Pap Smear: What to Expect

Medically Reviewed by Jabeen Begum, MD on March 29, 2024
Written by Kathryn Whitbourne
8 min read

A Pap smear, also called a Pap test, is an exam a doctor uses to find out if you have cervical cancer. The test can also see changes in your cervical cells that may turn into cancer later. It is named after Georgios Papanikolaou, the Greek doctor who invented it.

The test is done by collecting cells from your cervix, the lower narrow end of your uterus (womb) that connects your womb to your vagina (birth canal). The cells are checked to see if they have any signs of cancer.

A Pap smear looks for changes in cervical cells before they turn into cancer. If you have cancer, finding it early gives you the best chance of fighting it. If you don’t have cancer, finding cell changes early can help prevent you from getting cancer.

 

You should have the test every 3 years from ages 21 to 65. It's usually combined with a pelvic exam.

You may choose to combine your Pap testing with human papillomavirus (HPV) testing starting at age 30. If you do so, then you can be tested every 5 years instead of every 3 years. HPV is the most common sexually transmitted infection (STI), and it’s linked to cervical cancer.

Your doctor may recommend you have a Pap test more often than once every 3 years if you have:

  • Cervical cancer or a Pap test that revealed precancerous cells
  • HIV infection
  • A weakened immune system due to an organ transplant, chemotherapy, or chronic corticosteroid use
  • Been exposed before birth to diethylstilbestrol (DES), a hormone given to pregnant women between 1940 and 1971

You can probably skip the Pap smear if:

  • You've had a total hysterectomy (since your cervix will have been removed)
  • You're over 65 and your last three tests were negative

Even if these conditions apply to you, talk to your doctor before discontinuing your Pap tests. They may want you to continue for certain reasons, for instance, if you're over 65 and currently have multiple sexual partners.

If you’re transgender or nonbinary

If you are a transgender man or nonbinary person with female anatomy, you should get a regular Pap test:

  • Every 3 years from age 25 to 49
  • Every 5 years from age 50 to 64

Before your appointment, consider the following:

  • Let your health care provider know about your gender identity or ask a friend to do it for you.
  • Ask if a friend can be in the examining room with you for added comfort.
  • Ask for a longer appointment so you have more time to ask questions and have some breathing room for the procedure.
  • Let your nurse/doctor know if you're on testosterone replacement therapy. This can make the Pap smear more uncomfortable for you due to reduced natural lubrication. If they know in advance, they can take steps, such as using more lubricant, to correct it.
  • You may want to have your Pap smear done at a clinic specializing in trans health care.

If you are a trans woman or nonbinary with male anatomy, you don't need a Pap test as you don't have a cervix.

You shouldn’t have a Pap smear during your period. Heavy bleeding can affect the accuracy of the test. If your test is scheduled for that time of the month, ask your doctor if you can reschedule.

For the most accurate Pap smear, doctors recommend taking the following steps, starting 48 hours before your test.

  • Don’t have sex or use lubricants.
  • Don’t use sprays or powders near your vagina.
  • Don’t insert anything into your vagina, including tampons, medications, creams, and suppositories.
  • Don’t rinse your vagina with water, vinegar, or other fluid (such as a douche).

It takes about 10-20 minutes for the whole exam, but only a few minutes for the actual Pap smear. The test is done in your doctor’s office or clinic.

You’ll lie back on a table with your feet placed firmly in stirrups. You’ll spread your legs, and your doctor will insert a metal or plastic tool called a speculum into your vagina. They’ll open it so that it widens the vaginal walls. Then, they'll shine a light inside the vagina to see your cervix. 

Your doctor will lightly brush the cervix to take a sample of cells. They’ll place them into a liquid substance in a small jar and send them to a lab for review.

Pap smear tool

The tool used for the Pap smear is the speculum. It has two arms on a hinge, like a bird's bill. When the arms of the speculum are open inside your vagina, the vaginal walls widen. When the arms are closed, they narrow.

Doctors use different sizes of speculums. If you're a virgin or have undergone menopause, they may use a smaller speculum for comfort. If you've given birth vaginally, the speculum used may be on the larger side.

Do Pap smears hurt?

They don't hurt but can feel uncomfortable. Your doctor may tell you to relax or try to distract you with small talk, as feeling relaxed will allow the speculum to go in more easily than if you tense up. You'll likely feel the speculum inside your vagina but it shouldn't hurt you. The test only takes a few minutes. 

Some people have light bleeding afterward but it doesn't last long. If you do have bleeding, don't have sexual intercourse after your Pap smear for 24 hours.

Does a pap smear test for STDs?

No, it's strictly to look for abnormal cancer cells in the cervix. The test can check for HPV, which is sexually transmitted, but not every Pap smear does this. You usually have to request this in advance. If you'd like to get tested for STDs, you'll usually need to take blood and urine tests. Your doctor may also order one after examining you.

Your doctor will get your results — either negative (normal) or positive (abnormal) — within a few days.

Normal result

A negative result is a good thing. That means your doctor didn’t find any precancerous or cancerous cells on your cervix. You won’t need another Pap smear until you’re due for your next scheduled one.

If your results come back positive, it doesn’t automatically mean you have cancer. There are several reasons you could have an abnormal Pap smear.

  • Mild inflammation or minor cell changes (dysplasia)
  • HPV or other infection
  • Cancer or precancer
  • Lab test error

Most often, the abnormal test result means there have been cell changes caused by the human papillomavirus (HPV). Changes to your cervical cells caused by HPV can be mild, moderate, or severe.

Inflammation can happen if you’ve had sex or used a diaphragm shortly before having a Pap smear.

If you have inflammation or minor cell changes, your doctor may take a “wait and see” approach. They may suggest you have another Pap test in a few months.

Will I need more tests?

Your doctor will review your test results and let you know. Their answer will depend on what type of abnormal cells are found in your cervix. The most common ones are listed below.

Atypical squamous cells of undetermined significance (ASCUS). Thin, flat cells called squamous cells grow on the surface of a healthy cervix. ASCUS haapens when these cells are not typical. Your doctor will do a test with a special liquid to see if HPV is present. If it’s not, there’s probably no need for concern.

Squamous intraepithelial lesion. These cells may be precancerous. Doctors call changes to them “low-grade” or “high-grade.” If they’re low-grade, a precancerous cell may not turn to cancer for many years. If it’s high-grade, the cells could turn to cancer much sooner. Your doctor will likely order more tests, including a colposcopy, a procedure that shows changes in the cervix, requiring a biopsy of cervical tissue to check for cancerous cells.

Atypical glandular cells. These cells make mucus. They grow in the opening of your cervix and inside your uterus. If they appear to be abnormal, your doctor will order more tests, including a colposcopy, to find out for sure if it’s cancer.

Squamous cell cancer or adenocarcinoma cells. This means the cells on your cervix are so abnormal that your doctor is almost certain it’s cancer.

To be sure, your doctor will likely order two other tests: a colposcopy and a biopsy.

During a colposcopy, your doctor will insert a speculum into your vagina, just like they did for the Pap test. This time, they’ll look at the cervix with a colposcope. This is a tool that has a lens and a bright light that allows your doctor to get a better look at your cervix. They will swab your cervix with vinegar or some other liquid solution. It’ll highlight any suspicious-looking areas. Your doctor will be able to see them through the lens of the colposcope.

If your doctor finds areas that don’t look right, they’ll take a sample (this procedure is called a biopsy). They’ll send the tissue to a lab for further testing.

A Pap smear is considered a safe procedure. But sometimes, the test may miss some abnormal cells or cervical cancers. This is called a false negative. Talk to your doctor about the benefits and risks of cervical cancer screening.

A Pap smear is a test to check for cervical cancer. If you have a cervix and are between the ages of 21 and 65, you should have the test every 3 years. The test is performed by inserting a speculum into your vagina and collecting some cells from your cervix that are analyzed at a lab. It's usually quick and painless, with minor discomfort.

How often do you need to get a Pap smear?

Every 3 years if you're aged 21-65. If you combine this with an HPV test, you can wait 5 years between tests. You don't need to do an HPV test before age 30. You should still see your OB-GYN every year for routine care, such as pelvic or breast exams, or to discuss birth control or getting pregnant.

At what age should a woman get a Pap smear?

You should start at age 21. Before 21, the chance of having cervical cancer is very low (even if you're having sex regularly). So, the American College of Obstetricians and Gynecologists doesn't recommend the test below that age. On the other hand, if you haven't started having sex by 21, you should still start getting a Pap smear. That's because you can get cervical cancer from things other than sex, such as smoking, although this is quite rare.