Pap Smear

What is a Pap smear test?

A Pap smear (also called a Pap test) screens for cervical cancer. The test checks for abnormal cells on your cervix that are cancerous or have the potential to become cancerous and may also detect certain infections and inflammation. During a Pap smear, your healthcare provider takes cells from your cervix to examine under a microscope. The test is named for an American physician, Dr. George Papanicolaou, who developed the Pap smear.

Anyone with a cervix between the ages of 21 and 30 should get a Pap smear at least once every three years. Between the ages of 30 and 65, you should have one every five years. Healthcare providers consider a Pap smear to be the gold standard for preventing cervical cancer because it detects cervical cell changes before they can turn into cancer. Detecting precancerous or cancerous cells as early as possible typically increases your chances of beating the disease.

Going for your Pap test may feel like a nuisance, and you may dread going when the time comes. It’s easy to push the test off or think you don’t need to get one because your last one was fine, but it’s imperative for your reproductive health and putting it off could mean dangerous cell changes go unnoticed. Talk to your healthcare provider if you’re unsure when you’re due for your next Pap smear.

What does a Pap smear test for?

The test checks for:

• Cervical cancer.
• Potentially precancerous cells in the cervix (dysplasia).
• Human papillomavirus (HPV), a common sexually transmitted infection (STI) that increases the risk of cervical cancer.

A Pap smear can’t detect STIs like gonorrhea and chlamydia, but it may pick up things like trichomonas, bacterial overgrowth or yeast infections. Your provider performs gonorrhea and chlamydia tests separately from a Pap test.

What’s the difference between a pelvic exam and a Pap test?

During a pelvic exam, your healthcare provider examines and feels your uterus, ovaries and other parts of your reproductive system. A pelvic exam doesn’t always include a Pap smear, but a Pap smear almost always involves a pelvic exam.

What’s the difference between a Pap smear and an HPV test?

HPV tests check for certain types of HPV that increase your cervical cancer risk. There are many different types of HPV. Not all cause cancer.

Providers can do HPV tests and Pap tests at the same time, using the same steps (a gentle scrape of your cervix for cell samples). When sending these samples to a lab, your provider specifies whether the lab specialist (pathologist) should check for precancerous or cancerous cells (Pap smear), HPV or both (a co-test). The time between tests is slightly different depending on whether you get just a Pap test or a co-test.

How often do you need a Pap smear?

How often you’ll have the test depends on many factors, including your age, health history and results from your last Pap or HPV test. Most people don’t need Pap smears after age 65.

Generally, Pap smears occur:

Certain factors may cause you to have more frequent screenings or screening past age 65. Some of these are:

• Having human immunodeficiency virus (HIV) or being immunocompromised from another condition or treatment like chemotherapy.
• Exposure to diethylstilbestrol (DES) during fetal development (your birth parent took the medication). Healthcare providers prescribed it to pregnant people up until about 1971.
• Having a history of cervical cancer.
• Having a history of irregular Pap smears.

Do I need a Pap smear if I’ve had a hysterectomy?

It depends on what kind of hysterectomy you had and if you had it due to cancer or another condition:

• If you’ve kept all or part of your cervix, you should still have Pap smears.
• If you no longer have a cervix, you may not need a Pap smear again. But this depends on why you had a hysterectomy.

People who had a hysterectomy due to ovarian, uterine or cervical cancer may still need Pap tests to check their vaginal tissue for signs of cancer. If you had a hysterectomy for a condition like uterine fibroids, your provider may decide your risk for cancer is low and you no longer need Pap smears.

How should I prepare for a Pap smear?

Some things that you do in the days before a Pap smear can affect test results. For the most accurate results, you should:

• Not have vaginal sex for two days before your exam.
• Not use tampons, vaginal creams or medicines, birth control foams or jellies, lubricants or douches for at least two days before the test.
• Schedule the appointment for after your period ends. If you have your period on the day of your exam or suspect you will, contact your provider to see what they think you should do.

Should I get a Pap test if I am on my period?

It’s best to avoid having a Pap test while on your period as it could alter the results. Some healthcare providers will perform a Pap test at the end of your period (when bleeding is light). It’s best to check with your provider’s office to see what they recommend or reschedule your Pap for when you aren’t on your period.

How is a Pap smear done?

A Pap takes place in your healthcare provider’s office. The appointment is quick, and the Pap test takes just a few minutes to perform. First, you’ll undress from the waist down or undress completely and put on a hospital gown. Then, you’ll sit on an exam table with your legs spread and your heels in stirrups. Your provider will give you a drape or paper sheet to place over your legs.

During the procedure, your healthcare provider:

• Inserts a speculum into your vagina. You may feel a bit of pressure. This metal or plastic tool holds your vagina open so your provider can see your cervix.
• Uses a small brush or spatula to gently swab cells from your cervix.
• Places the brush or spatula containing cervical cells in a tube or jar.
• Removes the speculum.

Does a Pap smear hurt?

A Pap smear shouldn’t hurt but may feel uncomfortable. You could experience light bleeding afterward, but you shouldn’t feel pain or cramping. Let your healthcare provider know if you feel discomfort lasting more than a few minutes or if the bleeding lasts longer than 24 hours.

What should I expect after a Pap smear?

Your healthcare provider will send the sample to a lab. A specialist called a pathologist examines the samples under a microscope to look for abnormal cells that may indicate cancer or HPV.

What are disadvantages of a Pap smear?

Pap smears are very safe and highly reliable. You may experience light bleeding after the test, but you shouldn’t have cramps or pain. There’s a small risk of false-negative or incorrect results, but this is rare.

When should I get my test results?

It can take up to three weeks for your healthcare provider to receive the lab results. Your healthcare provider will let you know when to get your next Pap smear or if you need further testing.

What do Pap smear results mean?

When you receive your results, they may be:

• Normal: No sign of irregular cells. This means nothing unusual was found in the sample. It’s sometimes called a negative result. You won’t need another Pap test for at least three years.
• Unclear: The lab couldn’t decide whether the cells were normal or abnormal. Your healthcare provider may have you come back for another Pap smear.
• Abnormal: The size and shape of the cells look like they may be precancerous. Providers can further classify the cells as being low grade or high grade. Low-grade cells mean cancer is likely several years away, whereas high grade means the cells appear that they will change to cancer sooner.

Pap smears are a lifesaving screening tool. The test finds abnormal cervical cells before they have a chance to become cancerous. More than 95% of the time, people treated for precancerous cells don’t develop cervical cancer. An unclear or abnormal Pap test result doesn’t mean you have cervical cancer. Your provider can discuss test findings and the next steps with you.

What follow-up tests might I need after an abnormal Pap smear result?

If you have an abnormal Pap smear result, your healthcare provider will perform a procedure called a colposcopy. Some may choose to do another Pap smear to make sure the findings are the same.

Pap smears only screen for cancer — they can’t diagnose it. To get more information to help diagnose or rule out cervical cancer, your provider does a colposcopy. During this procedure, your provider:

• Uses a microscope device (colposcope) to view the surface of your cervix and vagina.
• Removes small tissue samples from areas that look abnormal.
• Sends the samples to a lab for testing.

Do you need a Pap smear if you’re a virgin?

Yes. Not all cervical cancers happen due to being sexually active. Even if you aren’t having sex, you still need a Pap smear if you’re 21 years old.

Can you say no to a Pap test?

Yes, you can decline a Pap test. But studies continually show that getting a Pap test is the best way to prevent cervical cancer.

What happens if you never get a Pap smear?

Since a Pap is the gold standard for detecting cell changes that could lead to cancer, not ever getting a Pap test means you could have cervical cancer and not know it. This could lead to cancer progressing and causing serious or life-threatening complications. Cancer is also much harder to treat once it begins to progress. Early detection is always best, and a Pap smear is how providers can detect cervical cancer as early as possible.

A note from Cleveland Clinic

It’s common to dread getting a Pap smear. Most people don’t enjoy getting them, but they’re so important to your vaginal health. Luckily, Pap tests take less than 10 minutes and any discomfort you feel passes quickly.

Pap smears are a critical tool for detecting irregular cells in your cervix that may lead to cervical cancer. Check with your healthcare provider if you’re between 21 and 65 to make sure you’re up to date on your Pap smears. Early detection of precancerous or cancerous cells on your cervix can increase your chances of fighting cervical cancer.