Talk:Pap test

Editors should be aware that the user Drsavard who proposed these changes does consulting work for QIAGEN pharmaceutical company, which is the owner of Digene, maker of the HPV test. Therefore they have a potential WP:COI regarding HPV testing. Zodon (talk) 05:59, 11 May 2008 (UTC)

I am a medical doctor specializing in internal medicine. I thought the Human Papilloma Virus Testing section would benefit from adding a visual. Thus, I propose that the following graphic be adding to the above mentioned section:

The original graphic can be found on http://www.thehpvtest.com/under-30/HPV-test-the-pap-HPV-faq.html. I have permission to repost this image on Wikipedia.

I would also like to propose the following edits:

Existing Text
By adding the more sensitive HPV Test, the specificity may decline. However, the drop in specificity is not definite.

Updated Text
By adding the more sensitive HPV test, the specificity may decline. However, the drop in specificity is not significant.^[1]

Existing Text
Regarding the role of HPV testing, randomized controlled trials have compared HPV to colposcopy. HPV testing appears as sensitive as immediate colposcopy while reducing the number of colposcopies needed.[10] Randomized controlled trial have suggested that HPV testing could follow abnormal cytology[4] or could precede cervical cytology examination.[6] We recommend that we delete this sentence. It is mentioned in one study from the American Journal of Obstetrics and Gynecology, but it’s not relevant. The study looked at how to manage ASC-US patients.

Updated Text
Regarding the role of HPV testing, randomized, controlled trials have shown that the HPV test is significantly more sensitive than cytology^[2][3]and it is FDA-approved for use along with the Pap for routine screening of women 30 and over, or as a follow-up evaluation of women of all ages with inconclusive cytology results.

Existing Text
The potentially pre-cancerous changes (called dysplasias or cervical or endocervical intraepithelial neoplasia) are usually caused by sexually transmitted human papillomaviruses (HPVs). The test aims to detect and prevent the progression of HPV-induced cervical cancer and other abnormalities in the female genital tract by sampling cells from the outer opening of the cervix (Latin for "neck") of the uterus and the endocervix.

Updated Text
The pre-cancerous changes (called dysplasias or cervical or endocervical intraepithelial neoplasia) are almost exclusively caused by sexually transmitted human papillomaviruses (HPVs).^[4] The test aims to detect the appearance or progression of cervical cancer or pre-cancerous lesions by sampling cells from the outer opening of the cervix (Latin for "neck") of the uterus and the endocervix.

Existing Text:
It is generally recommended that sexually active females seek regular Pap smear testing. Guidelines on frequency vary, from annually to every five years. If results are abnormal, and depending on the nature of the abnormality, the test may need to be repeated in three to twelve months. If the abnormality requires closer scrutiny, the patient may be referred for detailed inspection of the cervix by colposcopy. The patient may also be referred for HPV DNA testing, which can serve as an adjunct to Pap testing.

Updated Text
In the United States, medical guidelines generally recommend that females begin getting an annual Pap smear three years after they first become sexually active or at the age of 21, whichever comes first. Practices differ in other countries, but are generally similar. If a Pap result is inconclusive or appears abnormal, an HPV DNA test (which looks for the presence of the virus that is the primary cause of cervical cancer) can determine whether further examination is needed. If an HPV DNA test is done automatically at the same time as the Pap – a practice that is approved in the United States when women turn 30 – annual testing is not necessary. If both the Pap and HPV test are normal, the current guidelines say re-testing is needed only once every three years.^[5] Research conducted in Europe and elsewhere, however, suggests that re-testing could be delayed even further – to five or six years – since the HPV DNA test is so sensitive in identifying women at risk.^[6]

Existing Text
In the United States, physicians who fail to diagnose cervical cancer from a pap smear have been convicted of negligent homicide. In 1988 and 1989, Karen Smith had received pap smears which were argued to have "unequivocally" shown that she had cancer; yet the lab had not made the diagnosis. She died on March 8, 1995. Later, a physician and a laboratory technician were convicted of negligent homicide. These events have led to even more rigorous quality assurance programs, and to emphasizing that this is a screening, not a diagnostic, test, associated with a small irreducible error rate.

Updated Text
A report in the International Journal of Cancer found that about one-third of cervical cancers occurred in women whose last Pap smears had appeared normal.^[7] In the United States, physicians who fail to diagnose cervical cancer from a pap smear have been convicted of negligent homicide. In 1988 and 1989, Karen Smith had received pap smears which were argued to have "unequivocally" shown that she had cancer; yet the lab had not made the diagnosis. She died on March 8, 1995. Later, a physician and a laboratory technician were convicted of negligent homicide. These events have led to even more rigorous quality assurance programs, and to emphasizing that this is a screening, not a diagnostic, test, associated with a small irreducible error rate. This concern about missing pre-cancerous cells and cancer has also been one of the driving forces behind increased adoption of HPV DNA testing along with the Pap for older women.

Existing Text
Studies of the accuracy of HPV testing report:
• sensitivity 88% to 91% (for detecting CIN 3 or higher)[4] to 97% (for detecting CIN2+)[6]
• specificity 73% to 79% (for detecting CIN 3 or higher)[4] to 93% (for detecting CIN 3 or higher)[6]

Updated Text
Studies of the accuracy of HPV testing report:
• sensitivity94.2% to 97.4% (for detecting CIN2+) to 97.6% (for detecting CIN3+)^[8]
• specificity 92.9% to 93.6% (for detecting CIN2+)^[9]

I would also like to recommend that we delete the following paragraph entirely:
A study published in April 2007 suggested the act of performing a Pap smear produces an inflammatory cytokine response, which may initiate immunologic clearance of HPV, therefore reducing the risk of cervical cancer. Women who had even a single Pap smear in their history had a lower incidence of cancer. "A statistically significant decline in the HPV positivity rate correlated with the lifetime number of Pap smears received.

If no one protests, I'd like to make these changes within the next 48 hours.

Drsavard (talk) 15:51, 14 March 2008 (UTC)

The graphic is misleading and it isn't clear that it will help clarify the connection between HPV and cervical cancer. The vertical scale is quite misleading, it seems to suggest that cervical cancer has a comparable incidence to that of HPV. (Rather than HPV being very common, and cervical CA rare.) Also, the apparent complementary shapes of the graphs might confuse. Since it takes years for cervical CA to develop after HPV infection, not clear that this is good way to illustrate. Don't think it is a particularly helpful illustration here. (If vertical scales were fixed (both per 100,000) it might be better (and yes, I realize that the CA part might be invisible at that scale.)) Also, it should be noted that this graphic comes from the web site of the maker of the HPV test.

On the suggested edits to "Regarding the role of HPV testing..." Oppose changes. The "Updated text" is less specific. Certainly the coverage of HPV testing could be improved, but should move toward what has actually been demonstrated, not to vaguer statements. (It has been demonstrated to be useful for follow-up of abnormal cytology.) It has not been demonstrated to be more effective or more cost effective in screening, either as primary screening, or in combination with Pap smears.

Saying that it is more sensitive is not helpful in that don't specify sensitive for what (for HPV, for high grade disease, for low grade, etc.) Also, in screening, specificity is more important than sensitivity, so saying something more sensitive without caveats may mislead. (Many people don't understand importance of specificity in screening.) So think should retain the references and information there, and add to it, rather than overwriting it with vaguer statements.

On the suggested edits to "The potentially pre-cancerous" - seem okay, except should keep the word "potentially" (both initially and in the last sentence). Most CIN regresses without treatment, so only some of it is pre-cancerous.

On changes to "It is generally ..." Oppose. Proposed changes moving away from international view and away from NPOV. Annual screening is not typical of other countries. 3-5 year screening period much more typical, US is atypical. HPV test is only one option for follow-up of abnormal, Close-followup with Pap smears and colposcopy are others (depending on severity).

Annual testing is not necessary, regardless of whether an HPV test was collected. As noted above, annual testing is not the norm in most countries. Also, screening guidelines such as USPSTF (evidence based medicine) recommend Pap screening every 3 years. The USPSTF found no direct evidence that annual screening achieves better outcomes than screening every 3 years. (US Preventive Services Task Force (USPSTF), Guide to Clinical Preventive Services, Williams & Wilkins, Baltimore, MD, 1996 and Guide to Clinical Preventive Services 2006, USDHS, AHRQ Publication number 06-0588. http://odphp.osophs.dhhs.gov/pubs/guidecps/ http://www.ahrq.gov/clinic/uspstfix.htm)

Likewise, "ACS and others have recommended, since before 1980, that conventional cytology can be safely performed up to every three years for most women." (Smith, RA; et al.; American Cancer Society Guideline for the Early Detection of Cervical Neoplasia and Cancer, CA Cancer J Clin 52(1):8–22, 2002.)

No problem with more detail covering the ACS, etc. guidelines (been meaning to do that) - but need to use care to give equal weight to other major POVs. And especially to maintain NPOV with regard to HPV testing, since it is new and relatively unproven and there is considerable variation in opinion about its value.

On change starting "In the United States ..." - it appears that primarily added the first and last sentences. First one seems okay (though not immediately clear that it should be in that location). The last one should have a citation, and would be better in the section on HPV testing. (While HPV testing may be prompted by paranoia, it is not the only such measure, so should not overshadow the rest. The concluding sentence of that paragraph is better as it is.)

Oppose changing the sensitivity and specificity numbers, unless they are mis-quoted from Kulasingam. If you have other numbers want to add (with citations) - fine. If there are problems with some of studies/etc. need to be discussed, not just overwrite with a particular POV.

On paragraph "A study published in April 2007" deletion - why delete? No case is presented of why it is wrong/harmful/etc. Is it not supported by the citation? Is it a POV? Why?

Hope this helps. Zodon (talk) 03:27, 15 March 2008 (UTC)

You have a lot of comments, so let me try to respond one by one:

• I do not feel strongly about the graph, so I’ll remove it.
• As mentioned in my other edits, there is a wealth of data that supports the use of HPV testing for routine screening of women 30+. See my full comments on page [insert link].
• I have made clear in the revised edits below that in reference to the HPV test, sensitivity refers to CIN 3 and cancer (since I agree that sometimes CIN 2 is treated with “watch and wait.”) Note, though, that to be consistent, the sensitivity/specificity ranges cited for conventional and liquid-based cytology should have similar detail. Since most studies for cytology cite results for CIN 2+, I have updated the copy to include this parameter, as well as to include the most recent data. Likewise, for HPV testing, we can retain the lower end of the sensitivity/specificity ranges, but since the preponderance of recent data is now at the upper end, I have reflected that in my edits.

In addition: I have to disagree on one significant point. I consider sensitivity to be of equal importance to specificity. I – and my patients – would prefer to be told that they might be at risk, and then find out later they are fine, than to be surprised later with a diagnosis of invasive cancer. Most of the experts who speak at conferences on this topic agree. (Sensitivity is particularly important in low-resource countries, where frequent medical visits by women are not practical and a broader definition of “at-risk” is needed.)

• I agree that annual screening is not the norm ex-U.S. and have reflected that in my revised edits. However, although you are right that there are other methods for following up on ASC-US Paps, and I acknowledge that in my revised edits, all of the experts at the various conferences I attend – as well as the literature -- regard triage with HPV testing to be the gold standard.
• Finally, we can retain the reference to the April publication you mention, but then I would move it to the end of the conventional Pap section.

Thus, see my revised edited copy below:

However, it is not a perfect test. "A nurse performing 200 tests each year would prevent a death once in 38 years. During this time she or he would care for over 152 women with abnormal results, over 79 women would be referred for investigation, over 53 would have abnormal biopsy results, and over 17 would have persisting abnormalities for more than two years. At least one woman during the 38 years would die from cervical cancer despite being screened."[2] In addition, 2005 study published in the Journal of the National Cancer Institute found that 32% of invasive cervical cancers were due to Pap detection failure. Testing for HPV along with the Pap for women over 30, as well as the HPV vaccine, may offer better prospects in the long term.

•••

By adding the more sensitive HPV test, the specificity (correlation with actual disease) may decline. However, the drop in specificity is not significant.7

•••

Randomized, controlled trials have shown that the HPV test is significantly more sensitive in identifying women with cervical disease (CIN 2, 3 or cancer) than cytologyError! It is FDA-approved for use along with the Pap for routine screening of women 30 and over, or as a follow-up evaluation of women of all ages with inconclusive cytology results.

•••

Abnormal cell changes (called dysplasia or cervical/endocervical intraepithelial neoplasia) are almost exclusively caused by sexually transmitted human papillomaviruses (HPV). The Pap is designed to detect the existence of cervical cancer or potentially pre-cancerous lesions by sampling cells from the outer opening of the cervix (Latin for "neck") of the uterus and the endocervix.

•••

In the United States, medical guidelines generally recommend that females begin getting an annual Pap smear three years after they first become sexually active or at the age of 21, whichever comes first. Practices differ in other countries, with routine Pap testing often recommended every three to five years. If a Pap result is inconclusive or appears abnormal, further evaluation is needed with repeat cytology or – as many experts now recommend -- an HPV DNA test (which looks for the presence of the virus that is the primary cause of cervical cancer). Whatever method is used for follow-up evaluation – repeat cytology or HPV DNA testing – a colposcopy exam is normally performed if results are abnormal.

The HPV DNA test also is approved in the United States for routine screening of women over 30, when they are most at risk of developing cervical cancer, along with a Pap. If both the Pap and HPV test results are normal, U.S. guidelines recommend re-testing once every three years. Research conducted in Europe and elsewhere, however, suggests that re-testing could be delayed even further – to five or six years – since the HPV DNA test is so sensitive in identifying women at risk.

•••

A report in the International Journal of Cancer found that about one-third of cervical cancers occurred in women whose last Pap smears had appeared normal. In the United States, physicians who fail to diagnose cervical cancer from a Pap smear have been convicted of negligent homicide. In 1988 and 1989, Karen Smith had received Pap smears which were argued to have "unequivocally" shown that she had cancer; however, the lab had not made the diagnosis. She died on March 8, 1995. Later, a physician and a laboratory technician were convicted of negligent homicide. These events have led to even more rigorous quality assurance programs, and to emphasizing that this is a screening, not a diagnostic test, associated with a small irreducible error rate. This concern about missing pre-cancerous cells and cancer has also been one of the driving forces behind increased adoption of HPV DNA testing in addition to cytology for older women.

A study published in April 2007 suggested the act of performing a Pap smear produces an inflammatory cytokine response, which may initiate immunologic clearance of HPV, therefore reducing the risk of cervical cancer. Women who had even a single Pap smear in their history had a lower incidence of cancer. "A statistically significant decline in the HPV positivity rate correlated with the lifetime number of Pap smears received. [Moved up from the HPV testing section.]

•••

Studies of the accuracy of conventional cytology report:

• sensitivity (for detecting CIN 2, or moderate dysplasia, or greater): from 50% , to 72%.[4]
• specificity (for CIN 2 or greater): from 71% to 97%.7

Studies of the accuracy of liquid-based cytology report:

• sensitivity (for detecting CIN 2, or moderate dysplasia, or greater): from 61%[6] to 85%. , ,
• specificity (for CIN 2 or greater): from 64%20 to 97%.21

Studies of the accuracy of HPV testing report:

• sensitivity (for detecting CIN 3, or pre-cancerous dysplasia, or higher): as low as 88%, [4] but most studies have found higher rates, ranging from 93% to 100%. , , , ,
• specificity (for detecting CIN 3 or higher): 73% to 93% [4] ,

71.224.215.219 (talk) 20:08, 28 April 2008 (UTC)

EDIT WARNING Various problematic markup revised and reflist-talk dropped below. — MaxEnt 21:18, 18 May 2020 (UTC)

In Technical aspects section there's the following story:

I have added {{citation needed}} mark. But the bigger question remains. Did it really happen? I tried searching for it on Google, but the only Karen Smith that is somewhat related to Pap test or cervical cancer is a currently living doctor gynaecologist...

Should we just delete this story from the article?

--Alsh 14:28, 6 April 2008 (UTC)

The recent edit stating that cervical CA was a leading cause of death of women before the Pap test seems questionable/possible overstatement. From the cervical cancer article: "Worldwide, cervical cancer is the fifth most deadly cancer in women." (World Health Organization (February 2006). "Fact sheet No. 297: Cancer". Retrieved on 2007-12-01.) While this includes many places that have Pap smear screening programs, it still includes many that don't. Given the improvements in sanitation, maternal health care and prevention of communicable diseases (which have significantly reduced other causes of death in women) it seems unlikely that cervical CA was a leading cause of death. (Perhaps some qualifier was dropped, e.g. cancer death?).

The statement that "Since the introduction of the Pap test, deaths caused by carcinoma of the cervix have been reduced by up to 99% in some populations where women are screened regularly." Also seems problematic. Not that it isn't true, but perhaps it overplays the effectiveness of Pap screening. Adding some perspective might help (e.g. typical improvement attributed to Pap screening, or range, what populations showed most improvement, etc.) Not saying that Pap smear isn't highly effective, but 99% seems higher than the statistics I remember seeing. (Have to go check my notes.) Zodon (talk) 10:00, 3 January 2009 (UTC)

The "99% reduction" figure seems very hard to believe based on the detailed info provided about the effectiveness of the UK program. If only 50% of cervical cancers are detected in the UK THROUGH screening, it doesn't seem very likely that screening in other places was so effective that it reduced the number of deaths by 99%. —Preceding unsigned comment added by 74.38.254.45 (talk) 17:01, 20 March 2010 (UTC)

Would a Pap Smear be affected if a woman just gave birth? Would a Post-Partum Pap Smear be confused from a woman's sudden change of body chemistry due to birth? Or hormones? —Preceding unsigned comment added by 65.104.237.178 (talk) 20:04, 6 February 2009 (UTC)

It could be affected. Repair/changes in the cervical cells more likely to cause problems than body chemistry, etc. Pap smear should be at least 8 weeks Post-partum. (Think reference for this is Koss page 368, but have to check that) Zodon (talk) 22:11, 6 February 2009 (UTC)

I totally disagree that Babes was the first to describe the vaginal smear test as we know it from Papanicolaou. If you compare the two techniques, one can see that they are totally different in their design and concept. —Preceding unsigned comment added by 195.134.113.33 (talk • contribs)

I have removed your edit partly because of non-encyclopedic language, and partly because it doesn't have a citation. Please provide a citation to a WP:MEDRS and then we can work it in to the article. Thanks. Zodon (talk) 21:22, 12 March 2009 (UTC)

http://data.un.org/Data.aspx?d=WHO&f=inID%3aHSC15 Will maybe generate a map.Doc James (talk · contribs · email) 17:58, 13 November 2009 (UTC)

can trichomonas be found in a pap test —Preceding unsigned comment added by 173.75.177.74 (talk) 18:33, 6 January 2010 (UTC)

Yes it can. In fact, pap smears are good for a lot of things, like herpes and yeast infection. As the page is written now, it makes it look like pap smears are used almost exclusively to diagnose HPV or cervical cancer, which isn't true. The EMedicine pages have some good stuff if anyone has spare time. —Preceding unsigned comment added by Pathogenesis (talk • contribs) 02:42, 9 May 2010 (UTC)

Saying it is good for them is a bit of an overstatement. It can find various other conditions, but in many cases it isn't as good at detecting them as other tests. Zodon (talk) 05:38, 13 September 2010 (UTC)

I think it's a bit misleading to have content on liquid based cytology and HPV testing in a page titled "Pap test", because they are all different tests which are used for cervical screening. I'd propose a separate page on "cervical screening" which contains general information on cervical screening and the different types of test, which links through to this page. Jah998 (talk) 13:42, 28 March 2011 (UTC)

I have moved the sections on types of screening and HPV tests to cervical screening as it contains information on other types of cervical screening test than the Pap test. Jah998 (talk) 14:37, 28 March 2011 (UTC)

I oppose the split. In particular splitting liquid based (LB) Paps onto a separate page doesn't make sense. LB versus conventional Paps are just different procedures for preparing the slide. The collection is the same, the reading is done in the same way, it is just a matter of different handling of the samples in between. (Which also has different results for effectiveness as a screening test.) Eventually there might be enough material to warrant separate coverage of LB, but currently LB is hardly explained at all.

The coverage of cervicography and HPV testing could probably better be handled by splitting out separate articles on those topics, keeping a summary in the main article. But there should be just one main article, and it should remain Pap test. Zodon (talk) 09:11, 12 August 2011 (UTC)

I disagree. 'Pap test' is a very US-focused term. For example, in the UK, it's called a 'smear test', or just 'cervical screening'. I think it makes more sense to have an overall page on 'cervical screening' that discusses all the different methodologies, then links through to other pages where necessary. Thoughts? HenryScow (talk) 12:08, 19 October 2011 (UTC)

The name of the article is not important, per WP:Name. Other common names for the test should be redirects to whichever name the article resides under. (So if it is called a smear test or whatever - those should just be redirects to Pap smear.)

As far as the methods listed - liquid based cytology is still a Pap smear (it is just a different collection method, but it is still prepared into a slide just as with the conventional Pap). There is not enough material here to warrant a separate article on liquid based. Putting it in a separate article gives the false impression that it is a different test.

The material about "Testing in resource-poor areas" and "Other options" is just research into possible ways of using HPV testing. At best it would be under research (doesn't warrant much coverage until it becomes real).

Likewise "Visual inspection to detect pre-cancer or cancer" is something that has been tried, and so far hasn't panned out. (There have been numerous tests, such as cervicography, etc. which have been tried.)

HPV testing is so far approved as an adjunct to Pap smear screening (e.g. for triage of abnormal results). There are trials (some noted above) considering the possibility of using it for primary screening. It could make sense at some point to create an article about HPV testing. But so far all of the other methods are essentially variants of Pap smear, HPV testing or Colposcopy. Creating an article about cervical screening just means an extra article to maintain. Zodon (talk) 05:24, 15 March 2012 (UTC)

Pretty sure most women don't contract HPV at all (at least, not yet). Sounds like something you'd hear Senator John Kyl say at a pro-abstinence-only-education-bill signing party (as a non-factual statement). 184.18.13.121 (talk) 15:46, 15 April 2011 (UTC)

I'm pretty sure the meaning of the statement was more accurately, "Most women who contract HPV, do so soon after becoming sexually attractive (in their 20's)." But I removed it because it was poorly written. ~Ttony21^{(talk, contribs)} 02:26, 11 August 2011 (UTC)

Most women do contract HPV (HPV is the most widely spread STI, e.g. more than 80% of US women, with similar levels in other parts of the world, as evidenced by cervical cancer incidence). (See Human_papillomaviruses#Epidemiology)

So the sentence means exactly what it said. Most women do contract HPV, and most of them do so soon after becoming sexually active.

So I restored the sentence. I thought it had the benefit of being brief, but if you think it is too concise for clarity we can try to improve it. Zodon (talk) 08:57, 12 August 2011 (UTC)

The specific claim that (1) "most women contract it" and (2) "most who do contract it do so soon after becoming sexually active" implies (3) "most women contract it soon after becoming sexually active", is fallacious; for example, say 80% contract it, and 60% of those contract it soon after becoming sexually active -- then (1) and (2) are both satisfied, but (3) is not -- that would only be 60% of 80% = 48% of the total population. However, it is obviously possible to satisfy all three, but the data -- even in in the article linked to justify the claim -- doesn't seem to back it up. There is data that supports (1) (so my initial gut feeling that most women don't contract it was flat out wrong), but I don't see any that supports (2)...from the article: "Estimates of HPV prevalence vary from 14% to more than 90%" -- and most of them seem to be on the lower end. It seems the only way to get over 50% is is to look at the proportion who get it at least once in their lifetime.

In any case, since I'm not a doctor or an epidemiologist, I'm not going to remove the sentence...but in hopes of attracting someone more credible and knowledgeable than me to take a look at it, I am going to make the claim explicit -- the sentence will be changed to "More than three quarters of all women will contract HPV at some point in their lives, and more than half of all women will contract it soon after becoming sexually active." That way, no one can look at it and think "Oh, they must mean 'most women who DO contract it contract it shortly after becoming sexually active'", which is how I interpreted it as well...the only reason I said anything was because I thought it was a humorous / unfortunate choice of words. 184.18.13.121 (talk) 20:12, 10 September 2011 (UTC)

The assertion that most women contract HPV shortly after after starting having sex is not based on reasoning from 1) and 2). The discussion above was pointing out that 1) and 2) and 3) are all verifiable, not reasoning from 1 and 2 to derive 3.

I reverted the change to the wording of the section because it was not supported by the reference given, and it made the paragraph less clear by introducing material that was not directly relevant. The point is that those who recently started sex are at low risk of cancer, but highly likely to show changes due to initial HPV infection, so they should not be screened. In this context the only relevant claim is 2 "most who do contract it do so soon after becoming sexually active."

As indicated by the dead link flag, the source has changed. this edit fixed the dead link However the source no longer supports this item.

In looking back through the wayback archive for the page in question I have not yet found the version that did support the item. As such I have added a note indicating that additional/fresh citation would be helpful. Zodon (talk) 22:51, 10 September 2011 (UTC)

I have made an additional suggested change to the sentence in question, changing it from "Most women contract HPV soon after becoming sexually active" to "Most women who contract HPV do so soon after becoming sexually active." (Basically another phrasing of 2 above.) In this context this is the important observation. I hope that clarifies the matter.

Sorry if my edits were confusing or appeared to not acknowledge the discussion here, we were evidently both editing at once. I was in the middle of composing this response and it took longer than I expected. Zodon (talk) 23:06, 10 September 2011 (UTC)

There is a lot on the Internet about women finding smear tests very painful It is totally unnecessary for there to be any pain or discomfort at all. Women need to ask the nurse to use what is called a "virginal spectrum" which is half the size of the normal spectrum but still large enough for the nurse to see your cervix. They can also put some numbing cream in your vagina beforehand. — Preceding unsigned comment added by 86.161.16.236 (talk • contribs)

There is no such thing as a "virginal speculum" (or 'virginal spectrum' for that matter) There are different sizes and shapes of specula which can be chosen depending on anatomical differences, but there is not one designated specifically for women who have never had intercourse. Pain and discomfort are to different things. A pelvic examination will often be uncomfortable, but should not be frankly painful. If the exam is painful, then it could indicate that the person has a pathology that needs evaluation. "Numbing cream" should not be needed for an examination. Part of the examination is determining if there are areas that are painful. It is important to note that to allow them to be evaluated, and any numbing of the area would hinder this. If you experience pain or discomfort, discuss this with your healthcare provider. D.c.camero (talk) 16:41, 11 June 2018 (UTC)

I think searching for 'vaginal examination' should not direct here. Pelvic examination should be improved to cover internal vaginal exams during labour. — Preceding unsigned comment added by Sarahjeantaylor (talk • contribs)

I agree, vaginal examination and pap smear are not synonymous. A pap smear can be done during a vaginal exam, but that is where the connection ends. In fact, most vaginal exams do not include pap smear as pap smear is a specific test to screen for cervical dysplasia/cancer. D.c.camero (talk)

Cyberfreeworld (talk) 18:51, 23 March 2013 (UTC) Would like to see a section that shows more about the actual practice of this test. After research when did FDA (for example) approve this. When did medical providers actually begin using this test. Were there any objections or attempts to prohibit use of Pap tests (smear). Was there any controversy about its effectiveness in the early days? This should be under History.

The Papanicolaou test is a method of cervical screening used to detect potentially precancerous and cancerous processes ... The test was independently invented in the 1920s by Dr. Georgios Papanikolaou and Dr. Aurel Babeș and named after Papanikolaou.

Named after: You had one job. Care to explain yourself, or mum's the word?

A possible solution is to create a redirect from Georgios Papanicolaou (no such page as of today) to Georgios Papanikolaou and then standardize on the 'c' spelling within this article. — MaxEnt 21:06, 18 May 2020 (UTC)

On a moment's further thought, if I were moved to rectify this small inconsistency, I'd probably link "Georgios Papanicolaou" in the first instance (either through the proposed redirect, or by textual override to the existing link title) and then gloss this first instance with "(also spelled Papanikolaou)". And then standardize on the 'c' spelling for the rest of the voyage. — MaxEnt 21:11, 18 May 2020 (UTC)

This article was the subject of a Wiki Education Foundation-supported course assignment, between 8 August 2022 and 20 September 2022. Further details are available on the course page. Student editor(s): Christophermlee, Seyvonneip, Sophiakalei (article contribs). Peer reviewers: Yslee22, Zetinoy, Ymesfin.

The addition of sensitivity and specificity of pap smears was well written and easy to understand. I thought the gender-affirming care section was written with an objective lens and contained several clinical pearls! I appreciated the elaboration of the light microscopy technique but the following sentence doesn't add much to the section: "Screening with light microscopy is first done on low (10x) power and then switched to higher (40x) power upon viewing suspicious findings." Great job! Zetinoy (talk) 07:06, 17 September 2022 (UTC)

— Assignment last updated by Zetinoy (talk) 06:37, 17 September 2022 (UTC)

The article covers a broad range of topics falling under the umbrella of Pap smear. The photos of smear samples with descriptions below are helpful. The addition of gender-affirming care section is inclusive of people who may not identify as cis-gender women. The incorporation of statistics to corroborate effectiveness bolsters the informative nature of the article. The procedure section seem a bit jargon-heavy, so maybe reducing the amount of technical terms (or at least following up the use of technical terms with a brief explanation in few words) may be helpful. Lastly, it is uncertain how much value/benefit the "Experimental Techniques" section adds to the article, but overall a great update and revision of the previous article. Yslee22 (talk) 17:37, 16 September 2022 (UTC)

The introduction to the page offers great insights and an overview of the subject matter without being too overbearing to the reader. Your team did a great job of balancing just how much information to provide in the introduction to keep readers fully informed. In doing so, it also creates a nice segue into the more detail-heavy sections later in the article. All the major details are also substantiated by articles, and so the References sections is very extensive, offering lots of outside sources for readers to reference. Ymesfin (talk) 01:26, 17 September 2022 (UTC)