name=":5" />