Everything you need to know before your Pap smear!
In our last blog, we explored what HPV is, what a Pap smear is, and how often cervical cancer screening should be done.
As mentioned in the August 2026 blog, Pap smear screening should begin at the age of 21 regardless of whether or not you are sexually active.
So, if you are 21 years of age or older, and you have not yet had your first Pap smear, it is time to get that scheduled. We would love to see you at Cascade Women’s Health for your first Pap! Schedule your free appointment today!
We know the thought of your first Pap smear can feel nerve-wracking and intimidating. Today’s blog is intended to help you alleviate any anxieties related to your upcoming appointment and to help you feel best prepared for your first Pap smear.
We'll cover the following
Before You Schedule
Starting at age 21, you should have routine cervical cancer screening by means of a Pap smear. However, there are a few things to keep in mind as you are scheduling your first Pap smear:
When is your next period due to arrive? Do your best to schedule your Pap smear for a time you will NOT be on your period.
While it is not impossible to complete the Pap while a woman is on her period, many clinics will request that you reschedule if you are bleeding. Too much blood can obscure the cells, and crowded or blocked cells could lead to results being “inconclusive,” which would require you to repeat the testing. Last, your cervix is typically lower and can be more sensitive during your period – It could make the Pap smear more uncomfortable.
Nothing in the vagina for 48 hours prior to your appointment
Do not have intercourse for 48 hours prior to your appointment. Avoid any douching, vaginal washes, creams, spermicides, tampons, suppositories, etc. for 48 hours before your Pap smear. Intercourse and these products can wash away or hide important cells and impact your results.
Consideration for additional testing
If you also plan to do STI testing, it is often recommended that you abstain from intercourse for 7 days prior to testing to avoid false negative results (meaning that it was too close to the last sexual encounter to show positive on the test).
Wear comfortable clothes that are easy to change out of
Keep in mind that you will be asked to undress and get into a hospital gown for your exam.
Consider bringing a support person
If you have anxiety about this appointment and exam, you can consider bringing someone to support you. This may be a friend, a sister, a partner, etc. However, keep in mind that if you want them in the room, it is possible they might see a portion of the exam, although you can ask them to stand by your head so they see the least amount as possible. Please ensure that you feel comfortable with that specific person possibly witnessing a portion of the pelvic exam and also hearing sensitive information during your office visit. You can also ask that person to accompany you to the appointment, but wait in the waiting room during your exam so you have a bit more privacy.
Do you have a history of abuse, health anxiety, or PTDS?
If you have suffered from post-traumatic stress disorder, have a history of sexual abuse, or suffer from health anxiety, be sure to discuss this with your healthcare team prior to your exam.
Abnormal bleeding or spotting
If you experience abnormal spotting or bleeding and are concerned that it may interfere with your exam and potential testing, be sure to call your clinic ahead of time to make sure it is okay to proceed with your exam.
What to Expect
If you’ve never had a Pap smear, you may be a bit nervous about what it entails and what your experience will be like. Rest assured that if you come to us at Cascade Women’s Health for your Pap smear, we will talk you through the whole process before you even begin. We will explain step-by-step what will occur, and, during the exam itself, the healthcare clinician will notify you of every step before she proceeds with the next step.
Prior to the exam:
Empty your bladder! Be sure to ask the healthcare team if they need your urine sample for any testing. If not, be sure to empty your bladder just prior to your pelvic exam or Pap smear, as this may make it a bit more comfortable for you!
There should always be another staff member present in the room to assist the medical clinician with the exam.
You’ll be asked to fully undress and put on a gown (particularly if you opt to have a breast exam completed, too).
If desired, your clinician will perform a standard breast exam, as well as likely listen to your heart and lungs, and will perform a thyroid and abdominal exam.
Key points to keep in mind:
Your Pap smear should not be painful. It might be mildly uncomfortable, given you have a speculum in your vagina, but you should never experience pain. You may also feel some pressure in your abdomen or vagina. Taking long, slow deep breaths during your exam helps your body relax through the process.
Don’t be afraid to ask your healthcare professional questions prior to the exam. You are in control of the exam . . . if at any point you are uncomfortable or want to stop during the exam, say “STOP.” Your clinician should not proceed if you ask them to stop.
During the exam:
For your Pap smear, you will be asked to lie down on the exam table and scoot to the end of the table. Your feet will be put in stirrups that help to position your body best for the exam. The healthcare professional will insert a tool called a speculum into your vagina. The speculum spreads the vagina slightly, so that the clinician can locate the cervix and place the cervix within the speculum in order to collect the sample of cells from the cervix using a small, soft brush. This exam should last only a few minutes.
It is possible the clinician make collect other samples in addition to the Pap smear if you have requested them, including STI testing, testing for vaginal infections, etc.
Following the Pap smear, an internal exam known as the “bimanual exam,” is performed. Your healthcare professional will insert two lubricated, gloved fingers into the vagina while pressing on your lower abdomen with the other gloved hand. This is to check your ovaries and uterus for any abnormalities.
After the exam:
After the exam, your provider will ask you to get dressed and will notify you of any abnormal findings.
You may also be offered a pad in case you have some normal spotting after your Pap smear.
There are no special precautions you need to take after your Pap smear–-you can go about your day as usual.
The cells collected from your cervix will be sent to the lab to be analyzed for any abnormal changes and may also include HPV testing, depending upon your age and history. The lab will determine if HPV is present and if there are any abnormal changes in the cervical cells that require further intervention.
Your clinic should notify you of the results, typically within one week, and should also provide you with a recommendation for your next Pap smear and/or HPV testing.
Interpreting Pap Smear Results
Inconclusive Results
At times, test results are not clear and the lab cannot confidently say that the cells collected for the Pap smear are either negative or positive. If that is the case, you may need to repeat testing.
Negative Results
If your Pap smear reveals only healthy, normal-appearing cervical cells, it will be called a “negative” result. If you only had a Pap smear done (without HPV testing), the staff will recommend that you repeat your Pap smear in three years.
If you have no history of an abnormal Pap smear or HPV, your current Pap smear is negative, AND you had co-testing with HPV that was negative, the staff will recommend that you repeat your Pap smear with HPV testing in five years.
Positive Results
If concerning cells were found on your Pap smear, you will be told that you have a "positive" result (AKA abnormal). A positive result does NOT mean you have cervical cancer. It does mean, however, that you will likely need further follow-up, evaluation, and possible treatment.
If you had only a Pap smear, your clinician will likely recommend that HPV testing be added, as these two lab results will together help your clinician to make a recommendation about next steps.
Here are some possible terms your healthcare team might use if you have an abnormal Pap smear:
ASCUS – This stands for atypical squamous cells of undetermined significance. Squamous cells are thin and flat and grow on the surface of a healthy cervix. If your Pap indicates ASCUS, it means that the squamous cells look different than normal, healthy cells. However, it also means that these cells don’t look like precancerous cells. The changes to these cells are often a sign of HPV infection, and, as mentioned above, if it was not already done, your healthcare professional will also likely recommend that these cells be tested for HPV.
LSIL or HSIL – SIL stands for squamous intraepithelial lesion.
LSIL stands for low-grade squamous intraepithelial lesion, which means there are mild, early changes in the surface cells of the cervix. The use of the term “low-grade” indicates that the cells look only slightly abnormal under a microscope. It is also known as “mild dysplasia” or CIN 1 (cervical intraepithelial neoplasia grade 1).
HSIL stands for high-grade intraepithelial lesion. This means that there is an area of moderately or severely abnormal flat cells found on the surface of body tissues. It might be found on the cervix, vagina, vulva, anus, and even the esophagus. When observed under a microscope, a high-grade intraepithelial lesion can range from looking mildly abnormal to very abnormal. They are usually caused by chronic infection with certain strains of the human Papillomavirus (HPV). If not treated, these abnormal cells may become cancerous and spread into nearby tissue. A HSIL is sometimes called moderate or severe dysplasia.
Atypical glandular cells – Glandular cells may also be found in the cervix. This result means that the glandular cells in the sample look different from healthy glandular cells. Further testing will be needed to find out the cause of the atypical glandular cells.
Squamous cell cancer or adenocarcinoma cells – This result sadly means that the cells collected during the Pap smear are most likely cancer. Squamous cell cancer is the cancer that starts in the flat cells on the surface of the vagina or cervix. Adenocarcinoma arises in the glandular cells. If either of these cells are found, your healthcare professional will recommend immediate, further testing and intervention with a specialist.
If I have an abnormal Pap smear and/or HPV, what are the possible next tests and treatments?
This was discussed in our August 2026 blog. Please review HERE, if desired.
How often will I need to do a Pap smear?
If you have an abnormal Pap or HPV test, you may need further evaluation or treatment. Once that is complete, your healthcare professional will determine exactly when you need repeat testing. That could be as soon as three-six months from your last testing.
The frequency of your future Pap smears and HPV testing will depend upon the results of your recent Pap smear and HPV testing, as well as on your prior history of Pap smears or HPV testing. Your healthcare provider will make follow-up recommendations based on the updated American Society for Colposcopy and Cervical Pathology (ASCCP) risk-based management consensus guidelines.
These updates guidelines take into account the following:
Current Pap smear and HPV test results
Previous Pap/HPV test results
Previous treatments for precancerous cervical cell changes
Personal health factors including age
If you’ve never had an abnormal Pap smear or positive HPV, repeat testing is generally recommended in three–five years. If you are under the age of 30 and had only a Pap smear, it is recommended you repeat screening in three years. If you had “co-testing,” meaning a Pap smear AND HPV testing, it is typically advised to repeat testing in five years.
How can I schedule my Pap smear?
We would love to partner with you in your health at Cascade Women’s Health. Click here to schedule your free appointment today!
References:
Important Note: The information provided in this article is for educational purposes only. While it was written by a licensed healthcare professional, it is not a substitute for personalized medical advice, diagnosis, or treatment. If you have questions about your health, please schedule an appointment with a healthcare provider who can evaluate your individual needs.
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