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Medical Author:

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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In this Article

• What is a Pap smear?
• Who should have a Pap smear?
• Which women are at increased risk for having an abnormal Pap smear?
• How is a Pap smear done?
• What are the risks of having a Pap smear?
• How is a Pap smear read (analyzed)?
• What information is included on a Pap smear report?
• Why is a woman's menstrual status important for the Pap smear?
• Why is a woman's past Pap smear history pertinent?
• When might a Pap smear not be adequate for interpretation?
• How is the final Pap smear diagnosis made?
• What are the possible recommendations for follow-up after a Pap smear?
• What treatments are available if a Pap smear is abnormal?
• What is the follow-up after treatment for an abnormal Pap smear?
• What is the current status of human papilloma virus (HPV) testing?
• When should women start and stop having Pap smears, and how often should Pap smears be performed?
• What is the current status of the newer Pap smear technologies?
• With Pap smears so available, why are women still dying of cervical cancer?
• Historical note: Dr. Pap
• Pap Smear At A Glance
• Patient Comments: Pap Smear - Results
• Patient Comments: Pap Smear - Testing
• Find a local Obstetrician-Gynecologist in your town
• Pap Smear Index

When should women start and stop having Pap smears, and how often should Pap smears be performed?

The table summarizes the consensus of all the major organizations regarding these important questions. The key points of the table are as follows:

• All the guidelines agree that Pap smears should be started within 3 years of first sexual activity or age 21, whichever comes first.
  
  
• There are minor differences in the recommendations for the frequency and age at which to stop Pap smears.
  
  
• Older women who have had many normal Pap smears in a row and have been regularly screened are highly unlikely to have an abnormal Pap smear. These findings point to stopping Pap smears in older women, as reflected by several of the guidelines in the Table.
  
  
• Women who have had a total hysterectomy for a benign condition no longer have a cervix, and thus do not derive any benefit from screening for cervical cancer.
  
  
• In contrast, women who have had a subtotal hysterectomy still have a cervix, and thus should be screened according to the recommendations of women who have not had a hysterectomy.
  
  
• Women who have had a hysterectomy for abnormal Pap smears have their own special recommendations.

Special situations may impact the frequency of screening. For example, women who have had cervical cancer, exposure to diethylstilbestrol, or a compromised immune system (as with HIV infection, for example) should continue annual screening as long as they are in reasonably good health. Women who have had a hysterectomy for CIN2 or CIN3 (a type of abnormal Pap smear) should be screened until they have had three normal Pap smears, (and if no abnormal Paps show up in 10 years, they can stop having Pap tests).