Pap smear

A Pap smear, also called a Pap test or cervical smear, tests for abnormal cells in a woman’s cervix. Pap smears can also identify infections and inflammation of the vagina. They’re mainly used to screen for cervical cancer.

For many decades, cervical cancer was the leading cause of cancer deaths for women in the United States. The incidence of cervical cancer has declined by 60 percent since Pap tests became available in the 1950s.

When cervical cancer is found early, there’s a far greater likelihood that it can be cured. Experts have established a schedule for when and how often women should have a Pap test.

When to have a Pap smear

The schedule for having Pap tests varies according to the risk factors of each woman. Following are the recommendations of the U.S. Department of Health and Human Services, Office on Women’s Health for women who have no known risks.

AgePap smear frequency
< 21 years old, not sexually active, and no known risknot needed
< 21 years old and sexually activeevery 3 years
21-29every 3 years
30-65every 3 years; may be increased to every 5 years if your Pap smear and an HPV test are negative
65 and oldertalk to your doctor; you may no longer need Pap smear tests

What if I’ve had a hysterectomy?

Ask your doctor if you need to continue having Pap tests. Usually, Pap tests can be stopped if your cervix was removed during your hysterectomy and you’ve had negative Pap tests for three consecutive years.

Preparing for the Pap test

To increase the accuracy of your Pap test, there are several things you should avoid doing for 48 hours before the test:

  • having sex
  • douching
  • using tampons
  • using vaginal lubricants or medications
  • using vaginal sprays or powders

Also, you shouldn’t have a Pap test when you’re on your period.

Q&A: Pap smears and pregnancy

Q:

Do I need a Pap smear during pregnancy? Is it safe to get one?

A:

If you’re due for a Pap test and you’re pregnant, then you can have one up to 24 weeks into your pregnancy. After the sixth month and until 12 weeks after birth, you shouldn’t have a Pap smear. During the last three months of your pregnancy, a Pap test could be uncomfortable. After birth, you could get unreliable results due to insufficient or inflammatory cells present after birth.

Debra Sullivan, PhD, MSN, RN, CNE, COIAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

What happens during a Pap test

When you have a Pap test, you’ll be asked to lie back on the examination table with your knees up. You’ll place your feet in stirrups located on each side of the table. You’ll need to scoot your bottom to the end of the table.

Your doctor will place a metal or plastic speculum in your vagina to hold it open. They’ll then use a swab to lightly scrape off some of the cells and mucus on your cervix.

Most women don’t experience pain during the test, but may feel a slight pinching or pressure.

Your doctor will send your samples to a lab for evaluation under a microscope. When ordered by your doctor, the lab will also check for human papillomavirus (HPV). HPV tests are used for women ages 21 and older who’ve had abnormal Pap test results and for women ages 30 and older.

Learn more: Common types of human papillomavirus (HPV) »

Pap test results

Between 15 percent and 30 percent of Pap tests come back with false-negative results. False-positives also occur, but are less common.

Normal or negative

Most Pap test results come back as normal. This means you’ve been given an all-clear and should continue to follow the recommended schedule for future tests. You may hear these results referred to as a “negative” test. That means that you’ve tested negative for abnormalities.

Unsatisfactory

Sometimes, Pap test results come back as unsatisfactory. This isn’t necessarily cause for alarm. It can mean several things, including:

  • not enough cervical cells were collected to perform an accurate test
  • cells couldn’t be evaluated because of blood or mucus
  • there was an error in administering the test

If your results are unsatisfactory, your doctor may want to repeat the test right away or have you return sooner than the normal schedule for retesting.

Abnormal

Getting word that your Pap test results are abnormal doesn’t necessarily mean you have cervical cancer. Instead, it means that some cells were different from other cells. Abnormal results usually fall into two categories:

  • Low-grade changes in your cervical cells often mean you have HPV.
  • High-grade changes can indicate that you’ve had an HPV infection for a longer period of time. They also can be precancerous or cancerous.

Cervical cancer

When changes occur in the structure of cells of your cervix, which is the lower part of the uterus that connects to your vagina, they’re considered precancerous. These precancers can usually be removed in your doctor’s office using liquid nitrogen, an electric current, or a laser beam.

In a small percentage of women, these precancers will begin to grow quickly or in large numbers, and form cancerous tumors. Untreated, the cancer can spread to other parts of the body.

Nearly all cases of cervical cancer are caused by different types of HPV. HPV is transmitted through vaginal, oral, or anal sex.

HPV infection is very common. It’s estimated that the likelihood of getting HPV at some point in life, if you have at least one sex partner, is more than 84 percent for women and 91 percent for men. You can be infected if you’ve only had one sex partner. And you can have the infection for years without knowing it.

Although there’s no treatment for infections with the types of HPV that cause cervical cancer, they usually go away on their own, within one or two years.

Incidence and mortality rate of cervical cancer in the United States

Symptoms

Many women don’t have symptoms of cervical cancer, particularly pain, until it has progressed to a more advanced stage. Common symptoms include:

  • vaginal bleeding when you’re not on your period
  • heavy periods
  • unusual vaginal discharge, sometimes with a foul odor
  • painful sex
  • pelvic or back pain
  • pain when urinating

Learn more: Human papillomavirus (HPV) and cervical cancer »

Risk factors for cervical cancer

You are at greater risk of getting cervical cancer and may need to be screened more frequently if:

  • you smoke
  • you’re infected with HIV
  • your immune system is compromised
  • your mother or sister has been diagnosed with cervical cancer
  • your mother took the synthetic estrogen diethylstilbestrol (DES) while pregnant with you
  • you were previously diagnosed with precancer or cancer of the cervix
  • you or your partner had multiple sexual partners
  • you began having sex at an early age

Outlook

Pap tests save lives. Reduce your risk of getting cervical cancer, and improve your chances of beating cervical cancer if you should get it, by following the guidelines for screening.

Talk to you doctor about how frequently you should have a Pap smear and let them know if your health history has changed. That includes if you’ve changed sexual partners or if someone in your family has been diagnosed with cervical cancer.

Important tests for women

In addition to Pap smears, there are other tests that are important for women to have.

Test/ScreeningAges 21 to 3940 to 4950-6565 and older
Pap testfirst test at age 21, then test every 3 yearsevery 3 years; every 5 years if you also have an HPV testevery 3 years; every 5 years if you also have an HPV testtalk with your doctor; if you’re low-risk, you may be able to discontinue testing
breast exammonthly self-exam after age 20yearly by doctor; monthly self-examyearly by doctor; monthly self-examyearly by doctor; monthly self-exam
mammogramdiscuss with your doctorevery 2 yearsyearly65-74: yearly; 75 and older: discuss with your doctor
bone mineral density testdiscuss with your doctordiscuss with your doctordiscuss with your doctorat least one test to serve as a baseline
colonoscopydiscuss with your doctordiscuss with your doctorfirst test at 50, then every 10 yearsevery 10 years

Sources: Office of Women’s Health and Cleveland Clinic Health Guidelines for Women

Your doctor may recommend additional tests or other timelines, depending on your health history. Always follow your doctor’s recommendations as they are the most familiar with your health needs.