From the Guidelines
Bleeding after a Pap smear is a common and usually normal occurrence, and patients should be warned about the possibility of some light bleeding or spotting after the test, as noted in the American Academy of Pediatrics clinical report 1. The bleeding is typically light spotting rather than heavy flow and may last for 1-2 days, but can continue for up to a week in some cases. This occurs because during the procedure, the healthcare provider uses a brush or spatula to collect cells from the cervix, which can cause minor trauma to the cervical tissue. Several factors can increase the likelihood of bleeding, including:
- Cervical inflammation
- Cervical polyps
- Cervical ectropion (when the cells that normally line the inside of the cervical canal are present on the outside of the cervix)
- Infections, such as those caused by STIs
- Cervical sensitivity If you're pregnant, have certain infections, or have cervical cell abnormalities, you might experience more bleeding than usual. It is essential to contact your healthcare provider if the bleeding becomes heavy (soaking through a pad every hour), lasts longer than a week, is accompanied by severe pain, fever, or foul-smelling discharge, as these could indicate an infection or other complications requiring medical attention. Using pads rather than tampons for any post-pap bleeding is recommended to reduce infection risk, as indicated by the clinical report 1. The cytobrush used in Pap tests can cause bleeding, which may be more prominent in patients with an STI, highlighting the importance of proper patient education and warning about potential bleeding after the procedure 1.
From the Research
Post-Procedure Bleeding after a Papanicolaou (Pap) Smear
- Post-procedure bleeding after a Pap smear can be a concern for patients and physicians alike, but the provided studies do not directly address the normalcy of bleeding after a Pap smear.
- However, the studies suggest that bleeding can be related to various factors, including cervical dysplasia, cervical polyps, and infections 2, 3, 4, 5.
- A study on postcoital bleeding found that it may be a predictor for cervical dysplasia, and that patients with postcoital bleeding were more likely to present with CIN 1 or higher grade pathology 2.
- Another study on postmenopausal bleeding outlined a guideline for diagnosis, which includes a Pap smear as the first step in clarification, but does not specifically address bleeding after a Pap smear 3.
- Studies on inflammation on the cervical Pap smear suggest that it may be related to infection, but the presence of inflammation on the Pap smear cannot be used to reliably predict the presence of a genital tract infection 4, 5.
- A study on genitourinary infections after a routine pelvic exam found that urinary tract infections (UTIs) and urinary complaints were significantly more frequent during the first 7 weeks after a Pap smear 6.