A Pap smear or Pap test (short for Papanicolau test) is a routine part of women’s healthcare, so understanding what to expect and when you should get one can help you feel confident walking into your appointment.
What is a Pap smear?
A Pap smear is a procedure to collect a sample of cervical cells to test for abnormalities that either are, or could turn into, cancer. This procedure is different from a pelvic exam, but they are often completed at the same time. During a pelvic exam, your healthcare provider feels your reproductive organs for signs of infection or cancer, but a Pap smear utilizes a small brush to collect cells from the cervix only.
The cervix is the organ that connects the vagina and its opening to the uterus. The cervix produces mucus throughout the ovulatory phase depending on hormone production, and it opens and closes (a tiny bit) around times of fertility. It remains closed throughout pregnancy, until it dilates in preparation for delivery.
Why do women need Pap smears?
Routine Pap smears allow early detection of cervical cancer* or abnormal cells that could develop into cancerous ones. This can be critical in improving health outcomes and reducing the incidence of invasive cervical cancer [1].
Pap smears can also be utilized to test for human papillomavirus, known as HPV.
(*According to the CDC, “almost all cervical cancers are caused by HPV.” HPV is most commonly spread by sex, and according to the American Cancer Society, “HPV infections are more likely in people who have had many sex partners.” Therefore, the best way to avoid HPV—and, by extension, cervical cancer—is by practicing chastity and monogamy.)
How often should I get a Pap smear?
The American College of Obstetricians and Gynecologists (ACOG) and the U.S. Preventive Services Task Force (USPSTF) recommend that women should begin preventative Pap smear screenings as early as age 21, and should have them done every 3 years afterwards if results are negative. (However, one’s individual level of risk will vary significantly depending on the number of sexual partners one has, and women should always consider their own level/tolerance for risk when assessing whether any procedure is right for them.) Annual PAP smears are not necessary for those with a negative result in the past 3 years.
If you have certain risk factors like human immunodeficiency virus (HIV) or you had diethylstilbestrol (DES) exposure in utero, then your healthcare provider may suggest more frequent tests. Those with abnormal or cancerous results will receive guidance from their providers as to next steps and future Pap smears. Women who have had a complete hysterectomy or are age 65 and older no longer need to have Pap smears completed, unless directed by their doctor.
How can I be sure the results of my Pap test are accurate?
To increase the accuracy of a Pap smear, it’s best to avoid tampons, contraceptive foams or jellies, or vaginal products (like lubricants or moisturizers) for several days beforehand. Abstain from intercourse, as well, for two days before the test.
If you are on your period, call the clinic ahead of time to see if they can still perform the procedure, or if they prefer to reschedule to a time when you are not menstruating.
What to expect during your Pap smear
Knowing what to expect before it occurs can go a long way in helping a Pap smear be a positive experience. When you enter the exam room, you’ll be asked to take off your underwear and cover yourself with a sheet or paper cover. When the healthcare provider completing the Pap smear arrives, you’ll lay back on the exam table, put your feet in stirrups, and adjust your body’s position as needed.
The healthcare professional will insert a speculum into the vaginal opening and open it so that he/she can see your cervix. The insertion should be pain free, while the opening of the speculum may cause some pressure.* Your healthcare provider will then use a small brush with a long handle to insert into the vaginal opening and collect cells from the outside of the cervix. Although this can be an odd sensation, it should not be painful. The brush, then speculum, will be removed and the procedure is complete. It should take only a few minutes.
*If you do feel pain, be sure to let your provider know right away! As with any medical procedure, you have the right to revoke your consent. Especially in women who have not yet had sex, have not yet given birth, or are postmenopausal, the option of a smaller “pediatric” speculum should be available to help reduce pain or pressure. Be sure to talk to your doctor about this option if you fall into any of the aforementioned categories.
What to expect after a PAP smear
Immediately after the procedure, you may have a small amount of spotting. However, you should not experience pain or heavy bleeding. If you do, notify your healthcare professional.
Your cervical sample will be sent to a lab for testing and results will be made available to you several weeks later, through an online portal or a phone call. If results are normal, no action needs to be taken and your next Pap smear won’t need to be for another three years.
However, results may also come back abnormal, unclear, or unsatisfactory. An abnormal result means that your sample showed changes to your cervical cells, which can vary from minor to serious. There are many things that could cause these changes, and it does not automatically mean a positive cancer result. More often, any serious changes are treated in order to prevent the future development of cervical cancer. The abnormal cells could also be from HPV.
Unclear or unsatisfactory results mean that the technician reading the test was unable to determine whether your cervical cells were normal or abnormal. Therefore, further testing is necessary. This could be because the sample size was too small, or due to common life changes like pregnancy, infection, or menopause that can affect the appearance of your cervical cells.
Extra tips for a positive experience
Pap smears are quick and simple, and being prepared can help make the experience less intimidating. If you are going in for your first Pap smear, consider some of the following tips:
- Confirm which medical professional you’ll see ahead of time, so you can confirm it’s someone with whom you feel comfortable.
- Do all that you can to avoid being rushed, so that you are loose and relaxed.
- If it would make you feel better, bring along a trusted friend or family member.
- Consider wearing socks or a loose skirt if you prefer to retain some of your own clothing during the exam.
- Let the medical professional know if you have any questions for them before they leave the room.
For ways you can keep your cervix healthy in between Pap smears, be sure to check out this article from our “FAM Basics” series: “FAM Basics: Caring for Your Cervix.”
This article was updated on 8/27/2024 to include information about the fact that HPV (and consequent cervical cancer) risk is highly correlated with the number of sexual partners one has.
This article was updated on 9/04/2024 to include information about pediatric speculums for pap smears in women who have not yet had sex, given birth, or are postmenopausal.
References:
[1] Sasieni P, Castanon A, Cuzick J. Effectiveness of cervical screening with age: population based case-control study of prospectively recorded data. BMJ. 2009 Jul 28;339:b2968. doi: 10.1136/bmj.b2968. Erratum in: BMJ. 2009;339:b3115. PMID: 19638651; PMCID: PMC2718082.Additional Reading:
Birth control and cervical cancer: What’s the link?
FAM Basics: What is Cervical Mucus?
Cervical ectropion: A potential fertility awareness curveball
It’s very important to note that a woman should NOT have intercourse AFTER her PAP smear for at least 10 days (in a healthy woman) to 3 weeks to let her cervix heal after the exam. Abnormal pap smears can also be caused by cells that became abnormal because of sperm contact with the cervix before it had time to heal! Barbara O’Niell has more to share about Pap Smears in her Youtube video “Healing Hormones Naturally”.
It feels a bit like gaslighting to say it shouldn’t hurt or it will be pain free. I’ve had several of them and they are not pain free. People should be allowed to know it’s not something wrong with them if it hurts.
Hi Kris, thanks for your comment! We do believe that the procedure shouldn’t be painful, but we will clarify, as you’ve pointed out, that if it is, it’s not through the patient’s fault.