Cervical Cancer Screening (Pap Smear)

Cervical cancer screening in the form of Pap tests (Pap smears) looks for abnormal cells or changes in the cells of the cervix. Regular Pap smears are the best method for both prevention of cervical cancer and for catching cervical cancer in the earliest stages, which is why they're strongly recommended.

What Does a Pap Smear Test For?

A pap test is used to detect abnormal cells that may lead to cervical cancer. A Pap test is not specifically designed to detect or diagnose endometrial cancer, ovarian cancer, HPV (human papillomavirus) or STIs (sexually transmitted infections.)

Do You Need a Pap Smear if You're Not Sexually Active?

Yes, you should still get regular pap smears even if you're not sexually active, says the American College of Obstetricians and Gynecologists.

Most cases of cervical cancer are caused by infection with HPV, which often shows no symptoms. So, most people don't even know they have HPV in the first place. Even without sexual intercourse, HPV can spread through genital contact without intercourse, although it's rare.

There are also other factors, such as smoking and HIV infection, that can affect your risk for getting HPV and developing cervical cancer.

How Often Should You Get a Pap Smear?

The American College of Obstetricians and Gynecologists guidelines recommend:

Women who are 21 to 29 should have a Pap test alone every 3 years. HPV testing alone can be considered for women who are 25 to 29, but Pap tests are preferred.
Women who are 30 to 65 have three options for testing. They can have a Pap test and an HPV test (co-testing) every 5 years. They can have a Pap test alone every 3 years. Or they can have HPV testing alone every 5 years.

These screening guidelines remain the same for women who have had a partial hysterectomy, where the cervix is left intact. However, women who’ve had a total or complete hysterectomy, where both the uterus and cervix are removed, usually don’t need to have a Pap test or HPV test.

How to Prepare for a Pap Test

Before your appointment, you may have questions like can you get your pap smear on your period or if you can have sex before a pap smear? For the most accurate test, the American Cancer Society recommends:

Avoid scheduling during your menstrual cycle, instead testing at least five days after your period has stopped
Avoid using vaginal care products—such as tampons, vaginal creams or lubricants—for up to 7 days beforehand
Don't use a douche for two to three days before the Pap test.
Try not to have vaginal sex for two days before the Pap test

What to Expect During a Pap Test

During a pap test, a sample of cells is collected from the cervix—the lower part of the uterus. A plastic or metal speculum with two arms is gently inserted to hold the vaginal walls wider apart, then a medical brush or spatula is used to lightly scrape cells from the cervix. These cells are then sent to be examined in a lab to check for any early signs of cervical cancer or pre-cancer.

You may experience discomfort during a pap test, but it should not hurt. It's common to experience light bleeding, or spotting, after a pap test.

Self-Collection Test

A new self-sampling test was approved by the Food and Drug Administration in May 2024 for women ages 25 and up. The test screens for up to 14 types of high-risk HPV strains that can lead to cervical cancer.

Self-Collection Instructions

Individuals are given a Q-tip to insert and swab the vagina. Similar to urine samples, the swab is placed behind a collection door in the clinic bathroom and recovered for analysis at a lab.

If the sample comes back normal, it’s recommended to screen again for HPV in five years. If it’s abnormal, your doctor will discuss next steps with you.

HPV tests with self-collection gives patients in rural communities, or those uncomfortable having a full pelvic exam, access to life-saving screenings.

Kits should be available at local health clinics or in primary care offices. Check with your OBGYN provider as well.

While the majority of cervical cancers are caused by HPV, two to five percent are not. That’s why the combination of a pelvic exam and traditional Pap smear is still considered the gold standard. In a pelvic exam, providers examine the vulva, vagina, cervix, ovaries and uterus. Additionally, some studies show higher false positive rates with self-collection — which could mean follow-up tests, including a pelvic exam.

HPV self-collection, however, has the potential to make screening more accessible and available to patients. People who may otherwise decline a traditional pelvic exam and pap screening may be open to a self-collection option, making it an acceptable alternative for cervical cancer screening.

HPV Self-Collection Test

A new HPV self-sampling test was approved by the Food and Drug Administration in May 2024 for women ages 25 and up. The test screens for up to 14 types of high-risk HPV strains that can lead to cervical cancer.

HPV Self-Collection Instructions