Pap smears — What’s the Deal?

Whether you’ve had a Pap smear before, or it’s your first time, here’s the 411.

Illustrated by Marcy Gooberman

Illustrated by Marcy Gooberman

People with vaginas have been going to gynecologists, getting exams and Pap smears since the 1930’s. But what is a Pap smear and why do we need them? Who needs them? And how often?

So, what exactly is a Pap smear?

Many women* have the false impression that every time their doctor performs a pelvic exam (the exam where they take a look, and often a feel, of your cervix, uterus, and ovaries) they are also doing a Pap smear. This is a common misconception. A Pap smear (named after the person who invented it — Georgios Nikolaou Papanikolaou) is a very specific test, used to take some cells from the center of the cervix (also known as the “os,” or the opening), and examine them under the microscope to look for cervical cancer or pre-cancer. That is the full extent of the test.

There are other things that can be seen on a Pap smear, but its main purpose is to look for cervical cancer. (It gives no information about your uterus, fallopian tubes, or ovaries, each of which may have their very own cancers, but cannot be screened for with a Pap smear). The Pap smear may also reveal if there is yeast, bacteria, or a viral infection present, but again, those are not the main purpose of the Pap smear.

Who is most likely to get cervical cancer?

Cervical cancer is almost always a disease of women who are, or who have been, sexually active. We now know that most cervical cancers and precancers come from a virus called the Human Papillomavirus, or HPV. HPV has many different types and strains, some of which are more likely to cause cervical cancer. HPV is a sexually transmittable virus that about 70% of the sexually active adult population (male and female) carry in their system. Various strains of this virus cause almost all cervical cancer and precancerous conditions. So, yes, if your grandma had cervical cancer, it was essentially caused by an STI.

How often does one need to get a Pap smear?

Current guidelines on doing Pap smears state that women should start getting them at age 21, and continue every three years until age 29. At age 30, it is recommended to test for the HPV virus and have a Pap smear (which is referred to as a Co-Test, since these are two separate tests, one for the abnormal cervical cells, and one for the presence of the HPV). Believe it or not, the reason it is not recommended to test women under the age of 30 for HPV, is that it is almost assumed that sexually active women under 30 will be positive for the presence of the virus, but somehow will be able to clear the virus from their body after a period of time (which often, but not always, happens in a 3–5 year period after it has been acquired). From age 30–65, it is recommended to do a Co-Test every 3–5 years if they continue to both come out negative. Guidelines, surveillance and treatments change if the Pap smear and/or the HPV test come out abnormal. After age 65, most women who have a history of normal Paps and negative HPV do not need to have them done any more.

You should always talk to your doctor or healthcare provider about what yourindividual situation is, what your risk factors are (Is your immune system compromised? Have you had abnormal Pap smears in the past? Do you have a new partner? Do you use condoms for sexual encounters?) so you will know just how often you need a Pap smear, and if you need HPV testing. Do not assume that every time you have an exam you have had a Pap smear, because it may not be the case at all.

How can one prepare for a Pap smear?

First, if you’ve never had one, make sure to ask your healthcare practitioner to show you the “device,” or speculum, before they start the exam. You will be able to see that it is not sharp, painful, or scary — nor does it ‘clamp’ on to you in any way (many people call it “the clamp” for some reason). 
Dont’s: Do not have sex, use lube or any vaginal creams or gels the night before or the day of the exam (they may interfere with the Pap smear).

When you are actually having the exam done, try to relax all of your muscles in the pelvic area so it will be less uncomfortable. In most cases, it will be over in about a minute, and you will receive your results in a week to 10 days. Don’t forget to ask exactly how you will get your results — some practices call everyone, some send emails, or postcards. Do NOT ascribe to the adage “no news is good news.” You want to hear (or read) the words, “Your Pap smear was negative.” And, if you had the HPV test, you want to know those results, as well as next steps, depending on the results you receive.

Stay informed, talk to your doctor, and advocate for your health.

* In this context, “women” refers to people with vaginas, acknowledging, of course, that not all women have vaginas. For more information, check out the tabú bodies and gender basics!


Dr. Levy-Gantt is an ObGyn physician in Napa California, who has been practicing for 20 years. Also a writer ( blogger, memoirist, advisor, humorist).