A Pap smear (also called a Pap test) is a quick screening test that collects cells from your cervix to check for changes that could lead to cervical cancer. A small brush or spatula gently scrapes a sample of cells, which are then examined under a microscope for anything abnormal. Since widespread Pap screening began, cervical cancer incidence and deaths have dropped by roughly 70% in developed countries.
The test doesn’t diagnose cancer directly. Its primary job is catching precancerous changes early, when they’re highly treatable and long before they have a chance to become cancer.
What Happens During the Test
A Pap smear takes only a few minutes and is done during a pelvic exam. You’ll lie on an exam table with your feet in stirrups. Your provider inserts a speculum, a smooth plastic or metal instrument, into the vagina to gently hold the walls apart so the cervix is visible. The speculum can feel like pressure or mild discomfort, but it shouldn’t be painful. If it is, let your provider know so they can adjust.
Once the cervix is in view, your provider uses a soft brush or small spatula to collect a thin layer of cells from the surface. This part is fast and usually feels like a light scraping sensation. The cells go into a liquid solution or onto a glass slide and are sent to a lab for analysis. The whole process, from speculum in to speculum out, typically takes less than five minutes.
You may notice light spotting afterward, especially if you haven’t had the test before. That’s normal and usually stops within a day. You shouldn’t feel cramping or lingering pain. If bleeding continues past 24 hours or you feel significant discomfort, contact your provider.
How to Prepare
For the most accurate results, avoid vaginal intercourse, douching, and using vaginal creams, suppositories, or lubricants for about 48 hours before your appointment. These can wash away or obscure the cervical cells the test needs to examine. Scheduling the test for a time when you’re not on your period also helps, since blood can interfere with the sample. If your period arrives unexpectedly, your provider can decide whether to proceed or reschedule.
You’ll be asked to empty your bladder before the exam, which makes the pelvic exam more comfortable for you and easier for the provider.
Pap Smear vs. HPV Test
These two tests are related but look for different things. A Pap smear examines the actual cells under a microscope for visible abnormalities. An HPV test checks for the DNA of high-risk strains of human papillomavirus, the virus responsible for nearly all cervical cancers. Both tests use cells collected from the cervix, and they can be done at the same time from the same sample (called co-testing), so you don’t need an extra swab.
A Pap smear is not a test for sexually transmitted infections. It only screens for abnormal cell changes. If your Pap results come back unclear, your provider may run an HPV test on the same sample to determine whether a high-risk HPV strain is driving the changes.
When and How Often to Get Screened
Current guidelines from ACOG and other major organizations recommend starting cervical cancer screening at age 21. The schedule depends on your age and which tests you’re getting:
- Ages 21 to 29: Pap smear alone every 3 years. HPV testing alone can be considered starting at age 25.
- Ages 30 to 65: Three options are recommended. A Pap smear alone every 3 years, an HPV test alone every 5 years, or co-testing (Pap plus HPV) every 5 years.
- Over 65: Screening can generally stop if you’ve had consistent normal results over the previous years and your provider agrees.
These timelines apply to people at average risk. If you have a history of abnormal results, a weakened immune system, or other risk factors, your provider may recommend more frequent testing.
Understanding Your Results
Most Pap smear results come back normal, reported as “negative for intraepithelial lesion or malignancy.” That simply means no abnormal cells were found. If your results are abnormal, it does not mean you have cancer. Abnormal results are common and fall into a few categories:
ASC-US is the most common abnormal finding. It means some cells look slightly unusual, but the cause isn’t clear. Irritation, yeast infections, polyps, and hormonal shifts from pregnancy or menopause can all trigger this result without any connection to cancer. Your provider will typically order an HPV test on the same sample. If that comes back negative, the changes are likely harmless.
LSIL (low-grade squamous intraepithelial lesion) indicates mild cell changes, usually caused by an HPV infection. Most LSIL findings resolve on their own as the immune system clears the virus, but your provider will want you back for follow-up testing to make sure nothing progresses.
HSIL (high-grade squamous intraepithelial lesion) means more significant cell changes that could develop into cancer if left untreated. This result leads to a closer examination called a colposcopy, where your provider looks at the cervix through a magnifying instrument and may take a small tissue sample (biopsy) to determine exactly what’s happening.
What Happens After an Abnormal Result
The next steps depend entirely on the type and severity of the abnormality. For the mildest findings like ASC-US with a negative HPV test, your provider might simply schedule a repeat Pap smear in one to three years. For ASC-US with a positive HPV result, or for LSIL, the usual path is repeat testing sooner to monitor whether the changes persist or clear up.
HSIL results move more quickly toward a colposcopy. During this procedure, you lie in a similar position as the Pap smear, and the provider applies a mild solution to the cervix that highlights abnormal areas. If concerning tissue is found, a small biopsy is taken. The biopsy guides decisions about whether treatment is needed to remove the abnormal cells before they have any chance to become cancerous. These treatments are outpatient procedures with short recovery times, and they’re highly effective at preventing cancer from ever developing.
The key takeaway with any abnormal result is that catching changes early is exactly what the test is designed to do, and early-stage cervical cell changes are among the most treatable conditions in cancer prevention.