When Do I Need A Pap Smear Test?

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A Pap smear is the main method used to check the cells on your cervix to find changes that can lead to cancer. Regular Pap smears aim to diagnose abnormal or pre-cancerous cells at an early stage for treatment to be effective. A pap smear is generally performed on women between the ages of 21 and 65. In the United Kingdom, screening starts around the time you turn 25.

What Do Abnormal Cells on a Pap Smear Mean?

Receiving an abnormal result does not mean that you have cervical cancer, but rather that changes have been seen in the cervical cells which require further investigation. In more than 90% of cases, these abnormal changes are caused by the human papillomavirus (HPV). Although many HPV infections clear by themselves, a long-lasting infection with certain types of high-risk HPV can lead to cervical cancer.


Because the HPV virus can remain dormant for a very long time and produce no symptoms, many women are unaware that they have the virus. It is, therefore, very important to attend all your scheduled cervical screening appointments, which make early diagnosis and treatment possible.


What Time Of The Month Should I Have a Pap Smear?

You can have a cervical screening test at any time during your menstrual cycle (period). However, if you have a Pap smear done during your period, there is a risk that the presence of blood in a Pap smear sample may conceal abnormal cervical cells, potentially leading to a false-negative result.


Most women also find it more comfortable to schedule their appointment at a time outside of their period when they are not bleeding. You should try to schedule your Pap test for the middle of your menstrual cycle – between 10 and 20 days after the first day of your period. If you are post-menopausal, you can have a Pap smear at any time. 


Preparing For a Pap Smear

You should not use vaginal douches, vaginal medications, or spermicide (unless your doctor has told you to) for 48 hours before your Pap test. These products may wash away or hide abnormal cells. You should avoid having sex 24 hours before your Pap smear.

For the sake of convenience and saving time, it is recommended to wear easily removable clothing to your appointment, such as leggings and t-shirts. You do not need to worry about removing any pubic hair as this will not interfere with the procedure.

How Often Should You Have a Pap Smear?

In many countries, it is recommended that women aged 21 to 65 have a Pap smear every three years. In the United Kingdom, women will usually receive a letter from their NHS surgery, in the mail, inviting them to make an appointment. The NHS does not recommend cervical screening for anyone under 25 years old who has not been invited.


Regular cervical screening was done more often in previous years (e.g. once a year). Over-screening for cervical cancer is now considered potentially harmful. This is because too-frequent Pap smears are bound to pick up mild abnormalities or the presence of HPV. This has led to many women having unnecessary, invasive procedures, such as colposcopies, which carry their own risks. It also causes unnecessary anxiety in women who are concerned about getting cancer. Sticking to the 3-year (25 to 49 yrs) or 5-year (50 to 64 yrs) interval is advised as mild abnormalities and HPV often clear up by themselves.

It is extremely important, however, to attend all your cervical screening appointments. If you skip a Pap smear, cervical precancerous changes may go undetected until they have reached an advanced stage or turned into cancer.


Regular Cervical Screening

The frequency of your Pap smears will depend on your age. Usually, cervical screening is done at the following intervals in the UK:

  • Under 25 - Up to 6 months before you turn 25
  • 25 to 49 – Every 3 years
  • 50 to 64 – Every 5 years
  • 65 or older – Pap smears are no longer required unless 1 of your last 3 tests was abnormal.


Screening After a Hysterectomy

Women who have had a total hysterectomy (surgical removal of the uterus including the cervix) may not need to continue having Pap smears. If your hysterectomy was performed for a benign(noncancerous) condition, such as uterine fibroids, you can usually discontinue routine cervical screening.  However, if your hysterectomy was for a precancerous or cancerous condition of the cervix, you will probably need to continue having Pap smears.


Screening When Older

Women older than 65, who have no history of abnormal cervical smears, can usually stop having routine Pap smears.


Screening If You Are at Risk

If you have certain risk factors, your doctor may recommend more frequent Pap smears. These risk factors include:

  • A diagnosis of cervical cancer or a Pap smear that showed precancerous cells
  • Exposure to diethylstilbestrol (DES) before birth
  • HIV infection
  • Weakened immune system due to organ transplant, chemotherapy or ongoing (chronic) steroid use
  • A history of smoking
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