Any woman knows that we should get a pap smear, but oftentimes we don’t know exactly why we have to. After all, going to your OB-GYN to get one isn’t exactly a fun day at the beach. Nevermind the dreaded speculum, but there’s the whole awkward feeling of having your lower half on, uh, display. 

Still, pap smear tests are a vital part of our overall health as women. It may be easy or tempting to put them off, but getting a yearly pap smear should be a priority. Your life may very well depend on it. 

What Do Pap Smears Test For?

Pap smears test for a few key things. According to Sara Twogood, MD, an OB-GYN in Los Angeles and co-founder of the health education resource FemEd, pap smears are mainly a screening for cervical cancer. “The test is looking for changes to cervical cells that may be pre-cancerous or even cancerous,” she explains. 

The American Cancer Society estimates that, in 2020 alone, about 13,800 new cases of invasive cervical cancer will be diagnosed and roughly 4,290 women will die from cervical cancer. (This is why screenings, like regular pap tests, are so very important.) 

However, cervical cancer is not all that pap smears test for. As the Mayo Clinic notes, pap smears are usually done in conjunction with a pelvic exam, and, in women over 20, the pap may be combined with a test for human papillomavirus (HPV)

The National Cancer Institute defines HPV as “a group of more than 200 related viruses, some of which are spread through vaginal, anal, or oral sex.” Though HPV is common, most infections do not cause cancer. (However, this can be different if you have persistent, high-risk HPV.) 

What Happens During a Pap Smear?

First things first, you’ll lie back on the bed, chair, or table at your doctor’s office, scooch your butt forward and place your feet into stirrups. (As an added bonus, you’ll be wearing the ever-trendy paper gown.) 

During the pap smear, a speculum (this friendly pap smear tool) is inserted into the vagina so that the cervix can be visualized by your doctor. The cervix, Twogood explains, is the opening to the uterus. 

After the speculum is in place, Twogood says that the next step is to move a swab gently over the visible part of the cervix. “Sometimes a second swab is done to collect cells from the inside lining of the cervix, the endocervix,” she says. 

Twogood also points out that, sometimes, the external and internal cells are collected with the same swab. 

“There are different swabs but all do the same thing,” she says, adding, “Some swabs look like a tiny spatula, others look like a broom, and others look like a little brush.” The swab(s) are then placed in liquid. The whole process should take anywhere from 10-20 minutes. 

The swab(s) are sent to a pathology lab where, Twogood explains, “the cervical cells in the liquid are looked at with a microscope to see if there are atypical changes.” 

How Often Do You Need a Pap Smear?

How often you need to get a pap smear depends on a few factors. “For most females, screening starts at age 21,” Twogood says. The frequency of how often you need a pap smear can depend on the results of previous tests and whether or not HPV testing was done before. 

While Twogood notes that recommendations for pap smears can vary by country and organization, the United States commonly suggests that for females between the ages of 21 and 29, they are done every three years if the results are negative. 

For women between the ages of 30 and 65, pap and HPV can be tested together, Twogood says, and if they are both negative then screen can be done every five years. 

How to Prepare for Your Gynecologist Appointment

Whether you’re having a pap smear done for the first time, or you’re returning for another appointment, it can cause some anxiety or even fear. If you’ve never had a pap smear done before, Twogood says to make sure to tell your doctor. This way, she says, “They can explain exactly what they are doing and talk you through the exam before doing it.” 

“Some patients may want to have a talking appointment only to meet their doctor first and then schedule a second follow up appointment for the exam,” she says. While this is not necessary, it is an option, but you may want to check with your insurance provider first to see if they cover this kind of appointment. 

While a pelvic exam and pap smear can be uncomfortable, Twogood assures that it is typically not painful. In fact, the thought of the exam may be worse than the actual process itself. And, don’t worry about what your doctor may think, either. “Being embarrassed or shy is common and normal,” Twogood says, adding, “But I remind patients that this is what I do all day, every day.” 

What Do Your Pap Results Mean?

The results from your pap smear test can take upwards of two weeks. Your doctor will let you know if the results from your pap smear have come back as normal, unclear, or abnormal. 

According to the Office on Women’s Health, an unclear pap smear result is defined as when “Your doctor does not know whether the cells collected from your cervix are normal or abnormal.” 

If results are unclear,  Twogood says that your doctor may do more testing right away to rule out any problems, “or your doctor may have you come back in six months or a year for another test.” 

Normal Pap Smears

A normal pap smear result means they came back as “negative,” Twogood explains, adding, “It means there were no abnormal cervical cells found.” 

The Centers for Disease Control points out that while this is good news, “You still need to get pap tests in the future. New cell changes can still form on your cervix.” Your future pap tests will depend on your age and other factors, such as if you’ve been tested for HPV. 

Abnormal Pap Smears

Getting an abnormal pap smear test result back can be a frightening thing to hear but it’s important to be aware of what it all means. The results are actually categorized into different groups: atypical, low grade, and high grade. 

When it comes to atypical, Twogood explains it means the “patient has atypical cells of undetermined significance (ASCUS). HPV is then tested because atypical cells are more significant if caused by HPV, which is the virus that causes cervical cancer.” 

Low grade squamous intraepithelial lesion (LSIL), on the other hand, is little cause for concern according to the Cleveland Clinic. They note that low grade means you probably won’t need treatment, nor is it permanent or a high risk for cancer. 

High grade squamous intraepithelial lesion, Johns Hopkins Medicine explains, means “the cells appear very different from normal cells.” They are more severe than LSIL and treatment for HSIL is to remove the abnormal tissue. 

If you do have an abnormal pap smear result, Twogood says it’s typically recommended that you schedule a follow-up procedure called a colposcopy. “During a colposcopy, cold fluid called acetic acid is applied to the cervix and then the cervix is looked at with a colposcopy, which magnifies the cervix and allows us to look for atypical appearing cells and abnormal blood vessels,” she explains. 

Biopsies are commonly taken as well under these circumstances.  Your doctor’s recommendations following the colposcopy and biopsies will be given depending on the results of both your colposcopy and your biopsy, Twogood says. 

“Depending on the abnormal pap smear results, sometimes close follow up with a repeat pap in one year is recommended instead of a colposcopy.” 

If you need a pap smear for the first time, or you are due for a follow-up appointment, please contact your doctor. 

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