What to Expect at a Pap Smear

Maybe you had a bad experience with your last Pap smear and you’re wary of going back to the ob-gyn. Or maybe you’ve never had one before and are scared to make the appointment. It’s understandable to feel anxiety about women’s health care, but a Pap smear is an important screening tool for cervical cancer.

“A lot of people feel really nervous or anxious to get a Pap smear, and some people aren’t quite sure of exactly what we’re testing for,” says Dr. Jayme Trevino, an ob-gyn and fellow with the American College of Obstetricians and Gynecologists (ACOG). “One of my goals when a patient is coming to me for a Pap test is to thoroughly explain exactly what we’re looking for and the steps of the process.”

Here, two ob-gyns explain what a Pap smear entails and dispel some common misconceptions about the potentially life-saving test.

What is a Pap smear?

A Pap smear involves collecting a sample from the cervix to test for abnormal cells that are cancerous or could lead to cervical cancer. The procedure typically only lasts for a minute, if that. Your medical provider will insert a speculum into your vagina, and then swab a sample from your cervix.

Cervical cancer grows slowly, says Dr. Jennifer Lincoln, an ob-gyn in Portland, Ore. The earlier you can catch precancerous cells, the faster you and your medical provider can come up with a plan to treat them and prevent them from turning into cancer.

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People often confuse the procedure with a human papillomavirus (HPV) test or a pelvic exam. While an HPV test involves the same steps as a Pap smear—a speculum and a swab of the cervix—the lab tests specifically for strains of HPV, which can also lead to cervical cancer. A pelvic exam, meanwhile, is when a medical provider checks the uterus, cervix, and other parts of the reproductive system by using their fingers and hands or a speculum.

“The biggest misconception is that people think any time they’re having a speculum placed in their vagina, that that is a Pap smear,” says Lincoln, who previously made a YouTube video demonstrating the different procedures. “It’s really important for people to know that a Pap smear is a procedure where we are getting a little brushing or a sample of cervical cells in order to see if they look abnormal—either that they are cervical cancer or they could potentially become cervical cancer. It’s a very specific test.”

How often should you get one?

Generally speaking, you should start getting regular Pap smears at age 21, according to ACOG’s guidelines. That’s a better guideline to follow than when you first become sexually active, experts say, even though the latter date might be sooner, because the chances of someone under the age of 21 getting cervical cancer is so small. 

How frequently you should go for a Pap smear after that depends on your age and risk factors. But typically, you should get the screening done every three years between ages 21 and 29, according to ACOG’s guidelines. Between the ages of 30 and 65, you can choose one of three options: get a Pap smear and an HPV test every five years, get a Pap test alone every three years, or get an HPV test alone every five years.

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If you’re 65 or older, you may not need to get regular Pap smears anymore if you have no history of cervical changes and have tested negative on three Pap smears in a row, two HPV tests in a row, or two HPV and Pap tests in a row within the past 10 years, according to ACOG.

Does it hurt?

While a Pap smear can be uncomfortable, it should not hurt.

“If a Pap smear is hurting, that’s a sign that something is not right,” Lincoln says. It could be how the test is being performed—for instance, if it’s not being done in a gentle manner or if you’re clenching because you’re not sure what to expect from the test—or it could be a sign of an underlying condition, such as a pelvic floor dysfunction issue or vaginal dryness, according to Lincoln.

“It should feel like pressure; it can feel uncomfortable for a couple of minutes, but if it’s causing acute pain, it is absolutely okay to say, ‘Stop, this hurts.’ And they should absolutely stop and then try to figure out what’s going on,” Lincoln says. “You’re not supposed to be crying or in pain.”

What happens afterward?

It’s possible that you may experience cramping or some spotting after the procedure, according to Lincoln. But heavy bleeding is not normal, she says.

The test results typically take a couple of days. Lincoln recommends asking your provider how you’ll be getting the results back—if your provider will call you to walk you through the results or if you’ll be getting them electronically, for instance—because it can vary depending on your provider and their office.

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If the results come back normal, all is well. If they come back unsatisfactory, it may mean you need to come back in for another Pap smear because the sample didn’t provide enough cells for the test. If the results are abnormal, don’t panic—most of the time that doesn’t mean you have cervical cancer. Talk to your provider about what the results mean for you. Depending on your risk factors and the types of cells detected—minor or serious ones—your provider might recommend coming in for additional tests, like a colposcopy, which is when a medical provider inserts a speculum into your vagina and uses a magnifying instrument to get a better look at your cervix.

Talk to your doctor in advance

While Lincoln and Trevino understand why people may feel anxious or wary of getting a Pap smear—“It’s not super fun,” Lincoln acknowledges—they both emphasize the importance of the test.

“I always encourage my patients to feel really empowered, especially during the exam, to let me know what’s going on and if they need me to stop,” Trevino says.

Both doctors say there are ways to make yourself feel at ease during a Pap smear—whether that’s bringing someone to the appointment with you for support, listening to music, or taking ibuprofen an hour or so before the exam to help avoid cramps.

Lincoln and Trevino also encourage people to talk to their provider about what the test entails so they can be informed before getting the procedure done.

“I just wish more people knew that for the vast majority of people, getting a Pap smear is not painful,” Lincoln says. “We fear the unknown. So being informed about what to expect, I think, is huge.”