Cervical cancer used to be one of the leading causes of cancer death in American women. Thanks to routine screening and the HPV vaccine, it is now one of the most preventable cancers. But screening only works if you actually get it done.
If the idea of a Pap smear makes you anxious, you are not alone. Many women put off screening because they are nervous, confused about the schedule, or unsure what the test actually involves. This guide breaks it all down in plain language: what happens, how often you need it, and what to do if your results come back abnormal.
In Arizona, cervical cancer screening is covered by most insurance plans and AHCCCS with no copay. The Well Woman HealthCheck Program provides free screening for uninsured and underinsured Arizona women.
What Is a Pap Smear?
A Pap smear (also called a Pap test) is a quick procedure where your provider collects cells from your cervix to check for precancerous or cancerous changes. You lie on an exam table, and your provider uses a speculum to gently open the vagina, then uses a small brush to collect cells from the cervix.
The whole thing takes about one to two minutes. You may feel pressure or mild discomfort, but it should not be painful. If Pap smears have been painful for you in the past, tell your provider. They can use a smaller speculum, go slower, or try positioning adjustments to make it more comfortable.
What Is HPV Testing?
HPV (human papillomavirus) is a very common sexually transmitted infection. Most HPV infections clear on their own, but certain high-risk strains (especially HPV 16 and 18) can cause cervical cancer over time. An HPV test checks for the presence of these high-risk strains.
The HPV test is collected the same way as a Pap smear, often at the same time. In fact, your provider may do a "co-test" (Pap plus HPV) or an HPV primary test depending on your age and the current screening guidelines.
Screening Schedule by Age
Current guidelines from ACOG and the U.S. Preventive Services Task Force recommend the following. Ages 21 to 29: Pap smear every 3 years. HPV testing alone is not recommended in this age group because HPV infections are so common in younger women and usually resolve on their own. Ages 30 to 65: you have three options. A Pap smear every 3 years, an HPV test every 5 years, or a co-test (Pap plus HPV) every 5 years. Over 65: screening can stop if you have had adequate prior screening with normal results and no history of cervical precancer.
These are guidelines for average-risk women. If you have a history of cervical precancer, are HIV-positive, have a weakened immune system, or were exposed to DES in utero, you may need more frequent screening.
What Abnormal Results Actually Mean
An abnormal Pap result does not mean you have cancer. It means some cells looked different from normal, and your provider wants to investigate further. The most common abnormal result is ASC-US (atypical squamous cells of undetermined significance), which often resolves on its own.
Other possible results include LSIL (low-grade squamous intraepithelial lesion), which usually reflects an HPV infection, and HSIL (high-grade squamous intraepithelial lesion), which indicates more significant precancerous changes that need treatment. Your provider will explain your specific result and recommend next steps, which might include repeat testing, HPV testing, or a colposcopy.
What Is a Colposcopy?
If your Pap or HPV test is abnormal, your provider may recommend a colposcopy. This is an office procedure where your provider uses a magnifying instrument to closely examine your cervix. They may apply a vinegar-like solution that makes abnormal cells stand out, then take a small tissue sample (biopsy) for lab analysis.
A colposcopy takes about 10 to 20 minutes. The biopsy may cause a brief pinch or cramping. You may have light bleeding or spotting afterward. Results usually come back within one to two weeks. Most abnormalities found on colposcopy are easily treatable.
The HPV Vaccine
The HPV vaccine (Gardasil 9) is the most effective way to prevent HPV-related cervical cancer. It protects against the nine HPV strains most likely to cause cancer and genital warts. The CDC recommends vaccination at ages 11 to 12, with catch-up vaccination available through age 26.
Adults ages 27 to 45 may also benefit from the vaccine based on individual risk factors, so talk to your provider. The vaccine is most effective before any exposure to HPV, but it still provides protection even if you have already been sexually active. In Arizona, the HPV vaccine is covered by AHCCCS, most insurance plans, and the Vaccines for Children program.
Do Not Skip Screening Because...
You had the HPV vaccine: the vaccine does not cover all cancer-causing strains, so screening is still necessary. You are not currently sexually active: HPV can remain dormant for years, so past exposure still matters. Your last Pap was normal: cervical changes develop slowly, which is why the recommended intervals work, but skipping years beyond the guidelines is risky. You had a hysterectomy: if your cervix was removed and you have no history of cervical precancer, you may be able to stop screening. Ask your provider. You feel fine: cervical precancer and early cervical cancer typically have no symptoms. Screening catches problems before you feel anything.
Cervical Cancer Screening Checklist
- Know your screening schedule based on your age and risk factors
- Ask your provider whether you are due for a Pap, HPV test, or co-test
- If you are under 26 and not fully vaccinated, ask about the HPV vaccine
- Follow up promptly on any abnormal results
- Keep a record of your screening dates and results
- If you are uninsured, ask about Arizona's Well Woman HealthCheck Program
- Do not douche, use vaginal medications, or have sex for 48 hours before your Pap smear (it can affect results)
Frequently Asked Questions
Does a Pap smear test for STDs?
No. A Pap smear only screens for cervical cell changes. HPV testing checks for the virus that causes those changes. Other STDs like chlamydia, gonorrhea, and herpes require separate tests. Ask your provider about STD screening at the same visit if you want comprehensive testing.
Can I get a Pap smear on my period?
Light bleeding is usually fine, but heavy menstrual flow can affect the accuracy of results. If you have a choice, schedule your Pap for about two weeks after the start of your period. If your period arrives unexpectedly, call your provider to ask whether to keep or reschedule the appointment.
What if my HPV test is positive but my Pap is normal?
This is common. It means you have an HPV infection but no cervical cell changes at this time. Your provider will likely recommend repeat testing in one year to make sure the infection clears on its own. Most HPV infections do resolve without treatment.
Is cervical cancer screening covered by AHCCCS?
Yes. AHCCCS covers Pap smears, HPV testing, and follow-up procedures like colposcopy at no cost to the member. The Arizona Well Woman HealthCheck Program also provides free screening for uninsured women who meet income guidelines.
Can men get HPV?
Yes. HPV is extremely common in both men and women. In men, it can cause genital warts and cancers of the throat, anus, and penis. The HPV vaccine is recommended for boys and men through age 26, with shared decision-making for ages 27 to 45.