A Pap smear (also called a Pap test) screens for cervical cancer. The test checks for abnormal cells in the cervix that are cancerous or have the potential to become cancerous. During a Pap smear, your healthcare provider takes cells from your cervix to examine under a microscope for signs of cancer. A Pap smear may also detect certain infections and inflammation.
The cervix is the lower part of your uterus that connects to your vaginal canal. Sperm travels through the vaginal canal and cervix to your uterus to fertilize eggs. During pregnancy, the cervix closes to keep the baby in your womb (uterus). The cervix opens during childbirth. When you aren't pregnant, your cervix makes mucus to keep infection-causing bacteria out of your body.
Healthcare providers perform Pap smears as part of a pelvic exam. The test checks for:
. Cervical cancer.
. Potentially precancerous cells in the cervix (cervical intraepithelial neoplasia).
. Human papillomavirus (HPV), a common sexually transmitted disease (STD) that increases the risk of cervical cancer.
During a pelvic exam, your healthcare provider examines and feels (palpates) your uterus, ovaries and other parts of the female reproductive system. This examination helps your provider identify infections, problems and cancer if visible. Your provider may also perform STD tests during a pelvic exam. A pelvic exam doesn't always include a Pap smear.
HPV tests check for certain types of the virus that increase your cervical cancer risk. HPV is a common STD that affects approximately 79 million Americans. There are many different types of HPV. Not all cause cancer.
Providers can do HPV tests and Pap tests at the same time, using the same steps (a gentle scrape of your cervix for cell samples). When sending these samples to a lab, your provider specifies whether the lab specialist (pathologist) should check for precancerous or cancerous cells (Pap smear), HPV or both (a co-test).
A Pap smear can't detect STDs. To test for diseases like chlamydia or gonorrhea, your healthcare provider takes a swab from your cervix. Blood tests can also identify certain STDs.
Women and anyone assigned female at birth should start getting Pap smears starting at age 21 and HPV tests at age 30.
How often you'll have the test depends on many factors, including your age, health history and results from your last Pap or HPV test. Most people don't need Pap smears after age 65.
Generally, Pap smears occur:
Pap smear frequency
Younger than 21
21 to 29 years old
Every three years.
30 to 65 years old
Every three years with a Pap test alone or every five years with
a Pap/HPV co-test.
Older than 65
Not necessary if you've had adequate prior screenings, with
normal results and are not at high risk for cervical cancer.
Certain factors may cause you to have more frequent screenings or screening past age 65. Some of these are:
. Having human immunodeficiency virus (HIV) or being immunocompromised from another condition or treatment like chemotherapy.
. Exposure to diethylstilbestrol (DES) while in your mother's womb. This medication can increase your risk of cervical cancer.
. Having been treated for cervical cancer.
If you've had a total hysterectomy (cervix and uterus removed) and do not have a history of cervical cancer, you may not need a Pap test.
A total hysterectomy is a surgical procedure to remove your uterus and cervix. You may still be at risk for cervical cancer, so talk to your healthcare provider to make sure you can stop having regular Pap tests.
If you had a complete hysterectomy to treat a noncancerous problem, such as uterine fibroids, you probably won't need Pap smears.
Pap smears are very safe and highly reliable. You may experience light spotting (vaginal bleeding) after the test, but you shouldn't have cramps or pain. There is a small risk of false-negative or incorrect results, but this is rare.
Some things that you do in the days before a Pap smear can affect test results. For the most accurate results, you should:
. Not have vaginal sex for two days before your exam.
. Not use tampons, vaginal creams or medicines, birth control foams or jellies, lubricants or douches for at least two days before the test.
. Schedule the appointment at least five days after your period ends.
During the procedure, your healthcare provider:
. Inserts a speculum into the vagina. You may feel a bit of pressure. This metal or plastic tool holds your vagina open so your provider can see your cervix.
. Uses a small brush or spatula to gently scrape cells from your cervix (a biopsy).
It isn't painful, but you'll probably feel some discomfort.
The test itself takes just a few minutes and is performed in your healthcare provider's office.
Your healthcare provider will place the cell sample in a liquid substance in a tube or jar and send it to a lab. A specialist called a pathologist examines the samples under a microscope to look for abnormal cells that may indicate cancer or HPV.
A Pap smear should not hurt but may feel uncomfortable. You could experience light bleeding afterward, but you should not feel pain or cramping. Let your healthcare provider know if you feel discomfort lasting more than a few minutes or if the bleeding lasts longer than 24 hours.
It's best to avoid having a Pap test while on your period as it could alter the results. Some healthcare providers will perform a Pap test at the end of your menstrual period (when bleeding is light). It's best to check with your provider's office to see what they recommend or reschedule your Pap for when you are not on your period.
It can take up to three weeks for your healthcare provider to receive the lab results. Your healthcare provider will let you know when to get your next Pap smear or if you need further testing.
When you receive your results, they may be:
. Normal: No sign of disease. This means nothing irregular was found.
. Unclear: The lab couldn't determine whether the cells are normal or abnormal. Your healthcare provider may have you come back immediately or in six months for another Pap smear.
. Abnormal: The cells look different than they should.
An abnormal finding means that some cells in your cervix look unusual. In some cases, this could indicate precancerous changes of your cervix. An abnormal Pap smear doesn’t mean you have cancer. But, it does require careful follow-ups with your healthcare provider.
If you have an abnormal Pap smear result, your healthcare provider will likely perform a procedure called a colposcopy or may perform another Pap smear immediately or in a few months.
Pap smears only screen for cancer — they can't diagnose it. To get more information to help diagnose or rule out cervical cancer, your provider does a colposcopy. During this procedure, your provider:
. Uses a microscope device (colposcope) to view the lining of your cervix and vagina.
. Removes tissue samples from areas that look abnormal.
. Sends the samples to a lab for testing.
Pap smears are a lifesaving screening tool. The test identifies abnormal cervical cells before they have a chance to become cancerous. More than 95% of the time, people treated for precancerous cells don't develop cervical cancer. During a Pap smear, your healthcare provider may remove cells to test for HPV, an STD that increases your risk of cervical cancer. An unclear or abnormal Pap test result doesn't mean you have cancer. Your provider can discuss test findings and the next steps with you.
No, a Pap test doesn't detect ovarian cysts. However, a pelvic exam can detect a large ovarian cyst. During a pelvic exam, your healthcare provider feels your uterus and pelvis for lumps or masses. If a cyst is detected, they will likely order additional testing and discuss treatment options with you.
Not all cervical cancers are caused by being sexually active. Even if you are not having sex, you still need a Pap smear if you're over the age of 21.