What Is a Pap Smear?

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A Pap smear (or Pap test) is quick and does not usually hurt. A Pap test is used to screen for cervical cancer. A provider can look at cells from your cervix under a microscope and check for abnormal changes in the cells (cervical dysplasia) and precancerous or cancerous cells. If any are found, more testing can be done to diagnose cancer.

This article will go over why Paps are used, what to expect during a Pap smear, how long a Pap takes, and how to understand your Pap test results.

What to expect during a pap smear
Illustration by Emily Roberts, Verywell

Why Is a Pap Smear Done?

A Pap smear helps providers pick up on abnormal cervical changes that, in some cases, may suggest that cancer is likely to develop or that cancer has already developed. In many cases, it is possible to identify and treat developing cancer before it has a chance to spread beyond the cervix. Pap smears usually are done as part of regular pelvic exams.

The Pap test is named after George Papanicolaou, the Greek doctor who invented the procedure during the early 1940s.

For certain people, cells taken during a Pap smear can also be tested for high-risk strains of human papillomavirus (HPV), which can cause various cancers. 

There are more than 100 strains of the virus, but not all of them cause the disease. Around 70% of cervical cancers are caused by HPV 16 and HPV 18, with another 20% of cervical cancers being related to infection with HPV 31, 33, 34, 45, 52, and 58.

When Should You Get a Pap Smear? 

The Pap is a screening test, so there are specific guidelines about who should have one, at what age they should be tested, and how often they need to be tested based on their risk facts.

As of 2023, the current recommendations for cervical cancer screening and HPV screening from the American College of Obstetricians and Gynecologists (ACOG) are:

  • Women ages 21-29 should have a Pap test alone every three years (but should not be tested for HPV).
  • Women ages 30-65 should have a Pap test and an HPV test (co-testing) every five years. It also is acceptable to have a Pap test alone every three years, although ACOG prefers the five-year co-testing schedule.
  • Women over age 65 can stop having Pap smears if they do not have a history of moderate to severe abnormal cervical cells or cervical cancer and they have had either three negative Pap tests in a row or two negative co-test results in a row within the past 10 years, with the most recent test done within the past five years.

Although these recommendations refer to all women, there are some risk factors for cervical cancer that may make having more frequent Pap smears important such as:

  • Having a family history of cervical cancer
  • A diagnosis of cervical cancer or a Pap smear that showed precancerous cells
  • Infection by the human immunodeficiency virus (HIV)
  • Weakened immune system (e.g., from an organ transplant, chemotherapy, or corticosteroids)
  • Early onset of sexual activity (intercourse)
  • Multiple sexual partners
  • A sexually transmitted infection, such as genital herpes or chlamydia
  • Previous cancer of the genital tract
  • Smoking
  • Exposure to diethylstilbestrol (DES) before birth (a drug that was often used to prevent miscarriage until research showed that females born to people who took DES were at an increased risk of cancer. In 1971, the U.S. Food and Drug Administration advised healthcare providers to stop prescribing DES during pregnancy)

If you've had a hysterectomy, you still may need to have Pap tests, depending on whether your cervix was removed. Cervical cells can remain at the top of the vagina after surgery, and if you have a history of moderate to severe cervical changes or cervical cancer, ACOG recommends that you continue to have Pap tests according to the schedule your provider sets for you.

Risks and Contraindications

There are no major physical risks of having a Pap smear. The test is very safe, even when you are pregnant. It will not harm you or the fetus. If fact, you may have a Pap test done as a part of your first routine prenatal visit.

After the Pap, you might have some discomfort and light spotting from the swab scraping the cervix.

Before the Test

Keep in mind that the timing of a Pap smear is important if you're menstruating. 

When you have your period, the blood and other tissue can affect the results of the test. Unless your provider advises otherwise, it's best to schedule a Pap smear for one to two weeks after you expect your period, or five days after your period ends.

If your cycle is unpredictable and you start your period when you’re due for your appointment, call your provider's office as soon as possible. You might be advised to reschedule, although some providers will go ahead with a Pap smear if your flow is very light.

Besides menstrual blood and tissue, there are some other things that can interfere with the accuracy of a Pap test by masking abnormal cells:

  • Sexual intercourse: Do not have sex during the 48 hours before your appointment.
  • Spermicides (foams, jellies, or other birth control products): If you are not having sex, it's unlikely you'll be using a spermicide, but you should not do so for 48 hours before your Pap smear.
  • Vaginal lubricants: Do not use lube for at least 48 hours before having a Pap smear.
  • Tampons: Do not insert a tampon for 48 hours before your Pap.
  • Vaginal douches: Douching is never recommended, but if you do, make sure that you stop for at least three days before your appointment.

If you forget these guidelines and have intercourse, douche, or use anything in the vagina in the two days before your appointment, call your provider to see whether you can reschedule. If you have to keep the appointment, tell your provider about the mix-up.

How Long Does a Pap Smear Take?

Although a Pap smear takes only a minute or two, the total amount of time you're at your appointment will be a bit longer—particularly if you'll be having the test as part of your regular gynecological check-up. An hour is typically enough time to plan for. 

If this will be your first visit to a provider, you might be asked to arrive 15 minutes or so ahead of time to fill out new patient forms, have your health insurance card photocopied for your files, and take care of your insurance co-pay if you have one.

Location

Your Pap test will take place in an exam room at your provider's office, hospital, or other medical facilities. The room will feature a gynecological exam table that can be lowered or raised to allow you to sit up or lie back and devices called stirrups attached at the foot end. The stirrups are there to allow you to comfortably rest your feet during your exam.

There also will likely be other medical equipment in the room, such as a blood pressure cuff and a scale.

What to Wear

You will need to take off all clothing from the waist down for a Pap smear. You might want to wear a dress or skirt so that all you have to take off is your underwear and shoes, but this is a personal preference.

If you're having a full gynecological check-up that includes a breast exam, you may have to take off all your clothes and put on a hospital gown with an opening in the front. Exam rooms can be chilly, so you might want to have a pair of socks.

Cost and Health Insurance

Most private insurance companies cover a Pap smear with no out-of-pocket cost to you. Medicare will cover a Pap smear every 24 months. If you had a previous Pap smear that was abnormal or you're at high risk for cervical cancer, Medicare will pay for a Pap test every 12 months.

If you do not have insurance, you still have options for paying for a Pap test:

  • Free or low-cost screening through the Centers for Disease Control and Prevention’s National Breast and Cervical Cancer Early Detection Program (NBCCED): This program supports people with a yearly income at or below 250% of the federal poverty level. The CDC has an easy-to-use, interactive map showing programs by state, as well as specific services for Native Americans.
  • Your local or county health department: Both of these departments are likely to offer free or low-cost Pap smears to low-income and/or uninsured people.
  • Planned Parenthood: If your income level exceeds the allowable amount at your county health department, you might be able to have a Pap test at your local Planned Parenthood for less than it would cost to pay a provider.

What to Bring

Bring your health insurance card and your co-pay with you on the day of your appointment. 

If you have any specific questions about the test or related concerns, make a list and bring it with you.

You will need to tell your provider what the first day of your last period was, as well as if you've had known exposure to HPV. Also, tell them about any health symptoms or concerns that have come up since your last exam (such as infections, unusual discharge, or pain).

If you had previous Pap smears, colposcopies, or biopsies that are not in your medical record (for example, because you're a new patient), bring copies of your results with you if you have them. The same goes for any treatment records.

During the Test

At your appointment, you will talk with an office receptionist who will check you in, a nurse who will guide you through getting ready for your Pap smear, and the provider (often a gynecologist) who will do the Pap test.

Pre-Test

There likely will not be any test-specific paperwork to fill out before, but you may need to fill out some new-patient forms if this is your first visit.

Once a nurse has taken you to an exam room, you will need to undress, either from the waist down or fully if you are also having an annual exam. You can leave your socks on if you're wearing them, especially if the room is cold. The nurse will give you a paper drape to place across your middle and upper thighs. 

Throughout the Test

When you've been given enough time to undress, the provider or nurse will knock on the door to make sure that you're ready. A nurse or other authorized person also may be present during your exam, per recommendations by the American Medical Association.

When the healthcare provider arrives, they may ask if you have any questions about the Pap smear. They will want to hear about any issues you may have been having or ask you about any abnormal Paps you've had in the past that they may not be aware of. They also may engage you in friendly chit-chat to help you relax.

To set up for the test, the exam table will be tilted back so that you are lying on your back. You will bend your knees and place your feet in the stirrups on either side of the foot end of the table. This will make it easier for you to keep your knees apart while the provider takes the sample. You will be asked to scoot your buttocks down to the very edge of the exam table.

To access your cervix, the provider will insert an instrument called a speculum made either of metal or plastic into your vagina to hold the walls open. If it's a metal speculum, it might be warmed up first to make it more comfortable. The provider will apply a lubricant to the speculum regardless of what type it is so that it slides in and out easily.

Once it is in, you may feel some pressure as the speculum is adjusted to allow a clear view of your cervix. You may hear a clicking sound as the practitioner widens the speculum. This may feel a little strange or uncomfortable, but it should not hurt. Taking deep breaths can help you relax.

If the speculum does cause pain, speak up. It might be possible for the provider to use a smaller one that will be more comfortable for you.

When the speculum is in place, the provider will insert a tiny swab or a brush with a long handle that resembles a mascara wand into your vagina. Once the instrument reaches your cervix, your provider will gently rub its lining to collect a sample of cells. You may feel a bit of discomfort or you may feel nothing at all. If your provider wants to test for HPV as well, a second or the same swab can be used for this purpose.

It will take just a few seconds for a sample to be taken and a total of just a few minutes to do the complete test.

To prepare the cell sample for the pathology lab, your provider will either spread the sample onto a slide or preserve it in a liquid. With the latter, cervical cell samples can be washed of blood or other substances that might obscure abnormalities. Research suggests that both methods are equally accurate, but liquid-based cytology allows for the testing of cells for HPV viruses.

Finally, the provider will gently slide the speculum out of your vagina and the test will be done.

Post-Test

If you are only having a Pap smear, you will be able to take your feet out of the stirrups. The exam table can be adjusted to make it easier for you to sit up.

You might be given tissues or wipes so that you can remove any leftover lubricant from around your vagina before you get dressed. The provider and nurse will leave the room so that you can do this in private.

You may need to stop by the desk on your way out, or you might be able to leave straight away. Ask a nurse or other office worker if you are not sure what to do before you leave. 

You also might ask how and when you'll be notified of the results of your test if you're unsure.

After the Test

After a Pap smear, you can go back to your normal activities. If you are spotting after the test, it should not be much—a light-flow maxi pad should be enough to absorb it.

If you are concerned about any bleeding you’re having after a Pap, call your provider's office to let them know.

Interpreting Results

According to the Office on Women's Health, it usually takes from one to three weeks to get the results from a Pap test.

If three weeks have passed and you still have not received the test results, contact your healthcare provider. While some providers will not contact you if the results are normal, don’t assume that “no news is good news.” If you're unsure about the office policy, give them a call.

The result will be either positive or negative. Negative results mean that there is no sign of cervical dysplasia. Positive results mean that abnormal cells were detected. If it is positive, your provider will likely include instructions on what to do next.

An abnormal Pap result does not always mean a person has cancer. Remember, the Pap is a screening test, not a diagnostic procedure. In fact, most abnormal Paps are not because of cancer.

Positive (Abnormal) Results

There are four types of abnormal Pap smear results:

  • Atypical squamous cells of undetermined significance (ASCUS): These results indicate there are slightly abnormal squamous cells—thin, flat cells that grow on the surface of the cervix. Changes in these cells do not clearly suggest precancerous cells, however. If your provider is concerned, they may want you to have another test. 
  • Squamous intraepithelial lesion: This term indicates that the sample cells might be precancerous. You will likely need to have follow-up tests to find out more about what this result could mean.
  • Atypical glandular cells (AGC): This result means the cells appear slightly abnormal, but it's unclear whether they're cancerous. Further testing is needed.
  • Squamous cell carcinoma or adenocarcinoma cells: This result means that cancer is very likely to be present. Your provider will likely want to see you right away to do more tests.

False Results

False positives and negatives are possible with any test, so that's why it's important to get routine testing. There is also a diagnosis called “unsatisfactorywhich can happen if:

  • Too few cells were collected.
  • You have only a small number of abnormal cells.
  • Blood or inflammatory cells in the sample hid the abnormal ones.

If you get an "unsatisfactory" Pap test result, the recommendation is to repeat the test in two to four months.

People who get false-negative results may end up not getting follow-up tests to confirm cervical cancer or treatment for it. It also is possible for Pap results to be false-positive, in which case unnecessary tests and even treatment might end up being done. 

Getting Pap test results that are not accurate can delay a cancer diagnosis. Cervical cancer is very slow-growing, and the changes in cells that can lead to cancer can take three to seven years to take place. A Pap test can help spot those changes early—even before cancer has developed.

A Pap test can be the only way a person can find out they have cervical cancer because symptoms may not appear until the disease is more advanced.

Screening guidelines recommend a Pap test every three years for early detection. The National Cancer Institute says that this recommended schedule minimizes "the harms caused by treating abnormalities that would never progress to cancer while also limiting false-negative results that would delay the diagnosis and treatment of a precancerous condition or cancer.”

If HPV and/or abnormal cells are missed on a test once, it's very likely that they will be caught the next time around. However, that can also mean that any disease that's present may not be as treatable as it would have been had it been caught sooner.

Follow-Up

If the results of your Pap smear are abnormal, your provider may want to repeat the Pap test or do another type of test, depending on the findings. These additional tests could include:

  • HPV Test: If an HPV test was not done at the time of your Pap, your provider may order one as a follow-up test.
  • Colposcopy: A colposcopy is an in-office exam that lets your provider view the cervix more closely with a lighted instrument that magnifies the cervix (a colposcope). The scope is placed outside the vagina during the exam and the images can be projected onto a screen for a detailed view and biopsy planning.
  • Punch Biopsy: During a colposcopy, a provider can take a small amount of cervical tissue to be checked under a microscope in a lab (cervical biopsy). A punch biopsy, which uses a device similar to a paper hole punch to get a tissue sample, is often done. It can be a little uncomfortable to have done but only takes a few seconds. Depending on what the colposcopy showed, a few areas of the cervix might need to be biopsied.
  • Endocervical curettage (ECC): This type of biopsy can also be done during a colposcopy. A provider uses a small brush to remove tissue from the narrow area between the uterus and cervix (endocervical canal) to be looked at by a pathologist. Endocervical curettage can be painful and may feel like bad menstrual cramps.
  • Cone Biopsy: This procedure is used when a larger biopsy is necessary—either to diagnose cervical cancer or to remove tissue so that it does not become cancerous. During a cone biopsy, a cone-shaped piece of tissue is removed to be looked at. This procedure is done under general anesthesia, so you won’t be awake or feel anything during it.
  • Loop electrosurgical excision procedure (LEEP): This procedure is an alternative to cone biopsy. A loop electrosurgical excision procedure uses an electrically charged wire loop to remove a tissue sample. It's done under local anesthesia and is more commonly used to treat high-grade cervical dysplasia rather than to diagnose cervical cancer. 

Abnormal cells found during colposcopy and biopsy are sometimes described as cervical intraepithelial neoplasia (CIN).

Summary 

The Pap smear is the best way to screen for abnormal cervical cells that could be cancerous or precancerous, as well as detect certain strains of HPV that are associated with cervical cancer. 

A Pap test is quick and painless and does not have serious risks, though it can still be awkward and uncomfortable. Since it requires exposing your vagina and inserting medical devices into an intimate part of your body, a Pap smear can be a source of anxiety—especially if you've never had one before. 

Fortunately, the procedure takes just a few minutes and most people only need to have one every three years. 

If your Pap results are abnormal, it does not necessarily mean that you have cancer. However, your provider will want to follow up, possibly with another Pap or different tests, to make sure. 

Frequently Asked Questions

  • How long does a pap smear take?

    A pap smear itself takes only one or two minutes, but the entire appointment may be longer. This is because pap smears can be performed during a regular or annual gynecological visit, which involves a doctor talking to you about other aspects of your health.

  • When should you get a pap smear?

    Pap smear screening usually starts at 21 years old. From ages 21-30 it can be performed every three years as long as there are no issues detected. At some point during the ages of 30-39, a pap smear may only be needed every five years if there are no signs of the human papillomavirus (HPV). This continues until around 65 years old, when a gynecologist will discuss if future screening is necessary. There may be variations to this timeline in the case of a hysterectomy (uterus removal) or if cervical cancer is detected.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

By Elizabeth Boskey, PhD
Elizabeth Boskey, PhD, MPH, CHES, is a social worker, adjunct lecturer, and expert writer in the field of sexually transmitted diseases.