Chances are, a Pap smear isn’t first on your to-do list. The test, which checks for cervical cancer, can be cold, uncomfortable, and just plain awkward (who wants to lie on an exam table with their feet in stirrups, vagina and butt exposed?). 

It’s perhaps not a shocker, then, that a quarter of all American women are behind on their Paps, according to the National Cancer Institute. But we’re here to emphasize just how important it is to stay up to date on yours.

To do that, here's your Pap smear decoded: what it is, why you need it, where you get one, how it happens, and who should get it, when. 

WHAT Is a Pap Smear?

But first, a cervix reminder: It’s the lower part of your uterus, which opens up into your vagina. During a Pap smear, your medical clinician looks for precancers on your cervix. These are cell changes that could turn into cervical cancer if they’re not treated. 

During a Pap test, your doctor collects cells from your cervix. The sample is then sent off to a lab for testing.

WHY Do You Need a Pap Smear?

A Pap smear can save your life! In fact, death rates from cervical cancer have dropped significantly since the Pap smear was introduced in the 1940s. 

Still, 11 women die from cervical cancer every day in the United States, with half of them in their 50s or younger. It’s also the second leading cause of cancer death among women in their 20s and 30s. 

A Pap smear can find cervical cancer cells very early, when the cancer is easier to treat. By the time you start to have symptoms, such as vaginal bleeding, the cancer may have spread already, and treatment becomes more difficult. 

The Pap can also spot abnormal cervical cells before they even become cancerous. They can be removed before they start to cause cancer. This is why regular Pap smears prevent cervical cancer, as well as deaths from cervical cancer, by more than 80%.

WHERE Do You Get a Pap Smear?

You’ve got options. You can get a Pap smear at a doctor’s office, or at a health clinic such as Planned Parenthood. It’s usually done by a gynecologist, though your primary care provider may do them, too (but call ahead before your appointment and ask). 

Some physician assistants or nurse practitioners in these offices may do Paps, too. If you have a male clinician, they may also have a female assistant or nurse in the room to make you feel more comfortable.

You don’t have to do anything to prepare before your Pap smear or HPV test. Just don’t have vaginal intercourse, douche (but you shouldn’t do that anyway!), or use vaginal medicines or spermicidal foam for two days before the test. If you did have sex before the test, still go to your appointment but let your doctor know. (Sex can temporarily inflame your cervical or vaginal tissue, which could impact your test.) You can also have a Pap during your period, though a heavy flow could affect the results. 

HOW Does a Pap Smear Happen?

A Pap smear and an HPV test are done the same way. You’ll lie on your back on an exam table, with your feet on either side of the table in footrests. Your practitioner will then put a device called a speculum into your vagina, to open it up so they can see your cervix. They’ll then use a soft brush to take a few cells from the surface of the cervix. Those are placed on a glass slide and sent to a lab for testing.

These tests are quick—usually under five minutes. You may have some spotting, or light bleeding from your vagina, afterwards. The test shouldn’t hurt, but you might feel some discomfort of pressure when the speculum is inserted into your vagina. 

You don’t have to just grin and bear it, though. Speak up, because your doctor may be able to use a smaller speculum. Other ways to reduce discomfort include peeing before the test, so you have an empty bladder (this may help you feel more relaxed) and taking an over-the-counter pain reliever like acetaminophen or ibuprofen about an hour before your test.

WHO Should Get a Pap Smear and WHEN? 

If you’ve got a cervix, you’re going to need Pap smears—at least for now. The latest guidelines, endorsed by the American College of Obstetricians and Gynecologists (ACOG), recommend that the Pap smear eventually be phased out for the human papillomavirus (HPV) test. Conducted the same way as a Pap, the HPV test checks your cervical cells for infection with a virus called the HPV virus. There are certain high-risk HPV types that can lead to cervical cancer. 

Why the HPV test over the Pap? The HPV test is the more sensitive of the two, meaning it might catch more abnormalities. But currently, it’s not widely available enough for the general public, so many people at average risk will still get Paps.

Whether you have a Pap or an HVP test, your age, health history, and risk factors determine when you get screened. Here’s a breakdown.

21-29 years

You should have your first Pap smear at age 21 and, if it’s normal, repeat every three years. You don’t need to start earlier than this, even if you’re already sexually active. 

At this time, HPV testing isn’t part of routine screening for this age group. Though many young women contract the virus, their bodies typically clear it on their own.

30-65 years

If you’re in this age group, the American Cancer Society (ACS) and ACOG recommend the HPV test—also called a primary HPV test—if possible. If the result is normal, your doctor may suggest that you wait five years until your next screen.

Let’s say a primary HPV test isn’t available. Your doc might recommend what’s known as co-testing. This combines the Pap and HPV screenings. If results are normal, you also may be able to wait five years until your next test. 

Co-testing is only slightly more sensitive than a Pap alone, per the ACS, but it also has a higher rate of false positives. For most people, it may not be necessary. If your doctor determines you don’t need a co-test based on your risk factors, you’ll get a Pap smear only. With a normal result, you can go three years until your next Pap. 

Whichever screen you get, the most important thing is to stay on top of testing.

Over age 65

Good news! Your doctor may tell you that you’re done with screening if you meet the following conditions:

• You’ve had at least three Pap tests or two HPV tests in the last decade, all of which were normal
• You’ve never had cervical precancer or you’ve already had your cervix removed

If you have had a recent abnormal test—or haven’t gotten regular screenings—you may still need Pap smears. Talk to your medical provider about what’s right for you.

Ok! Now that you’ve read our explainer, it’s time to schedule your appointment, pronto. (Even if you’re not due for a Pap smear, you still need your yearly pelvic exam!) Ready to go?