Cervical Health: Do Pap Smears Hurt?

The words “pap smear” can be a cringe-worthy phrase for many women, especially young women who have yet to experience their first cervical cancer screening.

While this test is an important part of women’s health that can be the difference in catching precancerous cells and other abnormalities early, the uncertainty and personal barriers associated with a pap smear can leave many women scared or hesitant to schedule a visit with their OBGYN. To help alleviate any of these questions, specifically if a pap smear causes pain, we outlined how the test works and provided dos and don'ts to consider for your appointment. 

How does a pap smear test work?

A pap smear (also called a pap test) is a type of screening test for cervical cancer. The test uses an instrument called a speculum (it looks like a duck bill) to hold the vaginal walls open so a small cone-shaped brush can scrape cells from the opening of the cervix (the lower, narrow end of your uterus located on top of your vagina). The cells are collected and examined to screen for abnormal growths and the presence of precancerous or cancerous cells. 

Although some people get the two confused, a pap smear isn’t the same as a pelvic exam. A pelvic exam is when your doctor gently inserts a finger or hand into the vagina to check for abnormalities, cysts, masses and the shape and size of the uterus and ovaries. 

The pap smear test was invented in the 1920s (it wasn’t recognized and accepted until the 1940s) by George Papanicolaou, a physician who was a pioneer in cytopathology. From start to finish, a pap smear only takes a few minutes. Each OBGYN has their own way of conducting a pap smear, but they typically follow similar steps.  

Once you arrive, a health care provider will ask you to undress and lay on your back. You will then put your feet up and place them in stirrups to angle your pelvis. To protect your privacy, they will place a sheet over your lower body. 

Your doctor will gently insert the speculum with a lubricant to hold the vaginal walls open. This allows them to see the cervix and provide space for the swab to collect cells.  

To collect the cells, your doctor will either use a flat scraping device called a spatula or a cone-shaped brush with soft bristles. The sample is collected and transferred to either a glass slide (conventional Pap smear) or a liquid-filled vial (liquid-based Pap test) for further examination. 

Finally, your doctor will remove the speculum and allow you to get dressed to complete the test. 

Pap smear pain

In general, you shouldn’t experience any pain with a pap smear. Yes, it may feel uncomfortable, but the test doesn’t hurt when performed properly. 

That said, you may feel pressure in your abdomen or vagina when the speculum opens the vagina. You may also feel mild discomfort in the form of a pinching sensation when cells are being removed with the brush or spatula. If you find yourself unable to relax, the muscles in the pelvic area can tighten and cause some temporary discomfort. 

Bleeding after pap smear

Much like questions about pain during a pap smear, many women are concerned about bleeding after their pap smear. Light spotting is possible due to irritation the cervix sustains during the test. The bleeding is temporary, although you may want to wear a pantiliner after the test in case you do bleed. 

How often should you get a pap smear?

The days of needing a pap smear each year are long gone. Starting at the age of 21, the American College of Obstetricians and Gynecologists (ACOG) and the U.S. Preventative Task Force Services (USPSTF) recommend a pap smear every three years until you reach the age of 30. By comparison, the American Cancer Society recommends receiving a pap smear every three years starting at the age of 25. 

From ages 30 to 65, they recommend a pap smear every three years or a pap smear every five years when combined with human papillomavirus testing (also called HPV/Pap cotest). Alternatively, you can receive the high-risk human papillomavirus (hrHPV) test every 5 years in place of a pap smear. Once you reach the age of 65, a pap smear isn’t required if you’ve had a negative result in the past 10 years. 

While the starting age varies by organization, the recommendations of receiving a pap smear every three years or a hrHPV) test every five years remain the gold standard for cervical cancer screening. For more information, consult our guide on how often you should receive cervical cancer screenings. 

Dos and don'ts before a pap smear

If you’re preparing for your first pap smear, here are some simple tips to consider before your appointment. 

Dos

Do dress comfortably. Wear clothing that can be removed easily – your doctor may ask you to remove all of your clothes or just from the waist down. 

Do relax. Take deep breaths, relax your shoulders and soften your stomach muscles. Tense muscles can make the test feel more uncomfortable. 

Do distract your mind. Bring a tablet or listen to music if you’re worried about becoming too antsy during the screening. 

Do talk to your doctor. If you’re nervous about the pap smear, let your doctor know about any concerns or questions you may have. They can provide a step-by-step guide of how the test will work.  

Do speak up if you’re in pain. In the event you feel pain or discomfort, ask your provider to stop. 

Don'ts

Don’t worry about your menstrual cycle. While you should try and schedule your test when you’re not on your period, it’s not the end of the world. You can still receive a pap smear, but you may also opt to reschedule the appointment if you don’t feel comfortable. The choice is yours. 

Don’t come with a full bladder. Urinate before the pap smear, as a fuller bladder can make the test more uncomfortable. 

Don’t use any type of vaginal medication in the days leading up. Two days before your test, stop any type of vaginal medication you may take, such as creams or suppositories. These drugs can wash away or impact abnormal cells. The same goes for douching. 

Don’t have vaginal intercourse before your test. Don’t have sex two days before your test. Seminal vesicle cells from sperm can mimic atypical squamous cells and trigger a false positive pap smear.

Don’t worry about grooming. Your doctor is a professional and has likely done pap smears hundreds or thousands of times. You may be worried about judgment, but they won’t be judging you for your appearance. Do whatever makes you most comfortable. 

If you or a loved one have concerns about an upcoming pap smear, contact your OBGYN to discuss the test and talk about ways in which you can be more comfortable. When in doubt, always remember to speak up – your doctor is here for you.