Illustration by Marta Pucci
What are the differences between a pelvic exam vs a Pap smear?
What you can expect at the gynecologist’s office
Top things to know:
A pelvic exam is an assessment of your external and internal genital areas, as well as an evaluation of your reproductive system and organs
A Pap test (or Pap smear) screens for cancerous or precancerous changes on your cervix, while an HPV test (Human Papillomavirus test) screens for high-risk HPV types that can cause cervical cancer
Routine cervical cancer screening significantly reduces new cases of cervical cancer and helps lower deaths from the disease
You can use Clue to track symptoms related to pelvic health, such as pain, bleeding levels, and discharge, which can help you be better prepared for your next healthcare visit
What happens during a gynecological pelvic exam?
A pelvic exam is sometimes part of a well-woman visit, a routine checkup focusing on preventative care and reproductive health. During this visit, your healthcare provider will typically discuss your medical history, lifestyle, any symptoms you’re experiencing, and any concerns you may have. It’s also an opportunity to talk about family planning and birth control, and undergo screenings such as Pap smears for cervical cancer, breast exams, and tests for sexually transmitted infections (STIs) (1).
A pelvic exam typically involves a visual and physical exam of your internal and external genitalia and reproductive organs (1). This exam helps identify infections, atypical growths (such as uterine fibroids), or other conditions that could affect your reproductive health. It’s usually performed by a primary healthcare provider, such as a family doctor or nurse practitioner, or by a specialist in women’s health, like an obstetrician-gynecologist (OB/GYN).
A pelvic exam usually involves three parts:
A visual and physical inspection of the external genitalia: Your healthcare provider will examine your vulva, labia, pubic hair, and vaginal opening for any signs of infection or change.
A speculum exam: A speculum is a smooth instrument (usually made from plastic or metal) designed to gently widen the vaginal walls. Speculums come in different sizes to suit each person’s body and comfort. During the exam, your healthcare provider will insert the speculum into the vagina and gently open it so that they can clearly see the cervix. At this point, a Pap test or HPV test can be performed, in which a sample of cells is taken from the cervix to check for any precancerous or cancerous changes. While the speculum may feel cold or cause slight pressure, it shouldn’t be painful. You can ask your provider to explain each step as they go, so you know what to expect.
A bimanual exam: In this step, your healthcare provider inserts two gloved fingers into your vagina while pressing gently on your abdomen with their other hand. This allows them to assess the size, shape, and position of your uterus and ovaries. Although it may feel strange or uncomfortable, it shouldn’t be painful.
If you’ve noticed any changes in your bleeding, or have pain or unusual discharge, your healthcare provider may suggest a blood test or ultrasound (2). You can track these symptoms using Clue to help you discuss any changes with your healthcare provider.
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What is a Pap test?
A Pap test (Pap smear), named after its inventor, Greek physician Georgios Papanicolaou, checks for precancerous or cancerous changes in the cervix by looking for abnormal cells (3). Most cases of cervical cancer are linked to HPV (Human Papillomavirus), a common sexually transmitted infection that can cause changes in the cervical cells (4). While a Pap test does not directly test for HPV, HPV can be tested separately. We’ll cover this in more detail in the next section.
During the Pap test, a small tool called a spatula or brush is partially inserted into the cervix and rotated to collect a sample of cervical cells (5). This shouldn’t be painful, but some people may feel mild discomfort. The sample is then smeared onto a glass slide or placed into a liquid-filled container to be sent to a lab, where cytology (the study of cells) will be performed to check for any abnormal cells that could indicate precancerous or cancerous changes.
How do I prepare for a Pap test?
To get the most accurate results, avoid sexual intercourse, douches, and vaginal medicines or spermicidal foam for 48 hours before your Pap test, as certain fluids can interfere with the lab results (5). You can still have a Pap test if you’re menstruating, but some providers recommend scheduling your test in the middle of your cycle (5). If you're unsure about whether to reschedule, it's always a good idea to ask your healthcare provider.
What if I experience pain or discomfort during a Pap test?
It’s perfectly okay to feel nervous or uncomfortable during a Pap test, but if you experience any pain or have concerns during the procedure, it’s important to advocate for yourself. Speak up and let your healthcare provider know if something feels off. They can adjust their approach or offer suggestions to make the process smoother, like taking a break or using extra lubrication.
Understanding the results of your Pap test
It can take a few days to a few weeks to receive your test results. Abnormal results do not automatically mean cancer. In most cases, abnormal results are not cancerous and can often be treated or monitored with follow-up care.
Here’s a breakdown of the different types of results and what to expect if you receive them:
Normal (negative) result
What it means: Your Pap test showed no abnormal or precancerous changes.
What to expect: Your healthcare provider will likely recommend continuing with regular screenings, typically every 3–5 years, depending on the guidelines in your country, your age, and your medical history (6).
Unsatisfactory or incomplete result
What it means: The sample collected was too small to provide a reliable result.
What to expect: Your healthcare provider will likely recommend doing another Pap test in a few weeks (6).
Abnormal (positive) result
What it means: Your Pap test showed changes in the cells of your cervix. This doesn’t necessarily mean cancer, and in most cases, it isn’t. Non-HPV factors, such as irritation, infections (like yeast infections), growths (like polyps), or hormonal changes during pregnancy or menopause, can sometimes lead to abnormal results.
What to expect: Depending on your specific results, your healthcare provider may recommend (6):
HPV Testing: To check for high-risk HPV types
Colposcopy: Where a microscope is used to closely examine the cervix. This can help determine the severity of the changes and if a biopsy (tissue sample) is necessary
Biopsy: To take a tissue sample for further examination
Treatment: Options like cryotherapy (freezing abnormal cells) or LEEP (removal of abnormal tissue) may be recommended if the changes are more concerning
What is HPV and how is it linked to cervical cancer?
HPV is a very common virus, with most sexually active people being infected at least once in their lifetime (4). There are over 200 types of HPV, but two high-risk types—HPV 16 and HPV 18—are responsible for the majority of cervical cancer cases (4). These strains have also been linked to cancers of the anus, genital region, and throat. Other types, like HPV 6 and 11, cause genital warts (3). Most HPV infections clear up on their own within two years, without causing symptoms or disease (3,7).
However, persistent infections with high-risk types can lead to cervical cancer if not detected early. HPV infections may be harder to clear in people who smoke, have a weakened immune system, or are HIV-positive (4). Screening is important for catching precancerous changes before they develop into cancer.
Preventing cervical cancer
As of 2023, there are six HPV vaccines available worldwide, all protecting against the high-risk HPV types 16 and 18 (4). These vaccines have been shown to be safe and effective in preventing both HPV infection and cervical cancer. The vaccine is recommended for all girls aged 9–14 before they become sexually active. Some countries also offer the vaccine to boys to help reduce the spread of HPV in the community (4).
Even if you’re vaccinated against HPV, you still need regular screenings. The HPV vaccine protects against the most common high-risk strains, but it doesn’t cover every type of HPV—and it can’t protect you from strains you might’ve been exposed to before you got the shot. That’s why continuing routine Pap or HPV testing and other preventative care is important for staying on top of your cervical health (8).
Using condoms can help lower the risk of transmitting or contracting HPV, but they aren’t completely fail-safe. This is because HPV can be present on the skin around the genital area not covered by a condom. Even when condoms are used correctly and consistently, there’s still a chance that HPV could spread through any uncovered areas. However, using condoms remains an important way to reduce the overall risk of sexually transmitted infections (STIs), including HPV, chlamydia, and gonorrhea (9).
HPV tests
HPV tests can be done along with a Pap test (co-testing), using the same sample. The Pap test looks for abnormal cells, while the HPV test checks for high-risk HPV types that can cause these cell changes (10).
HPV primary testing only tests for the virus, and does not involve a Pap smear. This test specifically looks for high-risk HPV types and is considered more effective than Pap tests at detecting cervical cancer cases earlier (2).
Unlike the Pap test, you do not need to do anything to prepare for an HPV test.
Understanding the result of your HPV test
HPV test results show whether high-risk HPV types are present in cervical cells (6).
Negative result: No high-risk HPV detected. Your provider will likely recommend continuing regular screenings
Positive result: High-risk HPV found. Follow-up steps may include a repeat test in 1-3 years, a colposcopy, and, if cellular changes are found, treatment like cryotherapy or LEEP (depending on the severity of the changes)
The global shift toward HPV testing as the primary screening method
In many places around the world, testing for HPV is becoming the go-to screening method. It’s better than traditional Pap tests at detecting high-risk infections early on, which means more people can get the care they need sooner (11). By catching potential problems early, HPV testing can reduce unnecessary follow-up procedures. It’s also a cost-effective and proactive approach to cancer prevention (11).
In the United States, however, switching over to HPV primary testing has been slower, even though it’s recommended by multiple guidelines and widely recognized as the most effective screening option. Major health groups like the World Health Organization (WHO), the American Cancer Society, the American Society for Colposcopy and Cervical Pathology (ASCCP), and experts at the National Institutes of Health (NIH), all endorse HPV testing as the gold standard for cervical cancer screening (11-14).
The role of self-collection tests in HPV screening
Self-collection HPV tests allow people to collect their own sample for HPV testing, either in a healthcare setting or (in some counties) at home (15). This method offers more privacy and control, which can reduce anxiety for those who may feel uncomfortable with traditional exams. Self-collection tests also improve access, especially for underserved communities, and help increase screening rates where healthcare access is limited (11).
Why are Pap and HPV tests so important?
The Pap test, introduced in the 1940s, has had a major public health impact. Before its invention, cervical cancer was one of the leading causes of death among women of childbearing age in the United States of America. Since then, deaths from cervical cancer have decreased by 60%, primarily due to early detection (3). However, cervical cancer remains the fourth most common cancer in women worldwide, particularly in developing countries (4). Regular cervical cancer screening is crucial in preventing and detecting cancer early, saving lives, and improving outcomes for women and people with a cervix globally.
How often should you get a pelvic exam and Pap test?
The American College of Obstetricians and Gynecologists (ACOG) recommends having your first Pap test at age 21. After that, if results are negative, it’s generally recommended every three years until age 29. From age 30 to 65, a Pap/HPV co-test, or HPV primary test should be done every five years. After age 65, you may no longer need these tests if your previous screenings have been normal (10).
ACOG used to recommend that you get a routine pelvic exam at every yearly checkup. Now, the guidance is more personalized. A pelvic exam should be done if you have a specific concern or medical history that makes it necessary. For example, if you’re experiencing unusual pain, bleeding, or discharge, or if you have a past issue that needs monitoring. That means you only get a pelvic exam when it’s truly helpful for your health (16).
Guidelines may vary depending on where you live. If you’re unsure about when to start screening or how often to get tested, ask your healthcare provider.
FAQs
Is a Pap smear and a pelvic exam the same thing?
No, a Pap smear and a pelvic exam are not the same. A Pap smear (or Pap test) is a procedure where a healthcare provider collects cells from the cervix to check for abnormal or precancerous changes. A pelvic exam, on the other hand, involves the healthcare provider examining the reproductive organs, such as the ovaries and uterus, to look for any abnormalities. A Pap/HPV test may be performed during a pelvic exam, but a pelvic exam is not always necessary for a Pap test. (1).
Can I do a Pap test at home?
Currently, Pap tests must be performed by a healthcare provider, as they require the collection of cells from the cervix using specific tools. However, self-collection HPV tests are available in some countries, which allow you to collect a sample for HPV testing at home. These tests are different from a Pap test and are used specifically to check for HPV infection (15).
What does it mean if I have a positive HPV test after years of negative tests?
A positive HPV test after several years of negative results doesn't necessarily mean you’ve contracted a new infection. HPV can lie dormant in the body before becoming active again, similar to how the virus that causes chickenpox can later reactivate as shingles. Researchers are still unsure whether a reactivated HPV infection carries the same risk of causing cervical cell changes or cervical cancer as a new infection (6).
