May 20, 2026
For many women, a Pap smear is something you check off your to-do list — a routine part of staying healthy. Your doctor or OB/GYN says it's time for your Pap smear, and you do it. But do you know what a Pap smear does, why it matters and when it's recommended?
This quick screening is one of the most powerful tools to prevent cancer before it starts. "A Pap smear tests the surface of the cervix to look for abnormal cells that could lead to cervical cancer," says Nicole Shields, WHNP, a women's health nurse practitioner at MU Health Care. The ability to detect changes early is what makes cervical cancer largely preventable.
Still many women have questions — or even anxiety — about the screening process and abnormal results. Shields helps us answer the most common questions about Pap smears so you can feel informed, confident and in control of your health.
What Is a Pap Smear?
Cervical cancer is slow-growing and highly preventable with screening. A Pap smear screens for abnormal cervical cells that could eventually become cancer.
To check for abnormal cells, your primary care doctor or OB/GYN collects a small sample of cervical cells, typically during a pelvic exam. The screening test only takes a few minutes. Your doctor opens your vagina using a medical instrument called a speculum. The cells are gently collected using a soft, narrow brush or tiny spatula inserted through your vagina to reach the cervix.
"There's absolutely no reason for us not to catch cervical cancer before it becomes something severe," Shields says. "But prevention requires appropriate and consistent screening."
When Should You Start Getting Pap Smears and How Often Do You Need One?
Experts recommend getting your first Pap Smear at age 21. Since cervical cancers do not run in families, the initial guidelines are the same for everyone.
Until you are 29 years old, you should have a Pap smear every three years, as long as the results remain normal. How often you need screening may change based on what previous screenings show. After age 29, screening frequency extends to every 5 years when you add human papillomavirus (HPV) co-testing. The cells collected during your Pap smear are now also automatically tested by most providers for HPV — a critical risk factor for cervical cancer.
“If you're getting abnormal results, it's going to change the timeline of your screening,” Shields says. "Immunocompromised patients may also need more frequent screening — regardless of their age — because their bodies may not be able to fend off cancer-causing viruses like HPV."
Most guidelines recommend stopping routine Pap smears at age 65. Your doctor may make a different recommendation based on your individual risk and history of Pap smear abnormalities.
Why Does Cervical Cancer Screening Only Include HPV Testing After Age 29?
HPV is the most common virus that causes cervical cancer — associated with more than 90% of cases. HPV is also extremely common — more than 75% of people will have it at some point and most will never know it.
Young, healthy bodies have robust immune systems that naturally clear the HPV virus, so testing for it is not as critical at younger ages. But by age 30, your body is less likely to fight off the virus, so HPV testing is added as part of your Pap smear.
"If HPV co-testing shows that you are negative for HPV and you have normal cells in your Pap smear sample, your risk of getting cervical cancer is less than 1%," Shields says. "Then, we can extend your Pap smear to five years apart."
It’s important to note HPV vaccines exist and are one of the most effective tools to prevent cervical cancer. It can also prevent recurrence for patients who have had treatment for precancerous cervical conditions in the past. The vaccine is currently approved for both men and women between the ages of 9 and 45, though is most effective when received between the ages of 11 and 13.
Does a Pap Smear Hurt?
Anxiety and discomfort are common and valid concerns when it comes to Pap smears. While the Pap smear itself should not be painful, the experience can be uncomfortable. Although most patients do not require pain management for a Pap screening, your medical provider or OB/GYN understands your concern or fear and can offer options to help you relax.
Your health care provider may recommend:
- Anxiety medication
- Over-the-counter anti-inflammatory drugs for post-procedure cramping
- Numbing sprays
- Local anesthesia
Stopping the procedure is also always an option. "It is 100% appropriate for every woman to advocate for pain management and anxiety support," Shields says. "Even after the screening begins, if it's too much, tell your provider to stop. Then you can revisit what you need for pain control."
An alternative to Pap smear screening is a self-collection HPV test. You collect a vaginal sample in the privacy of your home that will be submitted for HPV testing. Self-collection HPV screening is not as effective as testing for HPV with a Pap smear. But for someone who is anxious or does not have access to screening with a provider, self-collection is a beneficial option.
"Anything that gets somebody who's not screening to screen is a great idea," Shield says. "Testing and following up on abnormal results will decrease your risk and the cancers we see."
What Happens If Pap Smear Results Are Abnormal?
Abnormal Pap smear results occur in approximately 4% of screenings. An abnormal result does not necessarily mean the cells are precancerous, just that they show early or temporary changes.
"Remember, a Pap smear is a screening test, and an abnormal result is not a diagnosis," Shields says. "But it does mean that we need to take a closer look to see what's going on."
The most common reason a Pap smear is abnormal is the presence of atypical squamous cells of unknown significance (ASCUS). The cells don't look normal but aren't necessarily cancerous. They could be caused by many things, such as inflammation or infections, including HPV.
Whether your results are due to ASCUS or possible precancerous conditions, your doctor will consider previous screening results, cervical treatments and personal health factors when determining next steps.
Your doctor may recommend one of the following:
- Repeat screening: Having another HPV test or a Pap smear with HPV co-testing in one or three years will highlight any changes to slightly abnormal cells.
- Colposcopy and biopsy: A closer exam of the cervix with a colposcope provides a better assessment of cancerous or precanerous tissue. A cervical tissue sample is taken at that time for evaluation in a laboratory.
If your cell changes are moderate to severe, your doctor may suggest treatment to remove or destroy cells that are at high risk for becoming cancer. The most common treatment methods include:
- Loop electrosurgical excision procedure (LEEP): A thin wire loop and electrical current are used to remove a cone-shaped piece of tissue. This procedure is typically performed under local anesthesia in your doctor's office.
- Cold knife conization: Your doctor removes abnormal cervical tissue with a scalpel in a hospital under general anesthesia.
"If you've had treatment to your cervix for high-grade abnormal cells, then you will have a Pap smear every three years for at least 25 years," Shields says. "We want to minimize the risk of recurrence."
Do You Still Need a Yearly Pelvic Exam If You Don’t Need a Yearly Pap Test?
Even though most women do not need a yearly cervical cancer screening, a yearly pelvic exam is still recommended, especially after the age of 21. Examination by a health care professional can identify abnormalities of the reproductive organs such as the vulva and vagina without waiting until your next Pap smear. You and your provider can decide together whether yearly pelvic exams are appropriate or necessary for your care
"As women, we often put our health care on the back burner, even if we don't feel great," Shields says. "But it's critical to be seen by a provider to prevent health issues that could be life-changing."
Next Steps and Useful Resources
- Want to discuss more with a doctor? Find one today.
