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Pap Smear (Pap Test): What to Expect

Overview

Did you know?
A Pap smear is named after Georgios Papanikolaou, the doctor who determined that this was a useful way to detect signs of cervical cancer.

A Pap smear, also called a Pap test, is a screening procedure for cervical cancer. It tests for the presence of precancerous or cancerous cells on the cervix. The cervix is the opening of the uterus.

During the routine procedure, cells from your cervix are gently scraped away and then examined for abnormal growth. The procedure is done at your doctor’s office. It may be mildly uncomfortable, but doesn’t usually cause any long-term pain.  

Keep reading to learn more about who needs a Pap smear, what to expect during the procedure, how frequently you should have a Pap smear test, and more.

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Pap smear by age

Who needs a Pap smear?

Most women should start getting regular Pap smears at age 21. Some women may be at increased risk for cancer or infection. You may need more frequent tests if:

  • you’re HIV-positive
  • you have a weakened immune system from chemotherapy or an organ transplant

If you’re over 30 and have had three normal Pap tests in a row, ask your doctor about having one every five years if the test is combined with a human papillomavirus (HPV) screening. HPV is a virus that causes warts. The primary causes of cervical cancer are HPV types 16 and 18. If you have HPV, you may have an increased risk for developing cervical cancer.

Women over the age of 65 with a history of normal Pap test results may be able to stop having Pap smears in the future.

You should still get regular Pap smears even if you’re in a monogamous relationship. That’s because the HPV virus can be dormant for years, and then suddenly become active.

Q&A

Q&A: Pap smears and sexual activity

  • I’m over 21 and a virgin. Do I need a Pap smear if I’m not sexually active?
  • Most cervical cancers are due to infection from the HPV virus, which is sexually transmitted. However, not all cervical cancers are from viral infections. For this reason, it is recommended that all women begin their cervical cancer screening with a Pap smear every 3 years beginning at age 21.

    - Michael Weber, MD
  • Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
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Pap smear frequency

How often do you need a Pap smear?

How often you need a Pap smear is determined by various factors, including your age and risk.

Age Pap smear frequency
<21 years old, not sexually active, no known risk factors none needed
<21 years old, sexually active every 3 years
21-29 every 3 years
30-65 every 3-5 years if your Pap smear and HPV test are negative
65 and older you may no longer need Pap smear tests; talk to your doctor to determine your needs
 

Learn more: When should you get a Pap smear test? »

Preparation

How to prepare for a Pap smear

Tips
  • Let your doctor know if you’re menstruating because it may affect your results.
  • Avoid sexual intercourse, douching, or using spermicidal products the day before the test.
  • Relax. Take deep breaths and try to stay calm.

You can schedule a Pap smear with your annual gynecological examination or request a separate appointment with your gynecologist. Pap smears are covered by most insurance plans, though you may be required to pay a co-pay.  

If you’ll be menstruating on the day of your Pap smear, your doctor may want to reschedule the test, since results could be less accurate. Try to avoid having sexual intercourse, douching, or using spermicidal products the day before your test because these may interfere with your results.

In most cases, it’s safe to have a Pap smear in the first 24 weeks of a pregnancy. After that, the test may be more painful. You should also wait until 12 weeks after giving birth to increase the accuracy of your results.

Since Pap smears go more smoothly if your body is relaxed, it’s important to stay calm and take deep breaths during the procedure.

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Procedure

What happens during a Pap smear?

Pap smears can be a bit uncomfortable, but the test is very quick.

During the procedure, you’ll lie on your back on an examination table with your legs spread and your feet resting in supports called stirrups. Your doctor will slowly insert a device called a speculum into your vagina. This device keeps the vaginal walls open and provides access to the cervix. Then your doctor will scrape a small sample of cells from your cervix. There are a few ways your doctor can take this sample. Some use a tool called a spatula, some use a spatula and a brush, and others used a device called a cytobrush, which is a combination spatula and brush. Most women feel a slight push and irritation during the brief scraping.

The sample of cells from your cervix will be preserved and sent to a lab to be tested for the presence of abnormal cells.

After the test, you might feel mild discomfort from the scraping, or a bit of cramping. You could also experience very light vaginal bleeding immediately following the test. Tell your doctor if discomfort or bleeding continues after the day of the test.

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Results

What do the results of a Pap smear mean?

There are two possible results from a Pap smear: normal or abnormal.

Normal Pap smear

If your results are normal, that means that no abnormal cells were identified. Normal results are sometimes also referred to as negative. If your results are normal, you probably won’t need a Pap smear for another three years.

Abnormal Pap smear

If the test results are abnormal, this doesn’t mean you have cancer. It simply means that there are abnormal cells on your cervix, some of which could be precancerous. There are several levels of abnormal cells:

  • atypia
  • mild
  • moderate
  • severe dysplasia
  • carcinoma in situ

Milder abnormal cells are more common than severe abnormalities.

Learn more: What does it mean if my Pap smear test is abnormal? »

Depending on what the test results show, your doctor may recommend increasing the frequency of your Pap smears, or getting a closer look at your cervical tissue with a procedure called colposcopy. During a colposcopy exam, your doctor will use light and magnification to see vaginal and cervical tissues more clearly. In some cases, your doctor may also take a sample of your cervical tissue in a procedure called a biopsy.

How accurate are the results?

Pap tests are very accurate, and regular Pap screenings reduce cervical cancer rates and mortality by 80 percent. It can be uncomfortable, but the brief discomfort can help protect your health.

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HPV

Does a Pap smear test for HPV?

HPV types
There are over 100 different types of HPV, and 40 types are sexually transmitted. The primary causes of cervical cancer are HPV types 16 and 18.

The main purpose of a Pap smear test is to identify cellular changes in the cervix, which could be caused by HPV. By detecting cervical cancer cells early with a Pap smear, treatment can start before it spreads and becomes a bigger problem. It’s also possible to test for HPV from the Pap smear specimen, too.

You can get HPV from sex with men or women. All sexually active women are at risk for contracting HPV and should get a Pap smear at least every three years.

The test doesn’t detect other sexually transmitted diseases. It can occasionally detect cell growth that indicates other cancers, but it shouldn’t be relied on for that purpose.

Learn more: Common types of human papillomavirus »

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