This site offers general information only and is not medical advice. For diagnosis or treatment, always speak with a qualified healthcare professional. In an emergency, contact your local emergency services.
Cancer Awareness GuideGeneral information & support

What is a Pap smear? Cervical screening explained

A Pap smear (Pap test) is part of cervical screening, one of the few screening tests that can help prevent a cancer rather than only find it early. This guide explains the Pap test and the HPV test, who is offered them, and what happens at the appointment.

For information only - this is not medical advice. Screening ages and tests vary by country and change over time. Please follow your doctor's advice or your national screening programme. If you have symptoms, do not wait for a screening appointment - see a doctor.

What a Pap smear is

The US National Cancer Institute (NCI) explains that the Pap test - also called a Pap smear or cervical cytology - collects cells from the cervix so they can be checked for changes caused by the human papillomavirus (HPV) that could, if left untreated, turn into cervical cancer. It can find precancerous cells and cancer cells, and it sometimes finds conditions that are not cancer, such as infection or inflammation (NCI: Cervical Cancer Screening). The NHS describes the cervix as the opening to the womb from the vagina.

NCI describes three main ways to screen for cervical cancer:

  • HPV test - checks the sample for infection with high-risk types of HPV that can cause cervical cancer.
  • Pap test - checks the cells themselves for abnormal changes.
  • HPV/Pap cotest - both tests on the same sample.

In England, what used to be called a smear test is now simply called cervical screening. The NHS checks the sample for high-risk HPV first; only if HPV is found is the sample checked for cell changes (NHS: What is cervical screening?).

A test to help prevent cancer

The NHS puts it simply: cervical screening is not a test for cancer, it is a test to help prevent cancer. NCI explains that the goal is to find precancerous changes when treatment can stop cervical cancer from developing. The World Health Organization (WHO) says cervical cancer is largely preventable through HPV vaccination and regular screening (WHO: Cervical cancer fact sheet).

Why HPV matters

The NHS explains that HPV is a very common group of viruses, that most people get some type of HPV during their lives, and that it is nothing to be ashamed of. In most cases the body clears it without problems. But if a high-risk type stays in the body for a long time, it can cause changes to cervical cells that may become cancer if not treated. The NHS says nearly all cervical cancers are caused by high-risk HPV (NHS: Why cervical screening is done).

The HPV vaccine protects against the types that cause most cervical cancers, but not all. That is why both NCI and the NHS say vaccinated people with a cervix should still go for screening. You can read more about HPV vaccination in our guide to reducing cancer risk.

Who is screened, and how often

Different organisations give different advice, and some guidance is being updated, so check the current rules where you live. Examples from official sources checked today:

  • USPSTF (United States, 2018): a Pap test every 3 years from age 21 to 29. From 30 to 65, a Pap test every 3 years, an HPV test every 5 years, or a cotest every 5 years. It recommends against screening under 21, over 65 after adequate prior screening (if not at high risk), and after a hysterectomy that removed the cervix for reasons not related to precancer or cancer (USPSTF: Cervical Cancer Screening). The USPSTF website shows that an update to this recommendation is in progress.
  • American Cancer Society (as summarised by NCI): start at 25 with an HPV test every 5 years through age 65; a cotest every 5 years or a Pap test every 3 years is still acceptable.
  • NHS England: women and people with a cervix aged 25 to 64 are invited every 5 years. People aged 65 or over are invited only if a recent test was abnormal (NHS: When you'll be invited).
  • WHO (global guidance): screening with a high-performance test every 5 to 10 years from age 30, and for women living with HIV every 3 to 5 years from age 25.

NCI notes that a doctor may suggest more frequent screening for people who are HIV positive, have a weakened immune system, were exposed before birth to the medicine diethylstilbestrol (DES), recently had an abnormal result, or have had cervical cancer. People who had the womb removed but kept the cervix should continue routine screening.

What happens at the appointment

The NHS describes the test like this. You undress from the waist down behind a screen and lie on a bed, usually with your knees bent. A nurse or doctor gently inserts a smooth tube-shaped tool (a speculum) into the vagina so they can see the cervix, and uses a soft brush to take a small sample of cells. The test itself takes less than 5 minutes and the whole appointment about 10 minutes (NHS: What happens at your appointment). NCI adds that some clinics may offer the option to collect the sample yourself, so it is worth asking.

If you feel anxious, the NHS suggests you can:

  • wear something you can keep on, such as a skirt or a long jumper;
  • bring someone with you for support;
  • ask for a smaller speculum, to insert it yourself, or to lie in a different position;
  • ask the nurse or doctor about breathing exercises, and tell them how you feel;
  • ask to stop at any time - you are in control of the test.

Screening does not usually hurt, but some people find it uncomfortable or painful. Light bleeding or spotting afterwards is possible and should stop within a few hours. The NHS advises seeing a GP if you have heavy bleeding, or spotting that does not stop after a few hours.

Understanding your results

NCI says results usually come back from the lab in about 1 to 3 weeks, and suggests contacting your provider if you have not heard. Under the NHS programme, the main results are (NHS: Your cervical screening results):

  • HPV not found - most people get this result. Your risk is very low and you are invited again in 5 years.
  • Unclear (inadequate) result - you are asked to repeat the test in 3 months. This does not mean anything is wrong.
  • HPV found, no abnormal cells - you are invited back in 1 year, and again a year later if HPV is still present. If it is still there after 2 years, you are asked to have a colposcopy.
  • HPV found with abnormal cells - you are invited for a colposcopy, a closer look at the cervix in hospital.

The NHS stresses that a positive HPV result does not mean a partner has been unfaithful - HPV can stay in the body for many years without being noticed. Abnormal cells are not cancer, and the NHS says any changes will not get worse while you wait for a colposcopy appointment.

Limits of screening

NCI says cervical screening saves lives, but it is not perfect. A result can look abnormal when there is no precancer (a false positive), leading to worry and more procedures, or look normal when changes are present (a false negative). Finding changes that would have cleared on their own can also lead to tests and treatment that were not needed. The recommended intervals are designed to reduce these harms. For the bigger picture, see cancer screening explained.

Screening is for people without symptoms. The NHS advises seeing a GP - without waiting for your next screening - if you have bleeding between periods, during or after sex, or after the menopause, or unusual vaginal discharge. See also our list of warning signs to see a doctor about. In an emergency, contact your local emergency services.

Sources

Published and last reviewed: 21 October 2026.

Common questions

What is the difference between a Pap smear and an HPV test?

A Pap test looks at cervical cells for abnormal changes. An HPV test checks the same kind of sample for high-risk types of human papillomavirus, which cause most of those changes. They can be done alone or together.

Does a Pap smear hurt?

It does not usually hurt, but some people find it uncomfortable. The NHS says you can ask for a smaller speculum or a different position, and you can ask to stop at any time.

How often do I need a Pap smear?

It depends on your age, your results and your country. Examples include every 3 to 5 years in the US (USPSTF) and every 5 years from 25 to 64 in England (NHS). Ask your doctor what applies to you.

Do I still need screening if I had the HPV vaccine?

Yes. NCI and the NHS both say the vaccine does not protect against every high-risk HPV type, so vaccinated people with a cervix should still follow screening recommendations.