Many young patients have questions about Pap smears and pelvic exams. When is it time to start getting a Pap smear?

Author: Norton Healthcare

Published: November 4, 2024

A Pap smear is a cervical cancer screening commonly done at the same time as a pelvic exam. An HPV test also can be done at the same time.

Anyone with a cervix should get their first Pap smear at age 21 and another every three years before turning 30. Those ages 30 to 65 should have a Pap test every three to five years.

“If you are younger than 21, the American College of Obstetricians and Gynecologists (ACOG) says you do not need this type of screening,” said Amy E. Farrell, M.D., OB/GYN with Norton Women’s Care.

What is a Pap smear test?

A Pap smear (also referred to as cervical cytology or Pap test and named for its developer George Papanicolaou, M.D.) can detect abnormal, precancerous cervical cells.

Precancerous changes to cervical tissue, or cervical dysplasia, won’t cause any symptoms, but can be identified through lab testing. A Pap test is a very effective cervical screening test. Early detection allows for early treatment, which can be the most successful. A regular Pap smear can identify abnormal cervical cells before they develop into cancer. Even if cervical cancer has started to develop, a Pap test can detect it and lead to early treatment that can preserve fertility.

The test is very brief, and while it may be a bit uncomfortable, it doesn’t hurt. You’ll lie on your back with your feet in stirrups and a drape over your legs. Your gynecologist or other health care provider will insert a speculum in your vagina to hold it open to provide access to your cervix. A small brush collects cervical cells and is placed in a tube for testing.

For two days prior to your Pap smear test, refrain from vaginal sex, stop using tampons, vaginal creams, medicines, lubricants or douches. Schedule your appointment for after your period ends. If you have your period on the day of the exam, contact your provider, as menstruation could alter the results.

A pelvic exam is not the same thing as a Pap smear. Although they commonly occur during the same visit, both tests are not a requirement for every appointment. They serve as important ways to keep you healthy, including prevention of certain medical conditions and screening for cancer.

According to ACOG, a pelvic exam is not necessary — unless certain symptoms are present or there is a risk of specific conditions — but a patient and provider should make this decision together.

Is a Pap smear also an HPV test?

Cervical cells collected during a Pap smear are also tested for HPV, a very common virus that often has no symptoms and clears up in a year or two without causing cancer. An HPV infection that persists for many years can lead to precancerous changes that can develop into cervical cancer.

HPV testing and vaccination can significantly reduce the risk of cervical cancer.

After an abnormal Pap test result

If you get an abnormal Pap test or HPV result, you and your provider will discuss next steps, which could include:

A review of your medical history with an emphasis on relatives who may have had cervical or another gynecologic cancer
A physical exam that includes feeling your lymph nodes for any abnormalities
Follow-up test called a colposcopy: This test gives your health care provider a magnified view of the surface of your cervix. As with a Pap smear, you’ll lie on your back, and your provider will insert a speculum in your vagina to provide access for the colposcopy. The exam causes no more discomfort than a Pap smear. A weak solution of acetic acid (the same acid in vinegar) will be applied to your cervix to highlight abnormal areas. A small piece of cervical tissue may be removed for a biopsy to determine whether there are signs of cervical precancer, cancer or neither.
A cone biopsy retrieves a bit of tissue for testing and can serve as treatment by removing all the abnormal cervical tissue. The small piece of tissue is cut in the shape of a cone and may leave you with some discomfort for about a week.