How frequently you should get a Pap smear or HPV test - and what to expect during the procedure

• A Pap smear is a procedure that screens for cervical cancer by testing cells for any abnormalities.
• If your Pap results are abnormal that does not mean you have cancer, and more likely indicates HPV.
• Pap smears should be started at 21 and continue every 3-5 years depending on age and medical history.

Cervical cancer is the fourth most common cancer found in women worldwide. But thanks to a screening test called a Pap smear, doctors can catch any abnormal cells early and treat them before they become cancerous.

Here's what you need to know about Pap smears, including how often you should be tested and what your results mean.

What is a Pap smear?

The Papanicolaou test, most commonly known as the Pap test or Pap smear, is a screening procedure to test for cervical cancer.

During your pap smear, a healthcare provider will place a metal or plastic medical device called a speculum inside your vagina to open up and push the vaginal walls apart. This allows the doctor to clearly look at your cervix and collect cervical cell samples with a small brush.

The test takes no more than five minutes, says Ashley Jennings, MD, an OB-GYN at UW Health. You may feel slight discomfort when the speculum is inserted, and some may experience mild cramping or spotting after, but the procedure should not be painful.

Once the Pap smear is completed, cell samples are sent to a lab and tested for any abnormality - or unusual changes in size, shape, or other characteristics. You should have your results within a few days, says Jennings.

Important: To prepare for a Pap smear, avoid sex 24 hours before your appointment, as it can inflame vaginal tissue or cause discharge which could lead to an abnormal result. Also, avoid any vaginal medicines, creams, or gels for two or three days beforehand. These products can interfere with the cell sample.

Likewise, it's important to avoid getting a Pap smear with a heavy period, says Gloria Bachmann, MD, the director of the Women's Health Institute at Rutgers University. Your doctor could end up swabbing red blood cells instead of cervix cells, which will throw off the results.

How often should I get a Pap smear?

When and how often you should get a Pap smear mostly depends on your age and medical history. The most recent guidelines break testing into four age categories:

Some people may need to get Pap smears more often, such as:

• People with a history of cervical cancer
• People with pre-cancer, or when abnormal cells are already known to be present
• Those with the HPV infection

Important: Most women who have had their cervix remove will not need a pap smear.

A large 2020 study conducted by the CDC found Pap smears are not medically necessary for women 15 to 20 years old as the likelihood of cervical cancer at this age is minimal. The tests were concluded to cause more anxiety and fear in young women and led to unnecessary costs.

Testing for HPV is also an important part of annual screenings for cervical cancer, which is why women over 30 do it alongside their Pap smear. Collections are done during the Pap, not as a separate procedure.

HPV, or the human papillomavirus, is a common sexually transmitted infection. Around 80% of sexually active people are infected in their lifetime.

There are over 200 variations of HPV, but only 14 are considered high risk for cancer. Of those, just two lead to the majority of cervical cancer cases. In addition to causing cervical disease, HPV also causes vulvar, vaginal, anal, and oral cavity cancers.

Latest research: A large 2020 study spanning seven years and 1.7 million women found the HPV vaccine, which treats the two HPV strains most likely to cause cancer, reduced cases of cervical cancer by 90%. Even if you've already had HPV it is still recommended that you get the vaccine.

It's important to understand that every person is different, says Buchmann. If you are sexually active, she advises establishing care with an OB-GYN provider who can best determine how often you should be receiving Pap and HPV tests.

Pap smear results

Your Pap smear results will fall into one of three categories:

1. Normal: A normal - or negative - test result is when your cervical cells do not show any precancerous abnormalities.
2. Abnormal: If your results come back positive - or abnormal - this means some of the cells in your cervix are atypical in size, shape, or other characteristics. This does not mean you have cervical cancer and in most cases, is due to an HPV infection. To ensure it is not cancer, your doctor will conduct further testing, such as:
   • HPV test
   • Colposcopy: The doctor will closely examine your cervix with a magnifying tool called a colposcope to better understand the range of the atypical cells and possibly collect a small sample.
   • Cone biopsy: If the colposcopy finds a suspicious area, then the doctor may perform minor surgery to remove the abnormal section and analyze it for cancer. Rarely this needs to be done in an operating room. Sometimes doctors will use lasers or freezing techniques to remove the worrisome section.
3. Unclear (ASC-US): This is the most common abnormal test result. Some of the cells in your cervix may look atypical, but it isn't clear if the cause is an HPV infection. If this happens, your doctor may ask the lab to run an HPV test. Infrequently, they may call you back for another Pap smear or an HPV test.

Insider's takeaway

Related Article Module: Why an abnormal Pap smear doesn't always mean you have cancer

A Pap smear is a procedure that screens for signs of cervical cancer in women from ages 21 to 65. The test only lasts a few minutes and you should get results within a couple of days.

An abnormal Pap smear does not mean you have cervical cancer. Most of the time, this means you could have an HPV infection, which is normally resolved on its own, but in some cases could develop into cervical cancer. Depending on the extent of cell abnormality, you may not need any treatment but require follow-up testing.

While Paps are an important screening tool to detect cancer early, the best prevention of cervical disease is the HPV vaccine.

While there are official guidelines to follow on when and how often you should get a Pap smear, it's important to set up regular care with an OB-GYN and discuss what works best for you and your body.

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