When should I get a pap smear?. . . and how often?

Many women have heard about a pap (Papanicolaou) smear before ever having one themselves. But many other women are unclear on how often they need to have a pap smear or even when they need to start getting pap smears.  The confusion is justified. Over the past 20 years the recommendations for pap smears have changed multiple times.

It used to be advised, that a pap smear was required yearly once a woman was sexually active. Then the recommendation was for a pap smear at 18 years old no matter the sexual history. Once again, things changed and pap smears were recommended every 3 years. Soon after a pap smear and an HPV (Human Papilloma Virus) test were recommended together. It is no wonder that there was so much confusion!

What is a pap smear? A pap smear can be a very useful tool that your doctor uses to screen for cervical cancer. It is generally performed during an exam with your gynecologist or family physician.

A pap test is often confused with a speculum exam, so let’s clarify:

What are the differences?

  1. A speculum exam is one where the cervix and vaginal canal are visually inspected by your provider with the use of speculum. A speculum is a device that is placed inside the vagina that allows your provider to see inside the vagina and to the cervix.
  1. A pap test/smear is a procedure where the surface of the cervix is brushed with a special brush and the cells examined under a microscope.

Some women believe that if they have had a speculum exam then they must have had a pap smear as well. This is not always the case and your provider should tell you if a pap smear was performed at the time of an exam.

A third way of evaluating the cervix now exists in the form of a HPV test. More on this later.

Though the rates of cervical cancer have declined significantly in the United States over the past 4 decades, this continued improvement depends on women getting regular pap smears.

When should a woman start seeing a gynecologist?

Well this is a trick question. Any woman can see a gynecologist at any age. There are even a select group of gynecologists who are specialists for young girls and adolescents. A visit with a gynecologist does not necessarily require an exam. Sometimes it is very useful to visit your gynecologist to discuss topics such as birth control, normal expectations for menstrual cycles and pregnancy planning.  

In general, an annual exam is recommended yearly once a woman is over 18 years old. An annual exam is a great time to check labs, make sure you review your plans for contraception and/or pregnancy and have a physical exam. An exam should include a breast exam and a pelvic exam (not necessarily a pap smear as detailed above).

When should a woman start having pap smears?

At 21 years of age it is recommended that a woman start having pap smears. Assuming the pap smear is normal (no abnormal cells seen) then a repeat pap smear is recommended 3 years later.

If you are not sexually active or are hesitant to have a pap smear or speculum exam, it is reasonable to discuss theses concerns with your provider and to come up with a customized plan that is best for you.

Between 21-29 years of age some providers choose to check an HPV test in place of a pap smear. This is performed in the same manner, during a speculum exam.

Between 30-65 years of age there are three options:

  1. Pap smear and HPV test every 5 years
  2. HPV test every 5 years
  3. Pap smear alone every 3 years

Over 65 years of age, pap smears and HPV testing may no longer be necessary depending on your previous results. If there have been two consecutive normal tests (either pap smear and/or HPV) your provider may not require further testing.

The HPV  vaccine has also helped change the frequency of cervical cancer. Though many young men and women have received the HPV vaccine, the recommendations for pap smears has not changed based on whether someone has had the HPV vaccine.

It is best to discuss the screening guidelines specific to your age and your previous history with your health care provider.

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