When should someone have a Pap smear and how often?

A Pap smear or Pap test involves a doctor taking a small sample of cells from a person’s cervix using a brush or spatula-like instrument to look for changes in the cervix’s cells.

A doctor may use a Pap smear to look for cellular changes that can result from cancer, precancer, human papillomavirus (HPV), inflammation, or an infection. A doctor may perform a Pap smear during a routine examination.

Keep reading for more information about Pap smears, including at what age and how frequently a person should get them.

The recommended age for a Pap smear

a doctor preparing a pap smear for a woman who is about the right age to have one
People between 21 and 65 should consider having regular Pap smears.

The Centers for Disease Control and Prevention (CDC) recommend that all women between the ages of 21 and 65 should get regular Pap smears tests.

The National Institutes of Health (NIH) do not recommend Pap smears for people under the age of 21. They also do not recommend that people over 65 get a Pap smear except under certain circumstances, such as abnormal results or increased risk factors for cancer.

How often based on age

The CDC further breaks down the testing times based on age. The following are the recommended testing schedules based on a person’s age:

Ages 21–29

A person should start getting Pap tests at the age of 21. If the result is normal, a doctor will likely suggest waiting 3 years until the next test.

Ages 30–65

A person may discuss with their doctor if they should have a Pap test only, or a combined Pap and HPV test.

If a person has a pap test only, and the results are normal, a doctor may suggest waiting 3 years until the next one.

If a person had a combined test, and both results are normal, a doctor may suggest waiting 5 years until the next screening test.

Age 65 plus

A doctor may suggest that screening is no longer necessary for a person over 65 if:

  • they have had normal screening test results for many years
  • they had a total hysterectomy, and a doctor removed their cervix

However, the National Cancer Institute recommend that people over 65 have Pap smear tests if they have any risk factors for developing cervical cancer.

Risk factors include:

  • being immunosuppressed
  • having previous treatment for a precancerous cervical lesion or cervical cancer
  • living with HIV
  • being exposed to diethylstilbestrol before birth
Preparation for a Pap smear

In general, there is nothing that a person needs to do to prepare for the examination.

If a person is menstruating at the time of their scheduled appointment, they should check with their clinician whether they should come in. In most cases, however, the Pap smear can go ahead.

Doctors also recommend that a person avoids the following before to a Pap smear:

  • having sex
  • douching the vagina
  • using tampons or vaginal lubrication
  • vaginal creams, suppositories, or medications
  • using birth control foam, cream, or jelly
Do I need a Pap smear?

Most people need regular Pap smears from the age of 21. However, some people may wonder whether they need a Pap smear if they:

Have had a hysterectomy

Some people who have had a hysterectomy will still need a Pap smear. This will depend on the person’s health history and the type of hysterectomy they had.

Are not sexually active

Pap smears test for the presence of abnormal cell growth. Though this can be the result of a sexually transmitted disease (STI), such as HPV, a person may still develop cervical cancer without having sex.

Are pregnant

A person’s doctor may recommend a Pap smear during pregnancy. However, a person should talk to their doctor about their situation and whether they need one.

Have gone through menopause

Women should still get Pap smears after menopause up until the age of 65. Continuing Pap smears after age 65 will depend on whether a person has risk factors for cervical cancer.

What happens during a Pap smear?
an infographic showing what happens during a pap smear

A healthcare provider typically performs a Pap smear during a routine care visit. During the visit, a doctor will ask the person several health questions and perform an examination.

During the Pap smear, the person will typically lie on their back with their legs separated. A healthcare provider will then insert a speculum into the vagina to keep the vagina walls open.

With the speculum in place, the healthcare provider will take a sample of cervical cells using a brush or spatula. They will place the sample inside a container filled with a transport medium, which is a fluid that will preserve the sample.

The healthcare provider will then remove the speculum. During the procedure, the person may feel slight discomfort, pain, or pressure. A person can reduce the discomfort by urinating before the test.

The examination does not require any recovery time, and the person can leave immediately following the Pap smear.

Test results

The healthcare provider will send the sample to a lab for examination. The test results can take about 1–3 weeks to come back, depending on the lab.

A person will usually get their results in a letter or through an online portal. A doctor can go over the results with the person to explain what they mean and discuss the next course of action, if necessary.

The results can be as follows:

  • Normal: The Pap smear showed normal cells, so no further action is required until the next routine exam.
  • Abnormal: The cells show abnormalities or growth, which does not necessarily mean a person has cancer. A doctor will likely order additional tests, such as a colposcopy, to check for certain conditions. The doctor may recommend another Pap smear immediately or in 6 months–1 year.
  • Unclear: The doctor cannot determine if the results are normal or abnormal. They may do additional tests or have the person come back in 6 months–1 year for another Pap smear.

Pap smears are not always accurate. In some cases, a Pap smear may return false normal or false abnormal test results. However, regular Pap smears are generally effective in helping to screen for cervical cancer.

Pap smears do not check for STIs. A doctor may test for an STI if the person has symptoms that indicate an STI may be present.

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