A Pap smear or Pap test (short for Papanicolau test) is a routine part of women\u2019s healthcare, so understanding what to expect and when you should get one can help you feel confident walking into your appointment. <\/p>\n\n\n\n
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. <\/p>\n\n\n\n
The cervix<\/a> is the organ that connects the vagina and its opening to the uterus. The cervix produces mucus<\/a> throughout the ovulatory phase<\/a> 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. <\/p>\n\n\n\n Routine Pap smears allow early detection of cervical cancer<\/a>* 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<\/a> [1]. <\/p>\n\n\n\n Pap smears can also be utilized to test for human papillomavirus<\/a>, known as HPV. <\/p>\n\n\n\n (*According to the CDC<\/a>, “almost all cervical cancers are caused by HPV.” HPV is most commonly spread by sex, and according to the American Cancer Society<\/a>, “HPV infections are more likely in people who have had many sex partners.” Therefore, the best way to avoid HPV\u2014and, by extension, cervical cancer\u2014is by practicing chastity and monogamy.)<\/p>\n\n\n\n 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<\/a>. <\/p>\n\n\n\n If you have certain risk factors like human immunodeficiency virus (HIV)<\/a> 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. <\/p>\n\n\n\n To increase the accuracy of a Pap smear<\/a>, it\u2019s 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. <\/p>\n\n\n\n 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. <\/p>\n\n\n\n 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\u2019ll 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\u2019ll lay back on the exam table, put your feet in stirrups, and adjust your body’s position as needed. <\/p>\n\n\n\n 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 <\/em>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. <\/p>\n\n\n\n *If you do <\/em>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<\/a> 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. <\/p>\n\n\n\n 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. <\/p>\n\n\n\n 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\u2019t need to be for another three years. <\/p>\n\n\n\n However, results may also come back abnormal, unclear, or unsatisfactory<\/a>. 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. <\/p>\n\n\n\n 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. <\/p>\n\n\n\n Pap smears are quick and simple, and being prepared<\/a> can help make the experience less intimidating. If you are going in for your first Pap smear, consider some of the following tips<\/a>:<\/p>\n\n\n\n It is important to be mindful of the fact that each woman\u2019s body and experiences are unique, and so her experience of getting a pap smear will be unique, too. Specifically for women who have experienced trauma\u2014sexual, medical, or otherwise\u2014it is important for them to be informed and aware of their rights and options when it comes time to get a pap smear.\u00a0<\/p>\n\n\n\n Writing for Medscape<\/em>, sexual medicine specialist Dr. Pebble Kranz draws attention to the special needs of women receiving pelvic exams and pap smears who have previously experienced trauma.<\/a> In order to serve these patients well, Dr. Kranz\u2019s trauma-informed approach seeks to equip patients with self-advocacy tools (such as knowing they can stop the procedure at any time, or ask for anesthesia), recognize and respond to subtle signs of discomfort, and \u201cacknowledge the parts of themselves that seek healing alongside those that deeply fear vulnerability.” This approach also involves describing the procedures to the patient, answering all her questions, and honoring her past experiences. Dr. Kranz says her trauma-informed approach to pelvic exams has allowed her to help her patients pursue the healthcare they need and desire.\u00a0<\/p>\n\n\n\n For ways you can keep your cervix healthy in between Pap smears, be sure to check out this article from our “FAM Basics<\/a>” series: “FAM Basics: Caring for Your Cervix<\/a>.” <\/p>\n\n\n\n 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. <\/em><\/p>\n\n\n\n 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. <\/em><\/p>\n\n\n\n This article was updated on 7\/05\/2025 to include information about a trauma-informed approach to pelvic exams.<\/em><\/p>\n\n\n\n References:<\/p>\n\n\n\n[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.<\/p>\n\n\n\n Additional Reading:<\/p>\n\n\n\n FAM Basics: What is Cervical Mucus?<\/a><\/p>\n\n\n\n Cervical ectropion: A potential fertility awareness curveball<\/a><\/p>\n\n\n\nWhy do women need Pap smears? <\/span><\/h2>\n\n\n\n
How often should I get a Pap smear? <\/span><\/h2>\n\n\n\n
How can I be sure the results of my Pap test are accurate?<\/span><\/h2>\n\n\n\n
What to expect during your Pap smear <\/span><\/h2>\n\n\n\n
What to expect after a PAP smear <\/span><\/h2>\n\n\n\n
Extra tips for a positive experience <\/span><\/h2>\n\n\n\n
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A final note on trauma-informed pelvic exams<\/span><\/h2>\n\n\n\n
Birth control and cervical cancer: What’s the link?<\/a><\/p>\n\n\n\n