Most people with cervixes who are between ages 21 and 29 should get screened for cervical cancer with a Pap test every three years. If you see a gynecologist or midwife annually, they may include a cervical cancer screening in your routine exam every three years automatically. But it’s important to keep track of when you were last tested, especially if you start seeing a new healthcare provider (HCP) between screenings.
What to expect on the day of your test
First of all, try to book your appointment for days when you don’t have your period. Being on your period can interfere with the test and make it feel more uncomfortable than it needs to be. If you happen to get your period that day, however, don’t stress—just let the office know. Most practices will still do the test, but they will just take your period into account when studying the results.
When your nurse calls you back to your room, they will ask you to put on a hospital gown. They’ll then help you get positioned on an exam table with stirrups, or supports, for your feet. When you put your feet in the stirrups and slide down to the bottom of the table, it puts you in a good position for your HCP to see and collect a sample of cells from your cervix.
Your HCP will start the exam by using a device called a speculum to open your vagina. This will allow them to access your cervix, which is located at the top of your vagina.
Pro tip: Ask your provider to warm up the speculum before they use it. This makes a big difference in how comfortable the procedure is. If they don’t have a warming machine, they can run it under hot water so it feels less cold.
It can also be helpful to put the speculum in yourself or, if necessary, to request a smaller speculum.
When the speculum is in place, your HCP will insert a long, thin brush or similar instrument into your vagina, until it touches the cervix. They will then brush it gently against your cervix to collect a sample of cells. For some, this may be uncomfortable or cause mild cramping, but it is very quick.
Some other ways to help make the procedure go smoothly: Focus on breathing deeply. Hold your sides or place your hands under your bottom. Coughing while your HCP inserts the speculum can help, too.
If you’re a survivor of sexual assault
Because of the steps involved, cervical cancer screening can be difficult or triggering for survivors of sexual assault. If you are a survivor, let your HCP know.
If they know ahead of time, some HCPs can book a double appointment so they can go slowly and give you all the support you need. If you have a preference, you can choose to see either a male or female provider. If it’s a teaching hospital or clinic, the medical secretary can make a note that you’d prefer to have no medical or nursing students in the room.
It can also help to bring a friend that day or—if the clinic has visitor limits—have a nurse sit with you to support you while the test is being done.
“Continuous, active consent is very important during a cervical cancer screening,” says Jessica Wells, PhD, RN, assistant professor at the Emory School of Nursing in Atlanta, Georgia, specializing in women’s health and cancer prevention. “You are in full control of the exam. At any point, if anything becomes too uncomfortable, you have every right to say so and end the exam. You can stop it at any time. If the provider needs to give you a break, that is absolutely fine, too.”
“There are also healthcare providers who do cervical cancer screenings who are trained in trauma-informed care,” adds Wells. “They are trained in working with sexual assault survivors. It can be helpful to seek out that kind of provider for this procedure and for your care moving forward.”
If you need an HPV test, too
This doesn’t involve any extra work for you. All it means is that when your cervical cells get sent to the lab, they will check for HPV in addition to cervical cancer. (The HPV test involves checking that sample for the top 13 to 14 types of HPV, a common virus known as human papillomavirus that can lead to cervical cancer.) Getting both done at the same time, called a co-test, is typical for people ages 30 to 65. If you knock both out at once, and the tests come back negative (no signs of cancer or HPV), you may not need to get tested again for another 5 years.
If your tests come back positive
It’s common for Pap tests to come back positive (with signs of possible cancer). This does not necessarily mean you have cancer; it just means you need more testing. In fact, most people who have a positive Pap test do not have cancer. Next steps might include:
Getting tested for HPV (if you haven’t been tested yet): In many cases, your HCP will be able to run this test on the cells they’ve already taken from your cervix.
Watching and waiting: Abnormal cells often go away on their own. Your HCP might have you simply come back in a year for another test to see if the issue has resolved by then.
Having a colposcopy: This test is very similar to a Pap test, but it involves taking a closer look at the cervix using a special magnifying device. It typically includes taking a sample of tissue from your cervix, called a biopsy, as well.
If your HPV test comes back positive, know that it doesn’t mean you’ll develop cancer as a result. HPV is incredibly common. More than half of people who are sexually active will have HPV at some point in their lives, and the infection tends to go away on its own. If it sticks around, there is a chance it could one day lead to cancer, which is why it’s important to follow your screening schedule. Some people may need to get tested again in a year.
If it turns out you do have cancer, knowing can save your life. In many cases, cancers that are detected earlier are treated more easily and effectively.
Rose Hayes, MA, RN, is a registered nurse specializing in patient education and nursing innovation. She is Director of Engagement at Emory School of Nursing.
