When it’s time for your Pap smear appointment, your cervical cells aren’t the first thing that comes to mind. It’s “What are they going to do, and will it hurt?” Or maybe you’ve had Pap tests before, but you aren’t quite sure what they were testing you for or why you’re no longer getting one every year.
That’s a normal way to feel because the Pap smear samples a very intimate part of your body. But the procedure itself is usually described in only a sentence or two. So knowing what to expect can make it go much more smoothly.
On this page
- What is a Pap smear?
- What is the difference between a Pap test and an HPV test?
- At what age do you really need a Pap smear?
- What happens during a Pap smear?
- Does a Pap smear hurt?
- How do you prepare for a Pap smear?
- What do the results of a Pap test mean?
- What if your Pap smear is abnormal?
- Will I still need cervical screening if I get the HPV vaccine?
- What about the cost of a Pap smear?
- When to see a doctor?
Key takeaways
- A Pap smear checks cells from the cervix for precancerous changes that could develop into cervical cancer.
- A woman aged 21-29 at average risk should have a Pap every 3 years.
- At ages 30-65, clinician-collected high-risk HPV testing alone every 5 years is the preferred United States screening standard, although other options are still available.
- A Pap smear may feel uncomfortable or like pressure but shouldn’t cause significant pain.
- An abnormal Pap does not always mean cervical cancer, and many abnormal results reflect HPV-related or other cell changes that need monitoring rather than treatment.
- HPV vaccination lowers risk but does not eliminate the need for cervical cancer screening.
What is a Pap smear?
A Pap smear, also called a Pap test or cervical cytology, is a screening test for cervical cancer. When the test is performed, a clinician collects a small sample of cells from the surface of your cervix. The specimen is sent to a lab for analysis to look for changes that do not look normal.1
The key word here is screening. A Pap is done before there is any reason to think anything is wrong, with the idea that early cell changes can be identified, checked, or treated before they can become cervical cancer. It can also show infection or inflammation, but that is not the goal.1
It is also important to understand what a normal Pap result does not tell you. A Pap smear specifically screens the cervix. It does not screen for vaginal or vulvar cancer.2 It is also not a general test for sexually transmitted infections (STIs).3
What is the difference between a Pap test and an HPV test?
A Pap test screens for changes in the cells of the cervix. In contrast, an HPV test screens for high-risk types of human papillomavirus (HPV) that can cause those changes. These tests are related but ask different questions.1
Most HPV infections do not cause cervical cancer, but long-term infection with high-risk HPV types is the main cause of cervical precancer and cervical cancer.1
| Test | What it looks for | What the result tells us |
| Pap test | Abnormal cervical cells | Whether cervical cells look normal or have developed changes. |
| High-risk HPV test | High-risk types of HPV | Whether HPV types associated with cervical cancer are present. |
At what age do you really need a Pap smear?
For women at average risk, screening for cervical cancer starts at age 21. At that point, decisions are made based on your age, previous screening results, whether or not you still have a cervix, and whether there are any other risk factors you should be checked for.4
The current American College of Obstetricians and Gynecologists (ACOG) approach is:
| Age | Current cervical cancer screening approach |
| Younger than 21 | Routine cervical cancer screening is not recommended for women at average risk. |
| 21–29 | Pap test alone every 3 years. |
| 30–65 | Clinician-collected high-risk HPV testing every 5 years is preferred. HPV/Pap cotesting every 5 years is an acceptable alternative. Pap testing alone every 3 years may also be used when HPV-based testing is unavailable or is chosen after discussion with a clinician. |
| Older than 65 | Routine screening may stop if previous screening has been adequate and there are no factors that place you at higher risk. |
For women ages 30 to 65, patient-collected high-risk HPV testing every 3 years may also be considered when an FDA-approved test is used, and a healthcare system is in place to provide results and arrange any necessary follow-up.4
There is an important distinction here: self-collected HPV testing is not a self-administered Pap smear. HPV testing looks for the virus, while Pap testing examines cervical cells themselves.
Cervical screening guidelines vary slightly by organization. For example, the American Cancer Society includes primary high-risk HPV screening as an option beginning at age 25, while this article follows the current ACOG approach mentioned above.4
These recommendations are based on whether a person has a cervix, not on gender identity. Transgender men and nonbinary people who have a cervix may also need cervical cancer screening according to the same age- and risk-based guidance.5
What happens during a Pap smear?
A healthcare provider or clinician uses a tiny sampling brush or tool to collect cells from the cervix. The actual collection of cells happens pretty quickly, but it may take a minute or two to get into position and get a view of the cervix.16
You typically will lie on your back on a table in the clinic, with your knees bent and feet supported. A clinician will gently insert a speculum (a device that opens up the vaginal walls so the cervix can be seen).
Once the cervix is in view, the clinician uses a soft sampling brush or tool to sweep across the cervix and collect cells. Those cells go into a container and are sent to a laboratory for analysis.16
Knowing what each part of the exam does can make it feel less mysterious. The speculum opens the vagina so we can see the cervix. The brush collects a cell sample. The lab can then tell us what, if anything, is happening in those cells.
Does a Pap smear hurt?
For most women, a Pap will feel more uncomfortable than painful. You can experience a little stretching or pressure as the speculum is inserted and a brief brushing sensation while the sampling tool sweeps the surface of the cervix.67
Not every woman will have the same experience. It can be more uncomfortable if you have had painful exams before or have pelvic pain, anxiety, or a history of sexual trauma.
If you do experience pain, tell the clinician. A pelvic exam should not be a painful exercise endured in silence. You can ask what will happen, take a break, or ask them to stop. In fact, the American College of Obstetricians and Gynecologists (ACOG) specifically recommends you let them know if the pelvic exam hurts so that adjustments can be made.7
You can also ask for a chaperone to be present during the examination if one is not already offered, and you can let the clinic know about this preference before the visit.8
Sometimes knowing what will happen before it happens can help a lot. You don’t need to fake being relaxed; you just need to be informed, and you decide what happens to your body.
How do you prepare for a Pap smear?
Preparation for a Pap smear is minimal. There is no need to clean your vagina unnecessarily before the appointment. For two days before the test, avoid sex, tampons, douching, and any vaginal creams, suppositories, or medicines, since these can affect the sample.6
The Office on Women’s Health advises against douching before a Pap or HPV test. You should also avoid putting products inside or around the vagina specifically to clean it. The vagina does not need internal cleaning before cervical screening.6
Light bleeding usually doesn’t affect a modern Pap sample, but heavy bleeding can, so try to schedule the test for a day you don’t expect your period. If your period arrives unexpectedly on the day, call the clinic and ask whether to keep the appointment.6
You also don’t need to shave, wax, or change how your body normally looks. Your provider is interested in the accuracy of the cervical sample, not in your usual grooming habits.
Bring your screening history if you can. Knowing when your last Pap or HPV test was done, and what the result was, helps your provider determine your next step.6
What do the results of a Pap test mean?
Pap test results usually tell you whether the cervical cells look normal, whether the lab found abnormal cells, or whether it couldn’t evaluate the sample.9 While the term abnormal can seem alarming, an abnormal Pap smear does not necessarily mean you have cancer.
Instead, you may have an HPV infection or abnormal cell changes that can be monitored or managed, if needed, before becoming cancer.9 Some common terms for Pap tests:
| Result | What it means |
| Normal or NILM | No abnormal cervical cells were identified. NILM means “negative for intraepithelial lesion or malignancy.” |
| Unsatisfactory | The laboratory could not evaluate the sample reliably, perhaps because there were too few cells or because blood or mucus obscured them. |
| ASC-US (atypical squamous cells of undetermined significance) | Some cells look unusual, but the reason is unclear. HPV testing may help determine what happens next. |
| LSIL (low-grade squamous intraepithelial lesion) | Mild, low-grade cervical cell changes are present and are commonly associated with HPV. |
| ASC-H (atypical squamous cells, cannot exclude HSIL) | Some abnormal cells could represent a more significant high-grade change, so further assessment is usually needed. |
| HSIL (high-grade squamous intraepithelial lesion) | More significant abnormal cervical cells are present and could become cancer if they are not appropriately evaluated or treated. |
| AGC (atypical glandular cells) | Glandular cells, which are cells that produce mucus, look abnormal and require further evaluation. |
An unsatisfactory result is different from an abnormal result. It does not mean the laboratory found dangerous cells. It means the sample did not provide a reliable answer, so you may need another test.
What if your Pap smear is abnormal?
Abnormal Pap smear results generally require further testing. The next steps depend on several factors: your exact Pap result, your HPV result, your age, your screening history, and whether you’ve been treated for cervical precancer before.9
For some women, the next step may be an HPV test, Pap test, or co-test at a future date. For others, it will be a colposcopy (a closer look at the cervix using a magnifying instrument called a colposcope).9
The colposcope itself remains outside of the vagina. A speculum is used to separate the vaginal walls so the clinician can view the cervix, and the colposcope gives a magnified image. If there is an abnormal area, the clinician may do a biopsy (removing a small amount of tissue to view under a microscope).9
Will I still need cervical screening if I get the HPV vaccine?
Yes. The HPV vaccine significantly reduces the risk of cervical cancer, but it does not eliminate the need for cervical cancer screening.
Vaccinated women follow the same age-based screening schedule as everyone else.13
What about the cost of a Pap smear?
For many people with U.S. health insurance, recommended cervical cancer screening is covered as preventive care without a copayment, coinsurance, or deductible under federal preventive-services requirements. Coverage can still vary by plan, network, and whether the visit includes services beyond screening, so check your plan if you are unsure about out-of-pocket costs.10
When to see a doctor?
A Pap smear is a screening test. So it is mainly for women who do not have symptoms. If you develop new symptoms, waiting until your next routine Pap smear is not the appropriate way to investigate them. Arrange a medical evaluation if you notice11:
- Bleeding after sex
- Bleeding between periods
- Any vaginal bleeding after menopause
- Periods that have become unusually heavy or longer than usual
- Persistent watery, bloody, or unusual vaginal discharge
- Persistent pelvic pain
- Pain during sex
These symptoms can occur for many reasons other than cervical cancer.
Seek emergency care if:
No. ACOG recommends an initial reproductive health visit between ages 13 and 15, but that visit usually does not require an internal pelvic examination unless symptoms make one necessary.
It depends on whether your cervix was removed and on your medical history. If your cervix remains, cervical screening continues. If the cervix was removed and you do not have a history of cervical cancer or a high-grade precancerous lesion, routine cervical cancer screening is generally not recommended.
Most U.S. health plans are required to cover recommended cervical cancer screening without patient cost sharing when preventive-services rules apply. Your actual cost can differ if your plan is exempt, you use an out-of-network clinician, or the visit includes additional diagnostic services, so it is worth confirming coverage with your insurer or clinic.
Yes, if you are in the screening age group. For average-risk women, ACOG states cervical cytology should begin at age 21, regardless of when they first became sexually active.
While pregnancy does not necessarily prevent cervical screening, you may want to ask your provider whether your screening should occur during your pregnancy. This depends on your screening history and other factors.
No. Pap and HPV tests screen for cervical cancer, not STIs.
No. A Pap smear may be done as part of a pelvic exam, but it is not the same thing. During a pelvic exam, the healthcare provider checks many of the structures of the pelvis.
There may be a small amount of spotting after cervical cells are taken for testing. If the bleeding is heavy, continues, or concerns you, consult with your healthcare provider.
Usually, Pap test results take 1 to 3 weeks, depending on the lab processing the test. If you have not heard the results, check with your provider rather than assuming that no news is good news.
Last medically reviewed on
References
Our commitment to accuracy is paramount; we use high-quality sources, including peer-reviewed studies, to support the facts in our articles. Learn more about our Editorial Process.
- National Cancer Institute (NCI). Cervical Cancer Screening. Updated February 13, 2025. cancer.gov
- Centers for Disease Control and Prevention (CDC). Screening for Vaginal and Vulvar Cancers. Updated September 9, 2024. cdc.gov
- Centers for Disease Control and Prevention (CDC). Human Papillomavirus (HPV) Infection: HPV-Associated Cancers and Precancers. STI Treatment Guidelines. Last reviewed July 22, 2021. cdc.gov
- American College of Obstetricians and Gynecologists (ACOG). Screening for Cervical Cancer. Committee Statement No. 28. Obstetrics & Gynecology. 2026;148(1):e63-e67. doi:10.1097/AOG.0000000000006257. acog.org
- American College of Obstetricians and Gynecologists (ACOG). Health Care for Transgender and Gender Diverse Individuals. Committee Opinion No. 823. Obstetrics & Gynecology. 2021;137(3):e75-e88. doi:10.1097/AOG.0000000000004294. Reaffirmed 2024. acog.org
- Office on Women’s Health (OWH). Pap and HPV Tests. U.S. Department of Health and Human Services. Updated October 24, 2025. womenshealth.gov
- American College of Obstetricians and Gynecologists (ACOG). Pelvic Exams. ACOG Women’s Health FAQs. Last reviewed April 2026. acog.org
- American College of Obstetricians and Gynecologists (ACOG). Making the Most of Your Health Care Visit. ACOG Women’s Health FAQs. n.d. acog.org
- National Cancer Institute (NCI). HPV and Pap Test Results: Next Steps After an Abnormal Cervical Cancer Screening Test. Updated June 6, 2024. cancer.gov
- Health Resources and Services Administration (HRSA). Women’s Preventive Services Guidelines. U.S. Department of Health and Human Services. 2026. hrsa.gov
- National Cancer Institute (NCI). Cervical Cancer Symptoms. Updated October 13, 2022. cancer.gov
- American College of Obstetricians and Gynecologists (ACOG). Abnormal Uterine Bleeding. ACOG Women’s Health FAQs. Published December 2021; last reviewed August 2025. acog.org
Update history
Our team monitors the health and wellness space to keep articles current.
Current version (September 28, 2026) — Medically reviewed by Dr. Sadaf Iftikhar, MBBS, FCPS. Written by Dr. Aqsa Munir, MBBS.
