PAP smear examination

Cervical abnormalities are abnormalities of the cervix. This includes cervical cancer. To detect this early, we have the population screening. Such an examination takes place periodically (once every five years at the population screening), in women between 30 and 60 years old. Every year, 1,200 women are diagnosed with cervical cancer or an early form of it. Cervical cancer or cervical carcinoma is the third most common cancer in women.

During the examination, a smear (collection of cells) is taken from the cervix. The cells obtained are forwarded to the cytology laboratory and examined closely under magnification.

On the Dutch version of this page you will find an information video from the RIVM about taking a smear (cytological examination). At the Women's Healthcare Center, the smear is made by the gynecologist.


Types of cervical abnormalities / cervical abnormalities

The cells obtained when the smear is taken is placed under the microscope after processing and evaluated based on PAP classification. PAP stands for Papanicolaou, the gynecologist, who invented this method. The PAP classification consists of 5 stages. When the smear is completely normal, it is given a classification 1. At PAP 2, there is minimal abnormality, and the examination should be repeated after 6 months. From PAP 3, it is important that extra attention and, if necessary, more extensive examination is done. What examination should be done is determined by the gynecologist together with the pathologist anatomist. Of course, the findings are first discussed in detail with the woman, then an explanation of the necessary examinations is given.

An abnormal smear is in most cases a case of infection with HPV (Human Papilloma Virus). Determination of the presence of HPV virus in the cervix is therefore very important.

Symptoms in cervical abnormalities (cervical abnormalities):

  • In the early stages of cervical abnormalities, you will have few or no symptoms. Initial indications may include;
  • Changed menstrual pattern;
  • Abnormal vaginal discharge (bloody and/or smelly);
  • Blood loss during and/or after intercourse (contact bleeding).

In advanced stages, the above symptoms may become more severe.


In case of an abnormal smear, the gynecologist will perform a colposcopy. During this examination, a type of microscope is used to get a clear view of the cervix. Abnormalities and/or irregularities of the cervix can be enlarged and more clearly visualized.

If necessary, a biopsy is taken during this procedure. In a biopsy, a small amount of tissue is taken and examined by a pathologist for the presence of abnormal cells.

If colposcopy and biopsy reveal the presence of abnormal cells, treatment options are discussed in detail with the woman. Depending on the findings, the advice may vary from waiting and repeating the smear after a while to lisexcision.

During a lisexcision, the gynecologist removes a layer of the uterus as in the place where the abnormal cells were found. This is done with a small thin metal lis that is heated electrically. After the abnormal cells are removed, new, healthy cells develop at the site within a short time. Lisexcision is usually done under local anesthesia.

After lisexcision, the smear is repeated for control after six months, one year and two years. After that, if the results are good, you can simply return to the population study. In more than 90% of cases, the smear turns out to be normal again after treatment: PAP 1.

Women's Healthcare Center Amsterdam

Would you like to know more about cervical abnormalities, their treatment or do you have any questions? Women's Healthcare Center in Amsterdam is happy to help. We are an independent treatment center (ZBC) for gynecology, urology and radiology. You can reach us at 020 64 20 229 or use our contact form.