What You Need to Know About Pap Smears

Pap smears are an important part of a woman’s regular health care, and the procedure is very simple and quick. Here are some facts to know before getting a Pap smear.

What is a Pap smear?

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

The same Pap smear sample can also be sent to check for human papillomavirus (HPV), which is the cause of the majority of cervical cancers. The earlier cervical cancer is identified and treated, the more likely it is that it can be cured.

Who needs to get a Pap smear?

Every woman should get regular Pap smears in order to help prevent the development of cervical cancer. The current guidelines are:

  • Women should start getting regular Pap smears at the age of 21.
  • From 21 to 29, women should get a Pap smear every three years.
  • Starting at age 30, women should get a Pap smear and an HPV test every five years as long as test results are 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 stopping screening.

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, and even women who are not sexually active should begin regular screening at 21.

What happens during a Pap smear?

A Pap smear is a simple procedure and is usually 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 to show the cervix. The cervix is positioned at the top of the vagina between the vagina and the uterus. The doctor will then use a small brush or spatula to gently remove cells from the cervix. The entire procedure takes around five minutes.

The collected cells will then be preserved and 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 the “risk-based estimates” to help you decide what the best next step is. Based on your current Pap smear result, your previous Pap smear screening results, and medical history will help your doctor determine your risk of having cells on the cervix that may become cancer later on (i.e. precancer). 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.

About the Medical Reviewer

Ross Berkowitz, MD, and Annie Leung, MD

Dr. Berkowitz received his MD from Boston University in 1973 and completed residency training in surgery at the Peter Bent Brigham Hospital. He trained in obstetrics and gynecology at the Boston Hospital for Women, where he completed a fellowship in gynecologic oncology. He joined the faculty of Brigham and Women's Hospital in 1980, and is the director of the Division of Gynecologic Oncology at Dana-Farber/Partners CancerCare.