What Is a Pap Smear? A Guide to Cervical Cancer Screening

Medical Writer: Oke Ikpekpe, MSc (PH)

Medical Reviewer: Azuka Chinweokwu Ezeike, MBBS, FWACS, FMCOG, MSc (PH)

Highlights

• A Pap smear detects abnormal changes in cervical cells before they develop into cancer.
• Regular cervical cancer screening helps prevent cervical cancer through early detection and treatment. 
• The test is quick, simple, and usually causes only mild discomfort.
• Your Pap smear results help determine whether you need further testing, monitoring, or treatment. 
• A Pap smear and an HPV (Human Papillomavirus) test are different but may be performed together for more effective screening.
• Following recommended screening schedules is one of the best ways to protect your cervical health.

Introduction

Your doctor has recommended a Pap smear, but you're not quite sure what it involves. Will it hurt? Do you really need one if you feel perfectly healthy? And why is it so important?

These are completely normal questions, especially if it's your first time.

Cervical cancer is one of the most preventable cancers, largely because screening can detect abnormal changes before they become cancer. A Pap smear detects abnormal cell changes before they develop into cancer, giving doctors the chance to treat them early and stop them from progressing [1,2]. 

Whether you're preparing for your first screening or simply want to understand why it's recommended, this guide explains what to expect before, during, and after the test, what your results mean, and how regular screening helps protect your cervical health.

What Is a Pap Smear? 

A Pap smear, also called a Pap test, is a screening test used to check for abnormal cells in the cervix. During the test, a healthcare provider collects a small sample of cells from your cervix, which are then examined under a microscope. If abnormal cell changes are detected, they can often be monitored or treated before they develop into cervical cancer [1,3].

There are two main methods used for Pap smear testing: conventional Pap smear and liquid-based cytology (LBC).

• In a conventional Pap smear, the collected cells are spread directly onto a glass slide before being sent to the laboratory for examination. 

• In liquid-based cytology, the collected cells are placed into a vial of liquid before being processed in the laboratory.  

Both methods are effective, but liquid-based cytology is increasingly used because it produces a cleaner sample and also allows HPV testing to be performed using the same specimen [1].    

Why Is a Pap Smear Done?

The main purpose of a Pap smear is to detect precancerous cell changes in the cervix before they develop into cervical cancer [1].

Cervical cancer usually develops slowly over several years, giving doctors a valuable opportunity to detect and treat abnormal cells early, preventing up to 80% of invasive cervical cancers [1,2]. 

Who Should Have a Pap Smear Test?

Most women should have regular cervical cancer screening, even if they feel healthy and have no symptoms. This is because abnormal changes in the cervix often develop without causing noticeable signs [2,3].

The World Health Organization (WHO) recommends cervical cancer screening for women in the general population beginning at 30 years of age, while women living with HIV should begin screening from 25 years of age because they are at higher risk of developing cervical cancer.

WHO recommends HPV DNA testing as the preferred screening method where it is available. However, Pap smear screening remains widely used in many countries and continues to be an effective method for detecting precancerous cervical changes.

Screening recommendations also vary between countries and professional organizations. For example, the American College of Obstetricians and Gynecologists (ACOG) recommends cervical cancer screening from 21 years of age, with Pap smear testing as one of the recommended screening options.

How to Prepare for a Pap Smear 

Before your appointment, there are a few things you should avoid to help ensure your Pap smear results are as accurate as possible [1,3].

For 48 hours before your appointment, avoid:

• Sexual intercourse.
• Using douches.
• Spermicidal creams or foams.
• Vaginal medications unless your healthcare provider tells you otherwise.

Although a Pap smear can still be performed in some situations during your period [1,5], many healthcare providers prefer to schedule it when you are not menstruating because it makes the sample easier to interpret. 

What Happens During a Pap Smear Test?

A Pap smear is a quick and straightforward procedure that usually takes only a few minutes [2,5].

Here's what you can expect:

1. You'll lie on an examination table with your knees bent and your feet supported on rests called stirrups [2]. 
2. Your healthcare provider will gently insert a speculum into your vagina to hold the vaginal walls apart and allow a clear view of your cervix [1].
3. A small soft brush or spatula is used to collect a sample of cells from the cervix. You may feel a little pressure or mild discomfort, but the sample is collected in just a few seconds [1,2].
4. The sample is then sent to a laboratory, where specialists examine the cells for any abnormal changes [1].

Does a Pap Smear Hurt?

Although everyone experiences it differently, most women describe a Pap smear as mildly uncomfortable rather than painful [1,5].

The procedure is quick, and any discomfort usually lasts only a few seconds. If you experience pain during the procedure, let your healthcare provider know so they can adjust the speculum or pause if needed [1]. 

What Happens After a Pap Smear?

Most women can return to their normal activities immediately after testing. Some may notice mild spotting or light bleeding for a short time, especially if the cervix is sensitive, and this is usually nothing to worry about [1]. However, if you experience heavy bleeding, severe pain, or fever after the procedure, contact your healthcare provider. 

Understanding Pap Smear Results 

Your Pap smear results are usually reported using a standard system called the Bethesda System. While some of the terms may sound unfamiliar, most results are not a cause for alarm [1,2].

Common results include:

• NILM (Negative for Intraepithelial Lesion or Malignancy): Your result is normal, and no abnormal cervical cells were found [1]. 
• Inflammation or infection: This is a common finding and may be caused by irritation or infections such as a yeast infection. It does not mean you have cervical cancer [2,3].
• ASCUS (Atypical Squamous Cells of Undetermined Significance): Some cells look slightly unusual, but it is unclear whether this is related to HPV or another cause [1,2].
• LSIL (Low-grade Squamous Intraepithelial Lesion): This indicates mild changes in the cervical cells, often linked to HPV infection. In many cases, these changes resolve on their own, but follow-up testing may be required [1,2].
• HSIL (High-grade Squamous Intraepithelial Lesion): This indicates more significant cell changes that require further evaluation and, if necessary, treatment to prevent cervical cancer [1,2].

Most Pap smear results are normal. Even when abnormal cell changes are found, they are often detected long before cancer develops, allowing appropriate follow-up or treatment when needed [2]. 

Sometimes the sample is reported as unsatisfactory, meaning there were not enough cells to interpret the test accurately. This does not mean anything is wrong. Your healthcare provider will usually recommend repeating the test [1,3,4].

What Do Abnormal Pap Smear Results Mean?

Seeing the word "abnormal" on your Pap smear report can be worrying, but it does not mean you have cervical cancer [2].

In many cases, abnormal results are caused by inflammation, an HPV infection, or early cell changes that can be monitored or treated before they become cancer [2,3].

Depending on your results, your healthcare provider may recommend:

• A repeat Pap smear after a few months
• An HPV test to check for high-risk strains of the virus
• A colposcopy, which allows the cervix to be examined more closely using a special magnifying instrument [1,2].
• A biopsy, where a small sample of tissue is collected for further testing if necessary [2].

Your doctor will explain what your results mean and whether any additional tests or treatment are needed.

Pap Smear vs. HPV Test: What Is the Difference?

Although they are often performed together, a Pap smear and an HPV test look for different things [1].

A Pap smear looks for abnormal changes in the cells of the cervix that could develop into cancer over time.

An HPV test looks for the DNA of high-risk types of the human papillomavirus (HPV), the virus responsible for almost all cases of cervical cancer.

For women 30 and older, health care providers may recommend co-testing, combining both tests during the same visit. Using both tests together improves the chances of detecting cervical abnormalities early.

How Often Should You Have a Pap Smear?

Your screening schedule depends on your age and your overall risk of cervical cancer [1]. 

The World Health Organization (WHO) recommends HPV DNA testing as the preferred screening method where it is available. 

For women in the general population, screening should begin at 30 years of age and be repeated every 5 to 10 years.

 Women living with HIV should begin screening at 25 years of age and be screened every 3 to 5 years.

While the American College of Obstetricians and Gynecologists (ACOG) recommends:

• Ages 21 to 29: Have a Pap smear every three years [1,4].
• Ages 30 to 65: You may have a Pap smear every three years, an HPV test every five years, or both tests together every five years, depending on your healthcare provider's recommendation [1].
• Over age 65: Screening may no longer be required if you have had regular normal results in the past and are not considered at high risk for cervical cancer [1].

Women with HIV, weakened immune systems, or previous cervical abnormalities may need a different screening schedule [1,3].

Conclusion

Cervical cancer is one of the few cancers we can actually prevent. Looking after your health isn't only about seeking treatment when something feels wrong; it is also about preventing problems before they begin.Regular screening allows your healthcare provider to identify abnormal cell changes early, often before they cause symptoms.If you are due for a screening or have concerns about your cervical health, speak with your healthcare provider and book your appointment.

Frequently Asked Questions About Pap Smear

1. Can I have a Pap smear if I'm on my period?

Although a Pap smear can be performed during your menstrual period, it is generally recommended to schedule the test when you are not menstruating. This is because menstrual blood can obscure cervical cells, making them more difficult to examine and potentially affecting the accuracy of the test results.   [1,5]. 

2. Can I have a Pap smear while pregnant?

Yes, it is safe. However, pregnancy causes cervical changes that can make interpretation more challenging [1,3].

3. What is the difference between a Pap smear and a pelvic exam?

A pelvic exam is a routine physical examination. A Pap smear is a specific test that collects cells from the cervix. They are often done together [4].

4. How long does it take to get Pap smear results?

Results are usually available within a few days to two weeks, depending on the laboratory. Your healthcare provider will let you know when to expect your results and explain any follow-up if needed.

5. Can I still do a Pap Smear if I've had a hysterectomy?

If your cervix was removed during the hysterectomy and you have no history of high-grade lesions or cancer, you generally do not need routine Pap smears [1,4].

References

1. Crifasi C, Parker J. Preventing Cervical Cancer: Best Practices in Pap and HPV Testing. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jun 22. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470165/
2. Sachan PL, Singh M, Patel ML, Sachan R. A study on cervical cancer screening using Pap smear test and clinical correlation. Asia Pac J Oncol Nurs. 2018;5(3):337-341. doi:10.4103/apjon.apjon_15_18. Available from: https://pubmed.ncbi.nlm.nih.gov/29963597/
3. Karra V, Ramulu PS, Rajanikar, Sudhakar B. Cervical Pap smear study and its utility in cervical cancer detection and prevention. Indian J Obstet Gynecol Res. 2021;8(4):470-475. doi:10.18231/j.ijogr.2021.098. Available from: https://www.academia.edu/68193561/Cervical_pap_smear_study_and_its_utility_in_cervical_cancer_detection_and_prevention
4. Mehta SJ, Jajodia P. Pap smear as a tool for cervical cancer screening: A retrospective analysis from Bhavnagar, Gujarat. Ann Med Med Sci. 2025;4:408-410. Available from: https://ammspub.com/index.php/amms/article/view/177
5. Akan A, Omo-Aghoja L, Adeyinka A. The diagnostic performance of Pap smear during both phases of the menstrual cycle: A community-based study in Southern Nigeria. Niger Postgrad Med J. 2025;32(2):120-126. doi:10.4103/npmj.npmj_296_24. Available from: https://pubmed.ncbi.nlm.nih.gov/40364679/

Disclaimer:
The information provided on this website is for general educational and informational purposes only. It is not intended to replace professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Published July 22, 2026