A pap smear is a screening test for cervical cancer. It does not detect endometrial (sometimes called uterine) cancer or ovarian cancer. The type of pap smear we order is dictated by national guidelines and changes slightly based on the patient’s age. Current evidence-based guidelines state pap smears should not be performed on women until they turn 21, even if they are already sexually active.

Additionally, it is not recommended to do pap smears on women after age 65. It is also recommended that pap smears be discontinued in a woman of any age who has had a hysterectomy with removal of her cervix with no history of a high-grade lesion (CIN II or CIN III). Women ages 21-65 should have a pap smear at least every 3 years and if a woman over 30 is negative for Human Papilloma Virus (HPV), she can have a pap smear every 3-5 years. Even if you do not receive a pap smear at every visit, it is still recommended that you have an annual gynecologic and breast exam.

Most abnormal pap smears are caused by HPV, but other causes of abnormal paps include things that cause inflammation on the cervix such as recent sexual intercourse, recent or current menses, vaginal infections, or menopause.

HPV is a very common sexually transmitted skin virus. Men don’t usually have any symptoms of HPV, and they can unknowingly carry and transmit this virus to their partners. There is no HPV screening test for men. Condoms provide some protection against transmission, but because the virus can live on the scrotum and groin as well as the penis, condoms do not provide complete protection.

What Kind Of Pap Smear Is My Provider Ordering For Me?

Pap Smears (Age 21-25)
The type of pap smear we order for this age group checks for abnormal cells on the cervix and only checks for HPV if an abnormality is seen. While the rate of HPV is high in this age group because women are usually exposed to HPV when they first become sexually active, the body usually does a good job of clearing this virus on its own.

For this reason, we don’t check for HPV unless it has caused an abnormality on the cervix. If an abnormality is detected, certain kinds of changes can be monitored with more frequent pap smears while others need to be further investigated with a biopsy.

The CDC recommends chlamydia and gonorrhea screening every year for all sexually active people age 25 and under. The rates of these bacterial infections are highest in this age group and many people do not experience symptoms.   If you wish to decline chlamydia and gonorrhea testing, please let your provider know.

Pap Smears (Age 26-29)
The type of pap smear we order for this age group checks for abnormal cells on the cervix and only checks for HPV if an abnormality is seen. While the rate of HPV is high in this age group because women are usually exposed to HPV when they first become sexually active, the body usually does a good job of clearing this virus on its own.

For this reason, we don’t check for HPV unless it has caused an abnormality on the cervix. If an abnormality is detected, certain kinds of changes can be monitored with more frequent pap smears while others need to be further investigated with a biopsy.

Testing for chlamydia and gonorrhea is not routinely done in this age group. If you desire STD testing, please let your provider know.

Pap Smears (Age 30-64)
The pap smear we order for this age group is called a “Pap with HPV, reflex to 16, 18.” This type of pap smear tests for any abnormality with the cervical cells and also checks for the presence of HPV. If the HPV test is positive, the lab will then check to see if the strain of HPV is type 16 or 18.

It is important to know if you carry one of these strains of HPV because they are more aggressive and are more likely to cause cervical cancer than other types of HPV. If an abnormality is detected, certain kinds of changes can be monitored with more frequent pap smears while others need to be further investigated with a biopsy.

By 30 years old, a woman has usually been exposed to HPV and her body has cleared it from the cervix. If HPV persists at this age, health care providers want to know so we can perform more frequent pap smears. Chlamydia and gonorrhea testing is not routinely done in this age group. If you desire STD testing, please let your provider know.

Pap Smears (Age 65+)
Current guidelines recommend discontinuing pap smears in women over 65 years old. However, the decision to discontinue pap screening needs to be made in connection with your health care provider who will consider your prior pap smear history and your sexual risk factors. While a pap smear may no longer be performed, women should continue to see their provider annually and report any signs of vaginal bleeding, persistent abdominal bloating or lesions on the vulva immediately.