# How is a smear test done? What does an unsatisfactory sample mean? > How a smear test is done, what helps you feel comfortable during the examination, and what happens next if the result is 'unsatisfactory' or abnormal. Published: 21 September 2026 · Medically reviewed by: Op. Dr. Murat Alpay **How a smear test is done, what helps you feel comfortable during the examination, and what happens next if the result is 'unsatisfactory' or abnormal.** Short answer: A smear test is done by taking a small sample of cells from the cervix with a soft brush during an examination. The sample is examined in a laboratory. If the result comes back "unsatisfactory", the test is repeated; if it is abnormal, follow-up or a colposcopy is planned according to your level of risk. ## How is a smear test done? You lie on your back on the examination couch. The doctor places a speculum (an instrument that gently opens the walls of the vagina) so the cervix can be seen. The smallest suitable size is chosen and it is warmed before insertion. If a lubricant is needed, a very small amount of gel is applied to the outside of the speculum; this amount has been reported not to affect the result or raise the rate of unsatisfactory samples. The cell sample is taken with a soft brush used together with a plastic spatula. In the conventional method the sample is spread on a glass slide. In liquid-based cytology (a method in which the cells are transferred into a special liquid), the brush is rinsed in a vial of preservative fluid. Because an HPV test can also be run from this single sample in the same laboratory, liquid-based cytology needs no extra preparation and no second examination. ## What is done to help you feel comfortable? - The doctor tells you what you will feel before each step. - Your legs are supported comfortably in the stirrups; raising the head of the couch slightly helps the abdominal muscles relax. - Before the speculum is inserted, you are asked to relax the muscles at the entrance of the vagina. This makes insertion easier, especially for people having their first examination, those who have sex infrequently, those who experience pain during sex, and those who are very anxious. If you feel uncomfortable, telling your doctor helps them set the pace of the examination. ## Can a smear be taken during a period, bleeding or discharge? With light bleeding the procedure can go ahead. With heavy bleeding the examination is usually postponed, because blood obscures the cells. Marked inflammation or infection can also obscure the cells; in that case it may be appropriate to treat the inflammation first and then repeat the test. Which day and conditions are right for your test, and preparation details such as sex or vaginal medication beforehand, are decided by your doctor for your individual situation. ## What does an "unsatisfactory sample" result mean? This result means the laboratory could not assess the cells reliably, so the test could be read neither as "normal" nor as "abnormal". The main reasons are: - Too few cells in the sample - Blood, heavy discharge, mucus or inflammation covering the cells - A thick smear on the slide (in the conventional method) Liquid-based cytology separates the cells from blood and inflammatory cells, so it markedly reduces the rate of unsatisfactory samples. **Next step:** After an unsatisfactory result the test is repeated as soon as possible and within 4 months at the latest. If two unsatisfactory results occur in a row, your doctor refers you for colposcopy (examination of the cervix with a magnifying device). An unsatisfactory sample is not a sign of disease; it only concerns the quality of the sample. ## What happens if the smear is abnormal? An abnormal result does not mean cancer. Current guidelines base the decision not on a single test result but on the smear, the HPV result and your previous screening history taken together, according to your risk of a more advanced cell change: - **If the risk is low:** No colposcopy is needed; a repeat test is planned after one or three years. - **If the risk exceeds a certain level:** Colposcopy is recommended, with a small tissue sample (biopsy) if necessary. - **If the risk is very high:** In some cases removal of the changed tissue on the cervix may be considered without waiting for a biopsy result. You can read how colposcopy is done in [what is a colposcopy and what happens during it](https://www.muratalpay.com.tr/en/blog/kolposkopi-nedir-islem-sirasinda-ne-olur/), and the difference between a smear and an HPV test in [the difference between a smear test and an HPV test](https://www.muratalpay.com.tr/en/blog/smear-testi-ile-hpv-testi-arasindaki-fark-nedir/). The pages on [smear and HPV testing](https://www.muratalpay.com.tr/en/tedaviler/pap-smear-ve-hpv/) and [colposcopy](https://www.muratalpay.com.tr/en/tedaviler/kolposkopi/) also contain related information. ## Frequently asked questions ### Can a smear test be done during pregnancy? During pregnancy, a smear and, if needed, colposcopy assessment can be done using the same risk thresholds as in non-pregnant women. However, some additional procedures, such as taking tissue from the inner canal of the cervix, are not performed. Your doctor decides which approach is suitable in pregnancy. ### Is any extra preparation needed for liquid-based cytology? No. A single sample is placed in the vial, and both the cell examination and the HPV test can be done from the same sample. ### Should I be worried if my smear was unsatisfactory? No. This result does not mean disease; it means the sample could not be assessed. The test is repeated shortly, within 4 months at the latest. Written and reviewed by **Op. Dr. Murat Alpay** Specialist in Obstetrics and Gynaecology · Istanbul University, Istanbul Faculty of Medicine (Çapa) [Full biography →](https://www.muratalpay.com.tr/en/hakkinda/) [← All posts](https://www.muratalpay.com.tr/en/blog/) --- Original page: https://www.muratalpay.com.tr/en/blog/smear-testi-nasil-yapilir-yetersiz-ornek-ne-demek/ Last updated: 2026-09-21 Op. Dr. Murat Alpay — Specialist in Obstetrics and Gynaecology Op. Dr. Murat Alpay Practice, Tekelioğlu Cd. No:51 B Kat:2, Filo Apt., 07160 Muratpaşa / Antalya 0505 351 77 88 · Monday – Saturday 09:00 – 18:00 · Closed on Sunday *This information is for general guidance only and does not replace examination, diagnosis or treatment.*