What You Need to Know About Pap Smears

Pap smears and HPV testing can be an important part of a person’s regular health care, and the procedure is very simple and quick.  

What is a Pap smear? 

A Pap smear, or Pap test, is a procedure that screens for cervical cancer. More specifically, it is used to check for abnormal cells on the cervix that may lead to cancer if not treated properly. 

Pap smear samples can also be sent to check for human papillomavirus (HPV), which causes most cervical cancers. For some people, doctors will recommend checking for HPV instead of, or in addition to, a pap smear. The earlier cervical cancer is found and treated, the more likely it is that it can be cured. 

Who needs to get a Pap smear or HPV testing? 

Every person with a cervix should get regular Pap smears to help prevent the development of cervical cancer. The current guidelines are: 

• Start getting regular Pap smears at the age of 21. 
• From 21 to 29, get a Pap smear or HPV test as directed by your doctor. 
• Starting at age 30, get a Pap smear and/or HPV test every five years if test results have been normal. This should continue until the age of 65. 
• Women over the age of 65 who have had regular screenings over the last 10 years with consistently normal results may consider ending screening. You may still need a pap or an HPV test if you have bleeding or symptoms. 
• If your tests are abnormal at any point your doctor will recommend additional testing 

Do you still need a Pap smear if you aren’t sexually active? 

Cervical cancer is most often caused by an infection of human papillomavirus (HPV), which is a sexually transmitted infection. Those who are not sexually active are unlikely to contract the virus, but there are other risk factors for cervical cancer (i.e., smoking or a compromised immune system), and even people who are not sexually active should begin regular screening at 21. 

What happens during a Pap smear and HPV test? 

A Pap smear is a short, simple procedure performed in a doctor’s office or clinic. You will be asked to undress from the waist down and lie on an exam table with your feet propped up in stirrups. The physician will then insert an instrument known as a speculum into your vagina to push apart the walls of the vagina and show the cervix which is positioned between the vagina and the uterus. The doctor will then use a small brush or spatula to gently remove cells from the cervix.  

The collected cells are sent off for testing for either HPV, abnormal cells (i.e., cytology), or both. 

Is the procedure painful? 

A Pap smear should not be painful. The test can be uncomfortable, as the speculum will put pressure on the inside of the vagina, but it should not cause pain. You may have mild spotting after the procedure, but if the bleeding is heavy, you should speak to your healthcare provider. 

Advice if you’re feeling anxious 

It is normal to be nervous before getting a Pap smear, and there are several things you can do to help reduce pain or discomfort before and during the test. 

• Remember that you are in control, and if you need to stop at any point, don’t be afraid to say something. 
• Ask if you can take an over-the-counter pain medication before the procedure (a non-steroidal anti-inflammatory such as ibuprofen). 
• Pee before the exam, as that can help to relieve some of the pressure felt during the exam. 
• Ask the doctor to use a smaller speculum. 
• Try to breathe deeply during the procedure to help stay calm and keep yourself relaxed. 
• Try to keep your pelvic muscles relaxed as tense muscles will increase pressure and discomfort. 
• Ask if you can listen to music during the exam to help distract yourself. 

What happens after my Pap smear? 

Once you and your physician receive the results of the test, your physician will use something called “risk-based estimates” to help you decide what the best next step is. Based on your current Pap smear or HPV test result, your past screening results, and medical history, your doctor will determine your risk of having precancerous cells on the cervix.  

For most patients, the risk of finding precancerous cells is low and you and your physician may decide to repeat the test in one, three, or five years. If the estimated risk of finding precancerous cells is greater than 4% (which is still very low), your physician may suggest undergoing a procedure called a colposcopy, which would allow your physician to get a closer look at the cervix and decide if further testing is needed. 

Can a Pap smear detect ovarian cancer? 

Ovarian cancer cannot be detected by a Pap smear. The only gynecologic cancer that a Pap smear screens for is cervical cancer. There is no reliable way to regularly screen for ovarian cancer. It is therefore important to stick to a regular OB/GYN visit schedule and to report any concerning signs or symptoms right away. Patients should also discuss potential ovarian cancer risk factors such as family history.