Age 25 – Pap Smear

These are two photos taken during a Papanicolau test (pap smear) done on a 25 year old woman 6 weeks postpartum.  A pap smear can detect potentially pre-cancerous changes (called cervical intraepithelial neoplasia (CIN) or cervical dysplasia), which are usually caused by sexually transmitted human papillomaviruses (HPVs). The test may also detect infections and abnormalities in the endocervix and endometrium.

In the top photo, you can see the metal speculum used to open this woman’s vagina and the wooden Aylesbury spatula used to collect a sample of the cells from the endocervix.  The spatula gently scrapes the area around the os in a circular motion to gather cells.  

The reddish area is called the “zone of transformation”  or squamocolumnar junction where the cervical tissue changes from one type of cell to another.  Though it may look inflamed, this is a normal appearance for some women.  This is the area from which the health care practitioner will obtain the sample for the pap test because it is the site where cell irregularities are most likely to be found.  The zone changes position at various times in one’s cycle, with age, pregnancy, or hormonal contraceptive use, sometimes tucking up into the cervical canal or blossoming outward towards the external os at other times, making it harder or easier to locate for the practitioner. When the zone is more external (as in this picture) some women may experience slight bleeding following a pap test or intercourse, simply because the capillaries are more exposed as well.

The bottom photo is of an endocervical brush being swiped in the os of the cervix.  The cells gathered on the brush and spatula will be wiped/smeared on a glass slide and examined in a laboratory or under a microscope to look for abnormalities.

91 thoughts on “Age 25 – Pap Smear

  1. Why is the opening of the cervix red? Is it from irritation from the scraping and swabbing, or is that what it looks like after someone’s had a child?

    [Reply]

    Chels Reply:

    Jes,

    That is called “cervical ectropion” or “cervical eversion”. What you are seeing is the endocervical epithelium (the layer of cells that makes up the surface of the inside of the cervical os) protruding out to the vaginal portion of the cervix. Think of putting hair up into a sock-bun where you roll everything inside-out; this is like the inside of the bun protruding out a little bit.

    It is a normal variation that is usually associated with higher estrogen levels such as during puberty, during pregnancy, and in women using a combined hormonal contraception. It’s not caused by the scraping/swabbing of the pap smear, and while some women do develop this during pregnancy, not everyone does.

    Cervical ectropion can, however, look like a neoplasm. So it is necessary to get a pap smear to make sure that it’s just normal cervical skin cells and not cancerous or pre-cancerous cell changes.

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    Maggie Reply:

    What you are seeing is the so called “zone of transformation” where the cervical tissue changes from one type of cell to another. This is not inflamed or irritated but a TOTALLY NORMAL appearance and in fact the correct spot where the health care practitioner will obtain the sample for the pap test. Interestingly, the zone changes position (and becomes easier/harder to visualize) at various times in one’s cycle, age etc. tucking up into the cervical canal at times and blossoming outward towards the external os at other times. When the zone is more external (as in this picture) some women may experience slight bleeding following a pap test or intercourse, simply because the capillaries are more exposed as well.

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    Jennifer Reply:

    At 6 weeks post partum many women are still bleeding similar to menstruation.

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    Katrina Reply:

    This appears like it is cervical ectropion/ectopy, a normal variety of cervical tissue where the tissue from inside the cervix is seen on the rim of the os. Can be related to adolescents, pregnancy or estrogen- containing contraceptives. A pap or cervical testing should not cause this redness, however with this cervical presentation, with cervical testing or manipulation of cervix (with penetrating vaginal sex) can cause mild bleeding.

    Cervical abnormalities and references also found in this website too
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3031439/

    I’m a NP student and found this site with searching for cervical abnormalities and treatments, just finished my women’s health clinical, and I think this site is great! Especially the self-awareness and education about our reproductive anatomy! So many women came into the clinic and are so apprehensive about speculums and even birth control (vaginal rings) since this is such an unknown for them! Kuddos to this website and those behind it!

    [Reply]

    e Reply:

    The os is red because that part is the squamocolumnar junction…it is often red, but especially after dilation. Hope that answers!

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  2. Hlw I did a papsmear test today 25th November, Is it normal to feel tired & painful the whole day or is it just me, When does it stop?

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