Why Do I Need a Pap Test?

Regular screening helps women prevent cervical cancer.

A regular pap test, most often called a pap smear in the past, is the best way a woman can avoid cervical cancer. The simple screening identifies abnormal cell changes and checks for human papillomavirus (HPV), which is the most common sexually transmitted infection. 

According to a Keck Medicine of USC obstetrician and gynecologist, more than 80% of men and women will have HPV in their lifetime. The good news is that with appropriate screening like a pap test, you can reduce the risk of HPV progressing into cervical cancer.

What is a pap test?

A pap test is a minimally invasive procedure that involves collecting a sample of superficial cells from around the cervix. Your provider may begin with a bimanual exam during which they’ll insert their fingers into the vagina to feel for any lesions around the cervix.

The next step involves inserting a speculum, which opens like a duckbill, into the vagina. This tool allows the provider a better look at the cervix. They’ll use a small brush to collect a cell sample. The process is relatively quick, taking 30 seconds to a minute.

Patients can expect to feel pressure in the pelvic area when the speculum goes in. A pap test may feel uncomfortable, but it shouldn’t be painful.

Can you get a pap test on your period?

It is possible to perform a pap test while a patient is on their period, but many providers may choose to delay the procedure until the period is over to ensure that test results are as clear as possible.

Patients should track their periods, not only so they’ll know when to expect the next one but also so they’ll know what to expect after a pap test. After a pap test, light spotting is normal, but heavier bleeding is not. If you experience heavy bleeding the day after you undergo a pap test, it’s likely your next period starting.

How often should you get a pap test?

Patients should start getting pap tests by age 21. Some providers will delay a pap test until age 25 if a patient isn’t sexually active.

The U.S. Preventive Services Task Force and the American Society for Colposcopy and Cervical Pathology (ASCCP) recommend patients 21-29 get a pap test every three years. Patients ages 30-65 are advised to get one every five years.

Annual pap tests are generally not necessary, according to the ASCCP, since most individuals’ immune system will naturally clear the HPV infection within that time frame, and the risk of developing cervical cancer remains low. These guidelines, however, only apply to patients who had normal pap test results.

What does a pap test look for?

A pathologist analyzes the shape, size and structure of the cells to assess for any potential changes that would indicate cancer risk.

Depending on the patient’s age and medical history, the specialist may also examine the sample for HPV. They’ll test for multiple strains of HPV to identify whether a strain is low-risk versus high-risk.

How long do pap test results take? Patients may wait days or a few weeks for the provider to receive the lab results.

What is an abnormal pap test?

The presence of atypical cells can cause “abnormal” pap test results, meaning the cells looked at in the lab have a different morphology compared to normal cells due to inflammation around the cervix.

Abnormal results can fall under different categories. Certain strains of HPV create a higher risk of cervical dysplasia, a precancerous condition in which abnormal cells grow on the cervix. 

If a patient tests positive for HPV but has normal cells, the typical recommendation is to repeat the pap test in a year. This recommendation is based on the fact that the immune system is more likely to eradicate the virus on its own. Providers will perform another pap test the following year to ensure the body successfully rid itself of the HPV.

What happens after an abnormal pap test?

If a patient has both HPV and atypical cells, the usual next step is a colposcopy. This exam is similar to a pap test in that the provider uses a speculum to better visualize the cervix. 

The provider then places a solution of acetic acid on the cervix. A microscope is then used to examine cervix, and if the cells turn white, it signals the presence of abnormal cells. The provider will then take a biopsy of the cervical tissue, and the results will help guide next treatment steps.

It’s important to remember that testing positive for HPV and having atypical cells does not mean you have cancer. It just means there is inflammation around your cervix causing these changes and that you should take steps to ensure it doesn’t turn into cancer.

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