A Pap smear, also called a Pap test, is a lifesaving screening tool used to detect abnormal cells on the cervix that may lead to cervical cancer. During the test, your healthcare provider collects a small sample of cells from your cervix and sends them to a laboratory for testing.

Your provider may also test for human papillomavirus (HPV), a common virus that causes nearly all cervical cancers. Testing for both HPV and abnormal cervical cells is called co-testing.

Regular cervical cancer screening can help detect changes early, when they are easier to treat.

What Is a Pap Smear?

A Pap test is a screening tool for cervical cancer. Your healthcare provider also may test for HPV. HPV is a virus that causes almost all cervical cancer. An HPV screen checks for the human papillomavirus. The Pap smear checks for abnormal cells that can develop into cervical cancer. Your healthcare provider may screen for both at the same time. This is called “co-testing.”

Pap Smear Versus Pelvic Exam: What’s the Difference?

Many people think a Pap smear and pelvic exam are the same, but they are different types of exams.

A Pap smear is often performed during a well-woman visit and may be done as part of a pelvic exam, but a pelvic exam does not always include a Pap smear.

How Often Do You Need a Pap Smear?

Guidelines are based on age and, for patients 30 and older, whether a Pap smear is combined with an HPV test. New cervical cancer screening guidelines: 

• A test for high-risk strains of HPV every five years
• A Pap test (cervical cytology) every three years, or
• Co-testing with both the HPV and Pap test every five years

Screening Schedule (by age group):

Under 21

• Cervical cancer screening is not recommended, even if sexually active

Ages 21 to 29

• Pap smear alone every three years
• HPV testing not recommended in this age group

Ages 30 to 65

Screening options include:

• HPV test alone every five years
• Pap smear plus HPV test (co-testing) every five years
• Pap smear alone every three years

Over Age 65

You may no longer need cervical cancer screening if you have had regular screenings with normal results and no history of significant cervical changes. Talk with your healthcare provider about whether screening is still recommended for you. 

Who Needs a Pap Smear More Often Than the Guidelines?

• Your healthcare provider may recommend more frequent screening if you have: A istory of abnormal Pap smear results or cervical precancerous cells
• HIV-positive status or weakened immune system (including organ transplant or long-term immunosuppressant use)
• Prior cervical cancer treatment

Pap Smear and HPV: What’s the Connection?

HPV is a very common sexually transmitted infection (STI). Most infections clear up on their own, and many people don’t even know they have HPV. Nearly every sexually active person will encounter HPV in their lifetime. 

While HPV vaccines have led to a significant decrease in HPV infection, you still can get HPV or cervical cancer even if you have been vaccinated. 

Getting HPV does not mean you have cancer, and it does not mean you will get cancer. However, almost all cervical cancers are caused by persistent HPV, which is an HPV infection that your body can’t clear on its own.

How to Prepare for Your Pap Smear

To help ensure accurate results:

• Schedule your appointment when you are not having your period, if possible.
• Avoid sexual intercourse for 48 hours before your test.
• Avoid vaginal creams, lubricants, douches or spermicides for 48 hours before your test.

Before your appointment, tell your provider if you:

• Are pregnant or may be pregnant
• Have symptoms such as unusual discharge, pelvic pain or bleeding
• Know the date or results of your previous Pap smear

Can You Have a Pap Smear on Your Period?

You can have a Pap smear during your period, but it is generally not recommended during heavy flow, as blood can interfere with results. Check with your healthcare provider before your appointment.

What to Expect During a Pap Smear

t is normal to feel nervous before a Pap smear, especially if it is your first one. Your healthcare provider will help make the experience as comfortable as possible.

During the test:

1. You will undress from the waist down and lie on an exam table with a drape covering your lower body.
2. Your feet will be placed in stirrups.
3. Your provider will gently insert a speculum into your vagina to view your cervix.
4. A small brush will be used to collect cervical cells.
5. The sample will be sent to a laboratory for testing.

The test usually takes only a few minutes. You may feel pressure or mild discomfort. Light spotting afterward can be normal. Let your provider know if you experience pain or heavy bleeding.

Understanding Your Pap Smear Results

Results from a Pap test typically come back within a week or two. Your provider’s office will contact you with your results.

Normal Results:

• No abnormal cells were detected.
• Follow standard screening schedule with a healthcare provider.

What If I Have an Abnormal Pap Smear Result?

An abnormal Pap test result does not mean you have cancer. You may have an infection, inflammation or minor cell changes (often temporary). Abnormal results are common.

The next steps after abnormal results may include a repeat Pap smear, HPV test or colposcopy, a procedure described below. 

What Is a Colposcopy?

A colposcopy is a follow-up procedure that allows your provider to closely examine your cervix for abnormal areas.

During a colposcopy:

• You will lie on an exam table like you did during a Pap smear.
• A speculum will be placed to view your cervix.
• A solution may be applied to highlight abnormal areas.
• A small tissue sample (biopsy) may be collected for further testing.
• Your provider will discuss your results and next steps based on your individual situation.

Who Should Get a Cervical Cancer Screen?

Anyone with a cervix should have Pap smears, including cisgender women, transgender men and nonbinary individuals with a cervix. Not all cancers happen due to sexual activity, so you should still start screening at age 21 even if you are not sexually active. 

Screening may not be necessary for people who have had a hysterectomy. Talk to your healthcare provider if a Pap smear is recommended for you.