Real Talk Blog

What is a Pap smear test for?

Key Takeaways:

  • A Pap smear is a screening method used to sample the cells of the cervix to test for changes that could indicate precancer or cancer of the cervix, therefore also referred to as cervical cancer screening.
  • During a Pap smear, your doctor or clinician will use a speculum to hold open the walls of your vagina and insert a cervical brush to collect a sample from your cervix. The sample will be sent to a lab for testing.
  • The HPV test can be performed on the same cervical cells collected during a Pap smear (and a co-test is when both tests are performed on the sample). 
  • According to USPTF and ACS guidelines, women 21 or 25 and older respectively should have one of the following: a Pap smear every 3 years, an HPV test every five years, or a co-test (Pap + HPV) every five years.

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Many of us get Pap smears because our doctor recommends them, without much thought into the process. You may groan when you see the appointment on your calendar and probably cringe a bit when it’s time to put your feet in the stirrups. At Teal Health, we are working to make the process of cervical cancer screening less uncomfortable, let's start by getting a better understanding the exam itself, and why it’s so important. 

What is a Pap smear? 

The Pap smear experience has not evolved much in its 80 years in medicine, however, there have been updates to what doctors can test for. Thanks to major advancements in research and technology, we know human papillomavirus (HPV)  is linked to nearly all cervical cancer diagnoses. These findings led to the introduction of a new test that can be performed on the same cervical cells collected during a Pap smear which tests for HPV. 

Below are the three tests that can be performed during your exam:

Pap Smear: According to Dr. Liz Swenson, Medical Director and OB-GYN at Teal Health, “A Pap smear is a screening method used to sample the cells of the cervix to test for changes which could indicate precancer or cancer of the cervix. Usually, this is due to an infection with a type of high-risk HPV.”   

Primary HPV: This screening test looks for a current HPV infection.  Detecting HPV is critical because having high-risk HPV is the single most important risk factor in developing cervical cancer, as almost all cervical cancers are caused by HPV.

Co-test: A co-test includes both a high-risk HPV test and the Pap test. 

It's good to understand which test you receive because the follow-up timelines can be different. If you have a Pap smear with normal results, you’ll need another one in three years (abnormal results for any test will result in more immediate follow-up with your doctor).  Following a normal HPV test, you won’t need to test again for up to five years.  It is, however, important to review your individual situation with your provider and determine the most appropriate timing for your next screening.  

What does getting a Pap smear entail?

We’ll speak plainly here: The Pap smear is in dire need of an upgrade.  Teal Health is currently working on an at-home self-collection option so that women can collect a cervical sample from the comfort of their own homes. While we work towards FDA approval (and you can be the first to know by signing up here), here’s what you can expect when you go into the doctor’s office for a Pap smear. 

When you arrive at the doctor’s office, you’ll undress from the waist down and likely change into a gown. Your doctor or clinician will have you place your feet in stirrups and spread your legs. From there, they will use a speculum to hold the vaginal walls apart so the clinician can access your cervix. They will insert a cervical brush and you may feel pressure as they collect a sample. It’s not a comfortable process, but it shouldn’t take longer than a couple of minutes. 

After your exam, your clinician will insert the brush into a preservation solution and send it to a lab with an order from the physician to perform a Pap smear on the sample. Within 1-3 weeks, you’ll get results from your doctor, indicating either “normal” or “abnormal” results and the appropriate follow up.  This could include doing additional testing if your results are abnormal.

What exactly *is* my cervix? 

So, your doctor or clinician will access your cervix via your vagina during a Pap smear.  But what exactly is the cervix?  Dr. Swenson explains, “The cervix is the lowest portion of the uterus which connects the uterus to the vagina. It produces mucus that cleans and hydrates the vagina. Because the cervix responds to hormonal changes, the character of the cervical mucus changes throughout the menstrual cycle.”

Perhaps if you’ve tracked your menstrual cycles or tried to conceive, you’ve noticed or looked for changes in your cervical mucus. Dr. Swenson says, “Near the time of ovulation, the mucus is thin and slippery, promoting sperm to pass through. During pregnancy, it develops a protective thick mucus plug which helps prevent infections. The cervix is the part of the uterus that opens/dilates during labor, allowing the fetus to move through the birth canal during a vaginal delivery. It can also be a source of sexual stimulation for some women during intercourse.”

What should I know before I get a Pap smear?

Now that we know more about what to expect and why a Pap smear is important, we asked Dr. Swenson if there’s anything else to know before getting one. 

She says, “Having sex just before a Pap smear can cause some changes to show up on the cells, indicating inflammation or atypical cells of undetermined significance. The presence of HPV is used to determine the significance of these findings. If there is no HPV, it is most likely benign and nothing to worry about.” So while it may be best to avoid sex the day or so before your Pap smear, Dr. Swenson says it’s fine to have sex as soon as you feel comfortable after your test. 

Lastly, she explains that it’s common to have some spotting after a Pap smear. 

When and where should I get a Pap smear? 

For now, the U.S. Preventive Services Task Force (USPSTF) and the American Cancer Society recommend a Pap smear every three years for patients 21 or 25 and older respectively. All insurance covers cervical cancer screening tests every three to five years, and most cover it every year.  

“Pap smears can be done by a variety of providers, including OB-GYNs, midwives, family practitioners, internists, nurse practitioners, and physician assistants,” says Dr. Swenson. “It's helpful to confirm that your primary care provider [performs a Pap smear] as part of their routine exams, as occasionally some don't include this as part of their care.” 

The future of cervical cancer screening is bright

If you haven’t had a Pap smear in the past three years or an HPV or co-test in the last five years, don’t wait to get screened. But a better way is on the horizon, and we’re so excited to share with you what we’ve been working on. 

Teal Health is designing a device that will enable women to perform self-collect primary HPV testing at home—no more uncomfortable speculum and stirrups at your doctor’s office—with a device you can use to screen for cervical cancer from the comfort of your own home. Teal’s device (think a swab similar to a tampon) will make screening more comfortable and accessible for all women. Sign up below to be the first to know when you can get Teal Health in your state. 

Liz Swenson, MD
Medical Director

Liz Swenson is a board-certified OB/GYN who has been providing care to women for more than 20 years. She has learned that women are genuinely interested in their own health and want to understand the science behind their medical conditions. Originally from Iowa, she completed her medical training in Northern California where she still lives with her husband and two daughters. She has worked in a busy multispecialty practice in Palo Alto and has taught OBGYN residents as an Adjunct Clinical Faculty Member of Stanford University. Now, with a focus on helping all women have choices and access to the gynecological care they need, she is excited to use her clinical experience to help improve the lives and longevity of all Teal patients.