How Often Do You Really Need a Pap Smear?

It might not be as frequently as you think.

nurse talking to patient

Medically reviewed in June 2022

Updated on June 9, 2022

Some 93 percent of cervical cancers can be prevented through human papillomavirus (HPV) vaccination and screenings. These screenings include regular Pap tests, also known as Pap smears. Pap tests help healthcare providers (HCPs) detect and treat unhealthy cells before they become cancerous. They also help HCPs spot cancers early, when they can be more effectively treated.

Thanks in large part to screening, cervical cancer diagnoses and deaths have dropped dramatically over the past few decades. Still, research shows that many women skip recommended screenings. In 2020, a study published in Preventive Medicine found that screening rates especially declined after age 45—a significant concern, since this group accounts for more than 60 percent of cervical cancer diagnoses.

In 2022, about 14,100 women will be told they have invasive cervical cancer, the American Cancer Society (ACS) estimates. More than 4,200 will likely die from the disease. That’s why, whether you’re new to Pap tests or you’ve been getting them for years, it’s important to understand how often you need one, why they’re essential for your health, and what your results mean.

What is a Pap smear?
In a nutshell, a Pap smear is an in-office procedure that allows your HCP to clearly see and collect cells from your cervix. 

During the actual exam, your HCP will insert a metal or plastic speculum into your vagina to keep it open. Next, they’ll use a small brush or wooden or plastic scraper to gather cells. Then, they’ll place the cells in a vial and send them to a lab for analysis. At the lab, technicians will study the sample under a microscope to check for pre-cancerous or cancerous cells.

How often should you have one?
Cervical cancer screening recommendations vary slightly from organization to organization. But most HCPs follow the guidelines set forth by the American College of Obstetricians and Gynecologists and U.S. Preventive Services Task Force, which depend largely on age and health history:

  • Women ages 21 to 29: Pap smear every three years
  • Women 30 to 65: Pap smear and human papillomavirus infection (HPV) test every 5 years OR a Pap smear alone every three years OR an HPV test alone every 5 years
  • Women 65 and older: You can stop screenings if you have had normal, regular screening results in the past 10 years, plus no CIN-2 (moderately abnormal cells) or more serious cervical issue found within the past 25 years. 

You and your HCP should discuss what’s best for you. More often than not, they will use these interval recommendations because there is science to back them up, says Thomas Zarka, MD, an OBGYN at Parkland Medical Center in Derry, New Hampshire.

You may need more frequent Pap testing if you’ve had abnormal Pap smears in the past, if your immune system is suppressed (you have HIV/AIDS, had an organ transplant, etc.), or if your mother took diethylstilbestrol (DES), a synthetic form of the female hormone estrogen, passing it to you in the womb.

An abnormal Pap isn’t always cause for worry
Dr. Zarka says that many people get upset if their Pap smear comes back abnormal, but that it does not necessarily indicate cancer. “In fact, because we have such a rigorous screening process in this country, cervical cancer really is a rare disease. We don't see it very often,” he adds.

So, how do you interpret Pap smear results? Typically, they are placed into one of three categories, based on the Bethesda System (TBS):

  1. Negative for intraepithelial lesion or malignancy: There are no signs of cancer, pre-cancer, or other abnormalities, but other non-cancerous conditions may be present, such as a yeast infection or herpes.
  2. Epithelial cell abnormalities: Cells lining your cervix or vagina indicate there may be a cancerous or pre-cancerous condition present.
  3. Other malignant neoplasms: Non-cervix related malignant conditions such as melanoma, sarcomas, and lymphoma may be present.

You should still see your HCP regularly
You may not need a yearly Pap smear, but don’t take it as a free pass to skip seeing your provider. An annual checkup is still recommended by some HCPs and expert groups, though others advise having one every three years. It may depend on your individual situation, including your medical history, risk, and symptoms.

At these regular appointments (whether it’s the year for your Pap smear or not), your HCP will perform a physical exam to check the health of your ovaries, uterus, and breasts. Depending on your age, you may also discuss fertility issues, perimenopause, or menopause symptoms.

Help ensure accurate results
Pap tests are the most well-known and effective method of detecting cervical cancer. To help ensure that your results are accurate, follow these tips:

  • Avoid seeing your HCP for a Pap smear during your menstrual period. If possible, schedule it at least five days after your period ends.
  • Refrain from using any products or medications that are inserted into the vagina two to three days before your test. This includes tampons, birth-control foams or gels, and vaginal creams, lubricants, and medications.
  • Avoid douching, especially two to three days before your Pap smear.
  • Abstain from vaginal sex two days before your Pap smear.
Article sources open article sources

Centers for Disease Control and Prevention. Vital Signs: Cervical Cancer is Preventable. January 6, 2020. Accessed June 7, 2022.
National Cancer Institute. Cancer Stat Facts: Cervical Cancer. 2022. Accessed June 7, 2022.
American Cancer Society. The Pap (Papanicolaou) Test. January 3, 2020. Accessed June 7, 2022.
The American College of Obstetricians and Gynecologists. Cervical Cancer Screening. May 2021. Accessed June 7, 2022.
U.S. Preventive Services Task Force. Cervical Cancer: Screening. August 21, 2018. Accessed June 7, 2022.
Harper DM, Plegue M, et al. Three large scale surveys highlight the complexity of cervical cancer under-screening among women 45-65years of age in the United States. Preventive Medicine. 2020 Jan;130:105880.
National Cancer Institute. Diethylstilbestrol (DES) Exposure and Cancer. December 20, 2021. Accessed June 7, 2022.
American Cancer Society. Key Statistics for Cervical Cancer. January 12, 2022. Accessed June 7, 2022.
American Cancer Society. What Is Vaginal Cancer? March 19, 2018. Accessed June 7, 2022.
National Cancer Institute. HPV and Pap Testing. May 9, 2022. Accessed June 9, 2022.
National Cancer Institute. Next Steps after an Abnormal Cervical Cancer Screening Test: Understanding HPV and Pap Test Results. March 22, 2022. Accessed June 9, 2022.
American Cancer Society. The American Cancer Society Guidelines for the Prevention and Early Detection of Cervical Cancer. April 22, 2021. Accessed June 9, 2022.
Cleveland Clinic. Pelvic Exam. July 23, 2021. Accessed June 9, 2022.

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