What Is a Pap Smear?

A Pap smear is a cancer screening procedure for those assigned female at birth. During the test, a healthcare provider inserts a speculum to visualize the cervix. Then, a small brush or spatula are used to collects cells from the surface of the cervical opening— the opening of the uterus or womb—and sends them to the lab to be checked for cervical cancer or cell changes that may lead to cervical cancer.

What's the Purpose of a Pap Smear?

Pap smears screen for cervical cancer (cancer of the cervix). They detect abnormal cells that may indicate human papillomavirus (HPV), pre-cancer, cancer, inflammation, and infection. 

Human papillomavirus (HPV) is a sexually transmitted disease (STD). There are many different strains of the virus, each identified with a number. Some HPV types cause genital warts. But, types 16 and 18 are high-risk types known to significantly increase the risk of cervical cancer in people with vagina, as well as penile cancer in males. 

When Should You Get a Pap Smear?

Typically, people 21 and older get Pap smears every 3-5 years until they are 65. These general guidelines and recommendations can vary based on a person's medical history, including:

• Signs and symptoms of cervical cancer
• High risk or history of cervical cancer 
• History of abnormal cells 
• Compromised immune system (i.e. human immunodeficiency virus (HIV) or exposure to diethylstilbestrol in the womb)

If you had a hysterectomy but still have a cervix, you still need a Pap smear. Pap smears may be unnecessary if you no longer have your cervix. Check with your provider as this depends on your medical history.

Sometimes providers use HPV tests to screen for cervical cancer. But, not every geographical area has access to HPV tests. Providers with access may suggest HPV tests or HPV/Pap smear co-tests every five years. 

The following are recommendations for Pap smears rather than HPV tests, as Paps are still the primary screening tool.

For Ages 21 to 29

People get Pap smears every three years, beginning at age 21. But, some experts suggest beginning at age 25. 

For Ages 30 to 65

Experts recommend a Pap smear every three years for women ages 30 to 65. An acceptable alternative is an HPV test or a Pap/HPV co-test every five years.

For Anyone Older Than 65 Years Old

Those over 65 with a history of normal Pap smears and no history of cervical cancer, can typically stop screening. “Normal” Pap smears mean three consecutive negative Pap smears (or two consecutive HPV or HPV/Pap negative tests) within 10 years before you stop screening.

If you have a history of cervical pre-cancer or cancer, you may need 20 more years of screening after diagnosis, even past the age of 65. 

How to Prepare for a Pap Smear

To prepare for a Pap smear, ensure the outside vaginal area is clean using warm water. If you have never had a Pap smear or sexual intercourse, let the provider know. They may need to use smaller instruments.

Otherwise, you don’t need to do anything special to prepare for a Pap smear. However, you can take the following steps to ensure the most accurate results.

• Avoid sexual intercourse for two days before the Pap
• Avoid douching, spermicides, tampons, or vaginal medicines for two days before the test

Some people avoid a Pap while menstruating. This is especially true when they are experiencing a heavy flow, as a lot of blood may affect test results. But not all experts agree, so check with your provider first.

What To Expect During a Pap Smear

A Pap smear is a quick test performed in a healthcare provider's office. They frequently do it during your annual pelvic and breast exam appointment, although the Pap specifically isn't necessarily performed annually.

During a Pap smear, you will lay on an exam table while your healthcare provider collects cells from your cervix.

While your waiting time will vary, the procedure only takes a few moments. If you are also getting a pelvic and breast exam, it only takes a couple of minutes.

What It Feels Like

A Pap can be slightly uncomfortable, but it should not be painful. You may feel pressure or pinching for a brief moment. Let your provider know if you do feel pain.

But getting a Pap or a pelvic exam can be nerve-wracking. It’s common to feel apprehensive, even if you’ve been through it many times. Many people find relaxation techniques help them cope with the stress before and during vaginal exams. 

To help you relax, you can:

• Focus on a spot on the ceiling or wall while taking deep breaths. 
• Visualize your happy place (ocean, hiking, garden) while taking deep breaths. 
• Use the 4-7-8 breathing technique.

The Procedure

Once you change into a gown, your provider will instruct you to lay on an exam table with your feet in stirrups. They will ask you to open your legs and tell you when they are about to begin the following procedure.

• The provider places a lubricated speculum in the vagina to widen it so they can visualize the cervix.
• They use a brush-like tool or spatula that softly sweeps cells of the cervix.
• Once they collect the cervical cells, they place them in a specimen jar and send it to the laboratory.
• A pathologist (a specialized doctor who examines body tissue and cells) will examine the cells under a microscope, looking for abnormal or precancerous changes in the cervical cells.

Your provider will instruct you to get dressed. They will typically give you a tissue and offer you a pantiliner. You may have mild vaginal bleeding or cramping that should resolve by the next day. 

What the Pap Smear Results Mean

It can take several weeks to receive results, typically in the mail or via your healthcare provider's online portal. If your provider has concerns about the results, they may contact you before then to schedule further testing.

Normal Results

Normal or negative means there are no abnormal cells. There is no evidence of disease or any irregularities. You will continue with your regularly scheduled screenings unless your provider suggests otherwise.

Abnormal Results

Receiving abnormal pap smear results can be a stressful experience, but it’s important to note that it doesn’t always mean you have cancer. 

Abnormal results mean you have abnormal cell changes on your cervix. They can be minor or more concerning. You may need further testing, treatment, or frequent monitoring. 

Minor changes are typically from HPV, inflammation, or infection. The abnormal cells often return to normal on their own or with mild treatment. 

More concerning changes include high-grade results, which could indicate abnormal “precancerous” cells that could turn into cancer if left untreated. Treatment typically prevents precancerous cells from becoming cervical cancer.

High grade could also mean you have cervical cancer. But, a Pap smear is a screening test, so it doesn’t diagnose cancer. If your results are abnormal or inconclusive, you may need further testing such as a:

• Repeat Pap smear 
• HPV test
• Colposcopy (procedure with a magnifying device to closely examine the cervix)
• Biopsy (removal of a small piece of cervical tissue with a specialized biopsy tool)

Inconclusive

If the results are inconclusive, you will most likely need another test. Unclear results can occur with infections or life changes such as pregnancy or menopause.