The exam is crucial to detecting cervical cancer early — but the guidelines keep changing. Here’s what you need to know.

By Rachael Schultz
Aug 26, 2020 @ 4:57 pm
gynecologist appointment
Credit: Getty Images

Pap smears used to be super straightforward: You’d get the exam every time you had your annual wellness check-up with your ob-gyn. But like everything with women’s health, the guidelines have become more complicated.

Now, the simple question of, “When was your last Pap?” can give a girl as much pause as, “How many sexual partners have you had?”

But a Pap smear is definitely one of those non-negotiables you need to be diligent about keeping track of: “It’s important to get regular pap smear screening in order to identify your risk for pre-cancer and cancer of the cervix that can be treated if caught early,” says Sherry Ross, M.D., ob-gyn and women’s health expert at Providence Saint John’s Health Center in Santa Monica, CA.

Here, everything you need to know about how often you should really be getting a Pap.

What Exactly Is a Pap Smear?

A Pap smear is a screening test to look for cancer and pre-cancerous cells in the cervix. Your ob-gyn will use a "broom" to sweep the face of the cervix, and then insert a brush into a specific part of your cervix called the os, Dr. Ross explains. The broom and brush are then sent off to a lab to be tested for any abnormal cells.

Once you hit 30 (more on that later), your doctor will also run an HPV test during your Pap, called “co-testing.” You can get just the HPV test (called “primary HPV testing”) in lieu of a Pap, but research shows co-testing is a lot more accurate and avoids thousands of cases of overtreatment than just using primary HPV testing alone.

Word of warning to those who haven’t experienced a Pap yet: Like most of the joys of womanhood, the exam is not enjoyable. Your doctor has to use a speculum, which is a metal device that helps spread your vaginal opening wider. Unfortunately, the duck-bill-shaped tool is required to see and examine the cervix during a gynecological exam, but it does come in small, medium, and large sizes, Dr. Ross says. If you have a small vaginal opening or don't have sex often (or ever), it’s a good idea to ask your doc for a smaller size.

What If It Comes Back Abnormal?

Abnormal Pap smears are very common, Dr. Ross reassures. “The good news is it rarely means cancer — millions of women will experience an abnormal Pap smear in their lifetime,” she adds.

More often, your abnormal cells are "atypical" (called ASCUS, or Atypical Squamous Cells of Undetermined Significance) and you don't have HPV. This will, however, require that you go back to your ob-gyn in one year for another Pap. If your cells are atypical (ASCUS) and you do have HPV, you may need a repeat Pap in six months, Dr. Ross adds.

If the abnormal cells are precancerous (like Low Grade Squamous Intraepithelial Lesion or High Grade Intraepithelial Lesion) you'll either need a repeat Pap more frequently or your ob-gyn might want to do a colposcopy — another exam that looks at the tissues of the cervix, vagina, and vulva. They might take a sample of any area that looks abnormal. This tissue analysis helps determine what type of cells and strain of HPV you have, since there are types both low and high risk for turning into cervical cancer.

FYI, there’s also a possibility that your test can come back ‘inconclusive’ — don’t freak. This means they didn’t get a good enough sample, and will require a repeat pap.

Who Needs to Get a Pap?

Every woman over the age of 21 needs to get a Pap smear regularly (that's every 3 years from 21 to 29 and every 5 years from 30 to 65). But there are a few categories of people who need to be extra diligent:

“The women who are most at risk for abnormal Pap smear results are those who did not get the HPV vaccine in their teenage years,” explains G. Thomas Ruiz, M.D., ob-gyn lead at MemorialCare Orange Coast Medical Center in Fountain Valley, CA.

You’re also more at risk if you started having sex as a teenager or have a history of multiple partners (so, yeah, a very large percentage of women)

How Often Should I Get a Pap Smear?

The Pap smear has evolved a lot in the last few decades as doctors have learned more, explains Dr. Ruiz.

The recommendation used to be that a woman get her first Pap at age 21 or when she started having sex. That makes sense, considering HPV is the main cause of cervical cancer and is transmitted via sex. But doctors started to realize that most young women who develop the precancerous condition cervical dysplasia usually never saw it turn into full-blown cancer. So to avoid overtreatment of the cervix in young women, they changed the recommendation, he adds.

Now, both the U.S. Preventative Services Task Force the American College of Obstetricians and Gynecologists recommend that women wait and get their first Pap till age 21, then every three years until they're 29. Once you hit 30, you can cut back to getting a Pap every five years until you’re 65. Your doc will also test you for HPV once you’re over 30.

...So Do I Only Need to See My Ob-Gyn Every Few Years?

Even though you only get a Pap every three to five years, you should still go in to see your OB every year. “It is important for women to come in on an annual basis for a pelvic exam, breast exam, and inspection of the cervix. The Pap smear is just one phase of annual healthcare maintenance,” Dr. Ruiz says.