Do I Really Need a Pap Smear Every Year?

A Pap smear, also known as a Pap test or Pap, is a screening test for cervical cancer. Many people are used to having one every year, because that was the previous recommendation. But, as research has evolved, a yearly Pap smear is no longer recommended for most people. Depending on your age and risk factors, you only need a Pap smear every 3 to 5 years. And at some point, you won’t need one at all. 

Learn more on the risks of a Pap smear, how accurate the results are, and how much it costs.

What is a Pap smear and why do I need one?

A pap smear is a screening test that looks for cervical cancer, or precancerous changes. When you have a Pap smear, your healthcare provider does a pelvic exam and uses a brush to get samples from the cervix. (The cervix is at the top of the vagina and is the opening of the uterus.) Depending on your age and risk factors, a Pap test may include testing for human papillomavirus (HPV), a virus that increases the risk of getting cervical cancer. During the pelvic exam, your healthcare provider also evaluates your vagina, uterus, and ovaries.  

Does a Pap smear hurt?

While it can sometimes cause discomfort, such as vaginal pressure or mild cramping, a Pap smear should not hurt. It’s important to let your healthcare provider know if you are anxious, uncomfortable, or if you experience any pain during the exam. And if you haven’t had a Pap before, make sure you tell your healthcare provider so that they can be sure to walk you through what they are doing and when.

How often do I need a Pap test?

Many people are used to having a pelvic exam and Pap smear every year, as this was done for many decades. But, it turns out, this is not necessary and leads to unnecessary exams and testing. 

The most recent guidelines from the U.S. Preventive Services Task Force recommend the following cervical cancer screening schedule: 

• Before age 21: no Pap needed

• Between ages 21 and 29: a Pap every 3 years

• Between ages 30 and 65: a choice between a Pap every 3 years, an HPV test every 5 years, or a Pap and an HPV test together every 5 years 

• After age 65: no Pap needed for those with prior screening and not at high risk

It’s a good idea to talk with your healthcare provider about the best cervical cancer screening options for you, as there are many factors that may play a role in this decision, such as: 

• Your comfort level with having a pelvic exam

• Your risk factors for HPV and cervical cancer

• Your other health conditions

• Your own preferences 

Do some people need Pap smears more often?

Yes, some people do need Pap smears more often. This includes:

• People who are immunocompromised

• People who have HIV (human immunodeficiency virus)

• People with a history of HPV or abnormal Paps in the past

• People who were exposed to diethylstilbestrol (DES), a synthetic form of estrogen, before birth 

The CDC’s DES Self-Assessment Guide can help you check your risk of exposure to DES.

What if I’m not sure if I need a Pap smear?

Even if you don’t need a Pap smear every year, it’s still a good idea to check in with your primary care provider or gynecologist yearly.

Some people may need a Pap smear and not realize. For example:

• Transgender or nonbinary people who have a cervix

• People who have a history of HPV or cervical cancer, but have had their cervix removed

And some people may need anal Pap smears. So be sure to talk with your healthcare provider about your risk factors. 

Do I still need a Pap smear if I’m not sexually active?

Pap smears are recommended even if you are not sexually active or have never had heterosexual intercourse. This is because HPV can still be spread even without intercourse, such as through genital contact. And while HPV is the most common risk factor for cervical cancer, it is not the only one. 

Do I still need a Pap smear if I’ve had the HPV vaccine?

Yes, it’s still important to have cervical cancer screenings even if you’ve had the HPV vaccine. The vaccine protects against many of the HPV strains that are linked to cervical cancer, but not all of them. It’s also possible to have been exposed to HPV prior to getting the vaccine. 

Can I have cervical cancer screening without a pelvic exam? 

For many reasons, people may not feel comfortable having a pelvic exam or may not be able to physically go to a health clinic. This can stop people from getting the screening they need.

It’s likely that there may soon be a self-test for HPV. This will involve doing your own HPV test from the comfort of your home. Self-testing for HPV could increase access to cervical cancer screening and lower the cost.

What if my Pap smear is abnormal?

Abnormal Pap smears are common. There are many reasons for an abnormal Pap, and the next steps depend on what specific abnormalities show up on the test. As a first step, you’ll probably need more testing. This could be a repeat Pap test, a procedure called a colposcopy, or even a biopsy. Longer-term, you may need more frequent Pap tests. 

Are there risks with having a Pap test?

Like any medical test or procedure, there are some downsides and risks. Pap smears can cause discomfort and anxiety. They may cause a little cramping and light bleeding. False positives — when Paps come back abnormal but turn out to be nothing concerning — lead to unnecessary doctor visits and procedures, as well as cause stress and anxiety.

How accurate are Pap tests?

Paps are a good screening tool, but, as with any test, they can sometimes be inaccurate. False positives, showing an abnormality when there is none, and false negatives, showing a normal result when there is an abnormality, occur.

Pap tests may be inaccurate if:

• There are not enough cells present in the Pap.

• There is blood in the Pap, making it hard to interpret.

• There is inflammation or infection.

• You have recently had sex or douched and there is not an adequate sample of cells.

Pap smears are the best screening test we have for cervical cancer. You can improve the chances of an accurate test by avoiding intercourse, douching, and use of vaginal products beginning 2 days before your Pap. It’s also a good idea to avoid having your Pap during heavy menstrual flow.

How much does a Pap smear cost?

Pap smears are considered preventive and should be covered by your insurance. If you do not have insurance, the cost of a Pap can vary, but it is generally under $150. There may be health clinics in your area that offer free or low-cost testing, such as a local Planned Parenthood. 

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Written by:

Christina Palmer, MD

Christina Palmer, MD, is a board-certified family physician with a special interest in chronic care management, women’s health, mental health, and preventive care. She has over 10 years of experience in primary care research, innovation, and practice.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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