A Pap smear uses three main tools: a speculum to hold the vaginal walls open, a small brush or spatula to collect cells from the cervix, and either a glass slide or a liquid-filled vial to preserve those cells for lab analysis. The whole process takes only a few minutes, but each tool plays a specific role in getting a reliable sample.
The Speculum
The speculum is the duck-bill-shaped device your provider inserts to gently open the vaginal canal and get a clear view of the cervix. Speculums are made from either stainless steel or plastic. Plastic versions sometimes have a small built-in light to improve visibility. Steel versions are reusable and sterilized between patients, while plastic ones are disposable.
Speculums come in several sizes, from a narrow pediatric size to larger options. Your provider selects the smallest one that still allows a clear view of your cervix. Factors like your age, genetics, and history with vaginal penetration all affect which size fits comfortably. If you’ve had discomfort during past exams, mentioning it beforehand helps your provider choose accordingly.
To reduce friction, providers often warm the speculum with lukewarm water before insertion. Lubricant gels can also be used, but they need to be applied carefully. Certain lubricants contain thickening agents that interfere with the lab processing of cervical samples. When lubricant is necessary, it’s applied only to the outer sides of the speculum blades, away from the tip, so it doesn’t contaminate the cell sample.
Cell Collection Devices
Once the speculum is in place, the provider uses one or more small instruments to gently scrape cells from the surface of the cervix. The target is the transformation zone, a ring-shaped area where two types of cervical tissue meet. This zone is where abnormal cell changes are most likely to develop, so getting a good sample from it is the entire point of the test.
There are three main collection devices:
- Spatula: A flat, paddle-shaped tool used to sweep cells from the outer surface of the cervix. Extended-tip spatulas (with a longer, tapered end) collect significantly more cells from the cervical canal than the traditional rounded Ayre spatula. Spatulas come in both wood and plastic. Both work equally well for conventional smears, but plastic is preferred for liquid-based tests because cells wash off plastic more easily.
- Endocervical brush: A thin, tube-shaped brush (sometimes called a cytobrush) that’s inserted into the narrow opening of the cervical canal and rotated to pick up cells from deeper inside. Using an endocervical brush along with a spatula collects far more cells than a spatula alone, making the combination the most effective sampling method. The American Cancer Society recommends using the spatula first on the outer cervix, then sampling the canal with the brush.
- Cervical broom: A single device with soft bristles arranged to collect cells from both the outer cervix and the canal in one step. It performs comparably to the spatula-and-brush combination and is widely used because it simplifies the process.
Cotton-tipped swabs are specifically avoided for Pap smears. They collect fewer cells from the cervical canal and are less effective at detecting abnormalities compared to brushes and spatulas.
How the Cells Are Preserved
After the cells are collected, they need to be preserved quickly so the lab can examine them accurately. There are two methods in use.
In a conventional Pap smear, the provider spreads the collected cells directly onto a glass microscope slide and immediately applies a fixative, typically a spray or a coating of 95% alcohol. The fixative prevents the cells from drying out or distorting before a lab technician can examine them under a microscope.
In liquid-based cytology (the more common method today), the brush or broom head is rinsed or placed directly into a small vial of preservative liquid. The vial goes to the lab, where a machine filters out blood and mucus, producing a thinner, more even layer of cells on the slide. This method tends to yield cleaner samples that are easier to read.
What About HPV Testing
If your provider is also testing for HPV (the virus responsible for most cervical cancers), the collection process looks almost identical from your perspective. In many cases, a separate sample is collected using the same type of brush or broom. Some labs can run both the Pap and the HPV test from the same liquid-based vial, while others require a second sample collected separately. Either way, you won’t notice much difference during the exam itself.
What the Experience Feels Like
The speculum insertion typically causes a feeling of pressure rather than sharp pain. When the spatula or brush contacts the cervix, most people feel a brief scraping or scratching sensation. Some light spotting afterward is normal. The entire collection, from speculum in to speculum out, usually takes under two minutes. The rest of your appointment time is spent on positioning, preparation, and the broader pelvic exam.
If you’ve found past Pap smears uncomfortable, ask your provider about using a smaller speculum, additional lubrication with a lab-compatible gel, or techniques like slow insertion and deep breathing to help relax the pelvic floor muscles. These adjustments can make a noticeable difference.