You might have heard about your first Pap smear during health education at school. Your parents and friends may have recalled their own experiences on the obstetrician and gynecologist’s (OB-GYN) examination table. If it left you a little bit bewildered (or even scared) about what to expect during your first Pap smear, then you’re not alone. Don’t worry — we've got you. We'll go through everything you might have questions about, so read on.
Put simply, a Pap smear (also known as a smear test) is a screening that your health care provider offers to check the cells from your cervix. If those cells appear to have changed, it may be an early indicator that they could become cancerous (more on this below). It’s “a test that collects [...] cells from the cervix and surrounding vagina,” says Dr. Barbara Levy, OB-GYN.
Dr. Amanda Kallen, OB-GYN, adds that the name Pap smear is a shortened version of Papanicolaou smear, “named for Dr. George Papanicolau who pioneered the test.” It was Dr. Papanicolaou’s wife who helped him with his research, by taking a smear test every day for 20 years to provide him with more evidence. Sounds intense, right? But this research has been fundamental in saving millions of lives.
Cervical cancer is the fourth-most common cancer among women globally, according to the World Health Organization, so being able to potentially prevent it from developing with the help of a Pap smear is important.
So, if you’re curious about what will happen at your Pap smear, Flo medical board experts Dr. Levy and Dr. Kallen have broken down all the information you need so you know exactly what to expect.
If you’re reading this, then perhaps you’ve already booked your first Pap smear (if so, go you!). And while guidelines change depending on where you live, both Dr. Kallen and Dr. Levy agree that if you live in the United States, you should start getting Pap smears at the age of 21.
Dr. Levy says, “Guidelines [in the United States] recommend a Pap smear by itself every three years from ages 21–65 if the results are normal. If there are early changes to cells, you may be asked to return in a year to determine if those changes persist.” This is in line with recommendations from the American College of Obstetricians and Gynecologists. You can call your health care provider shortly before your 21st birthday to establish how to book your Pap smear.
If you live in the United Kingdom, the National Health Service recommends that you have your first Pap smear at 25. They will send you a letter inviting you to book your appointment. It should arrive around six months before you turn 25 and then every three years afterward.
As we now know, getting a Pap smear is really important because it can detect if you have abnormal cells that may develop into cervical cancer. It’s important to remember that the detection of abnormal cells is incredibly common and isn’t a cancer diagnosis. The leading cause of cell changes is human papillomavirus, a really common group of viruses passed on through sex.
Dr. Levy explains, “Cervical cancer is a totally preventable disease.” It takes several years for your cells to change and develop into cancer. “A Pap smear detects the early changes in cells well before cancer develops,” says Dr. Levy.
Knowing what will go down during your first Pap smear might help you feel more in control (keep reading to find out more), but there’s nothing you need to do to prepare. It’s a test that everyone with a cervix is advised to have, so don’t be afraid to outline any worries you have to your health care provider either before or during your test. Other than that, you can just show up to your appointment.
Although there’s really no need to worry, it’s natural that you might feel self-conscious about getting undressed in front of your health care provider. You might even wonder if you should “do something” about your pubic hair. But Dr. Levy says, “We don’t even notice ‘grooming.’ It is totally unnecessary to stress over how recently you showered or to do anything out of the ordinary for you.”
If you’re concerned about starting your period the week of your Pap smear, know that it’s no big deal if you do. You’ll just need to reach out to your health care provider. “Spotting usually doesn’t affect the quality of a Pap smear, but heavy bleeding will definitely make collecting surface cells challenging,” says Dr. Levy. “If your flow is heavy, it is better to reschedule your appointment for a time after the flow has stopped.”
The day of your first Pap smear has finally arrived, but what should you expect?
When you enter the examination room, your health care provider will talk you through the process in full. If you have anything you’re worried about, or you don’t understand something, then you’re well within your rights to ask them.
They will ask you some questions about your medical history. This could include questions about any conditions you’ve had in the past and any medication you currently take. Dr. Levy says that “you should be given the chance to empty your bladder, which makes the exam far more comfortable.” Feel free to ask to use the bathroom if you haven’t already been offered.
Your health care provider will then give you some privacy to undress from the waist down. If you’ve come in a skirt or dress, you can leave it on and just take your underwear off. You can then get on the examination table and put your feet into raised stirrups, where your legs will remain open during the exam.
Dr. Levy explains that your health care provider will then “gently separate your labia to see the vaginal opening, then slowly insert a lubricated tool known as a speculum (a tube-shaped device) into the vagina.” The speculum holds the vaginal walls open so that the doctors can see and access the cervix. Your cervix is a small, donut-shaped organ that connects your uterus to your vagina.
Once they can see it clearly, your health care provider will swab your cervix with a brush to gently remove some cells (if you’re curious about how your Pap smear will feel, then continue reading). Once the doctor is done, they’ll collapse and remove the speculum. You’ll be asked to get dressed, which you can take your time with. And that’s it — you’ve had your first Pap smear.
“Once the pelvic examination is over, you will be given some tissue to wipe away extra lubrication (after your health care provider has left the room) and get dressed,” Dr. Levy adds.
You don’t need to rush after your exam. Take your time getting dressed, and if you have any questions for your health care provider about what happens next, then they should be able to help you.
You might have booked your Pap smear as part of your annual wellness visit. This is a checkup where “you can decide what you want to have done,” Dr. Levy says. “You may have a breast check and screening for other conditions like sexually transmitted infections, blood pressure, and bladder or bowel issues, among others.” Whether you’re booked to have your Pap smear or not, it’s highly recommended that you go for this checkup once a year with your health care provider.
Typically, you will be able to go about your day-to-day life after your Pap smear. But “it isn’t unusual for there to be some light spotting or bleeding” afterward, says Dr. Levy. If you’ve noticed light bleeding or pink discharge, then consider wearing a panty liner for 24 hours after your test. If the bleeding goes on for longer than this or you’re at all worried, reach out to your health care provider.
So, the burning question: Does your first Pap smear hurt? Luckily, the answer is pretty clear. A Pap smear “should not hurt,” says Dr. Kallen. But, she notes, the “speculum can feel a bit uncomfortable,” because the instrument is metal and can therefore feel cold.
Additionally, for people with small vaginal openings, survivors of sexual trauma, or people who have never had penetrative sex, it can be a difficult feeling. Dr. Levy says, “A good tip is that if placing a tampon hurts, then you should let your health care professional know. There are lots of tricks we can use to make collecting the Pap smear a better experience for you.”
If you’re worried that the speculum will cause you physical or emotional discomfort, then try to explain this to your health care provider. Having a friend or loved one to advocate for you at the clinic might help too.
But, as for the brushing of the cells, most people feel very little. If anything does feel uncomfortable or painful, both Dr. Kallen and Dr. Levy say that you should absolutely speak up.
“I [always] tell a patient that they are in control of the situation. They can request a smaller speculum, ask for the speculum to be repositioned, or even stop the exam altogether,” says Dr. Kallen. “The most important thing here is communication.”
Being worried about getting a Pap smear is completely normal, especially when you’re not sure what will happen or what it’s for.
Both Dr. Kallen and Dr. Levy advise that it’s always important to talk through any concerns with your health care professional. If you aren’t comfortable with the person who is doing your examination, then you can absolutely ask for someone else.
“It is OK to ask questions and let the health care team know that you are worried. They should take the time to explain each step in the process to you. Remember, your body belongs to you. If at any time during an exam or Pap collection you want the doctor to stop, say that,” Dr. Levy says.
Additionally, if you have any trauma related to your genitals, you should tell your health care provider so that they can adequately explain each step to you and understand how to approach you when doing your Pap smear.
Dr. Kallen says, “Communication is so helpful here. Even if someone is not comfortable disclosing specific trauma, knowing that someone has concerns about the exam or it’s maybe their first exam is helpful.”
It can take up to a couple of weeks depending on how busy your clinic is, explains Dr. Levy. If it’s taking longer than you thought, then don’t be afraid to reach out and ask when you should expect them.
Once they’re in, your health care provider will either let you know your results over the phone, in a letter, or by text. They may come back negative (or normal), meaning the test didn’t pick up any changes to your cells.
Alternatively, your results may come back as unclear or abnormal. If your test is unclear, you may be invited back for another Pap smear. Learning you have “abnormal” cells can sound really scary, but try not to worry. This doesn’t mean you have cancer. It just means your health care provider might want to keep a closer eye on your cells.
Your health care professional will talk through your options with you if they’ve found changes in your cells. This could involve “something as simple as a repeat Pap smear at some point,” or it could require “further testing to try to understand what the abnormality is,” Dr. Kallen says.
If your Pap smear highlights very slight cell changes, then you may be invited back for another test in a year.
Further testing can mean a variety of things. But if your results show more substantial changes in your cells, then the first test is usually a colposcopy. This is where the doctor looks at your cervix through a special tool called a colposcope to identify where any abnormal cells are.
A biopsy of those abnormal areas will likely happen as well, to investigate them further. “If the Pap smear is only very slightly abnormal (not precancerous but not 100% normal either), that could be due to mild inflammation or some other condition that will resolve itself,” explains Dr. Levy. “If that is the case, you will be asked to return in one year for a follow-up Pap smear to be sure the changes have resolved.”
Your first Pap smear might not feel like the most enticing idea, but remember that it shouldn’t hurt, and it’s generally over with fairly quickly. You should feel listened to and in control throughout your appointment. Your health care provider will provide you with a safe space to ask questions and explain any concerns. You can also use resources like Flo to learn more about what you can expect.
Attending your appointment every three years is the best way to spot any changes in your cells that could indicate precancers. You should feel proud that you’ve taken the self-care step to prioritize your health and book your appointment. And if your test comes back indicating that there are some changes to your cells, remember not to jump to conclusions and cause yourself unnecessary worry. Your health care professionals will provide you with options for further testing to find out what’s going on.