How Often Should You Get a Pap Smear?

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

A Pap smear is a screening test for cervical cancer or precancerous changes. The cervix is the opening of the uterus, located at the top of the vagina.

Getting a Pap smear often involves a pelvic exam. A healthcare professional inserts a speculum inside the vagina and uses a small brush to get a sample of cells from the cervix. The cells are then sent to a laboratory for examination under a microscope.

Depending on your age and risk factors, a cervical screening test may include testing for human papillomavirus (HPV), a virus that increases the risk of getting cervical cancer. Certain strains of HPV are “high-risk,” meaning they’re more likely to cause cancer. So testing for these types is an important part of screening.

How often should I get a Pap smear?

For decades, women were advised to get a pelvic exam and Pap smear every year. But, it turns out, this isn’t necessary and can lead to unnecessary exams and testing. Cervical cancer takes a long time to develop, so it’s OK to space out testing intervals a bit more now.

The Women’s Preventive Services screening guidelines recommend the following cervical cancer screening schedule:

• Before age 21: no screening needed

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

• Between ages 30 and 65: an HPV test every 5 years (preferred), OR a Pap and an HPV test together every 5 years, OR a Pap test every 3 years if HPV testing isn’t available

• After age 65: no Pap needed for those with prior screening and who aren’t at high risk

Can I have cervical cancer screening without a pelvic exam?

Yes, you can get screened for cervical cancer without a pelvic exam. In recent years, the FDA has approved self-tests for HPV. The goal is to make cervical cancer screening more accessible, as pelvic exams can be difficult for some people. And self-testing for HPV is just as accurate as testing done by a healthcare professional.

Self-testing involves collecting your own sample to be tested for HPV. There are two types, and both require an order from a healthcare professional:

• In-office: A healthcare professional will give you the supplies you need, instruct you on how to collect the sample from your vagina, and give you privacy while you collect your sample.

• At home: This involves using a kit with supplies and instructions, including where to send your sample after you collect it.

It’s important to know that self-tests can only detect HPV. They don’t look for changes in cervical cells like a Pap test does. But this is a good screening option for people ages 30 to 65 without any risk factors (as mentioned above).

What if my Pap smear is abnormal?

Abnormal Pap smears are common. There are many reasons for an abnormal Pap result, 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.

How accurate are Pap tests?

Paps are a good screening tool. But, as with any test, they can sometimes be inaccurate. They catch any abnormal result (even low grade) 50% to 80% of the time. For more serious changes, the sensitivity is 70% to 80%.

Pap tests may be inaccurate in some cases:

• There aren’t enough cells present in the sample.

• There’s blood in the sample, making it hard to interpret.

• There’s inflammation or infection.

You can improve the chances of an accurate Pap test by avoiding intercourse, douching, and use of vaginal products for 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?

A Pap test is preventive care. That means most health insurance plans are required to cover it without any copayments, coinsurance, or deductible.

If you don’t have insurance, the cost of a Pap can vary, but it’s generally under $150. There may be health clinics in your area that offer free or low-cost testing, such as a Planned Parenthood health center or your local health department. Sometimes, hospitals and clinics sponsor events that include free cancer screenings, so it’s worth a quick internet search.

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Written by:

Christina Palmer, MD

Christina Palmer, MD, is a board-certified family physician with a focus on chronic care management, women’s health, and mental health. She’s the co-author of the book, “Open Heart: When Open-Heart Surgery Becomes Your Best Option”.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. A pulmonologist and hospitalist, she practiced and taught clinical medicine at hospitals in London for a decade before entering a career in health education and technology.

Reviewed by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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