You should get your first Pap smear at age 21. That’s the recommendation regardless of when you became sexually active. Screening continues on a regular schedule until age 65, though the type of test and how often you need it changes as you get older.
Why Screening Starts at 21
Even if you’re sexually active before 21, guidelines don’t recommend starting earlier. The main reason is that HPV infections are extremely common in teens and young adults, but the vast majority clear on their own within a year or two without ever causing cell changes that lead to cancer. Screening before 21 tends to pick up these temporary infections, leading to follow-up procedures and treatments that cause anxiety and potential harm to the cervix with essentially no benefit. Cervical cancer in people under 21 is exceedingly rare.
Screening in Your 20s
Between ages 21 and 29, the recommended test is a Pap smear (also called cervical cytology) every 3 years. HPV testing isn’t typically part of the routine at this age because HPV is so common in this group that a positive result wouldn’t be very useful for guiding care.
If your Pap result comes back normal, you wait three years before your next one. If results are abnormal, your provider will recommend follow-up testing on a shorter timeline, but a single abnormal result doesn’t mean cancer. It usually means the lab found minor cell changes worth monitoring.
Screening From 30 to 65
Once you turn 30, you have three options for how to screen:
- Pap smear alone every 3 years
- HPV test alone every 5 years
- Pap smear plus HPV test together (called cotesting) every 5 years
All three approaches are considered equally acceptable. The reason HPV testing enters the picture at 30 is that an HPV infection that persists past your 20s carries more clinical significance. At this age, knowing your HPV status helps identify who needs closer monitoring. The longer intervals with HPV-based testing reflect the fact that cervical cancer develops slowly, typically over 10 to 20 years, so five-year gaps between screens are safe when results are normal.
The American Cancer Society now considers primary HPV testing (with or without a Pap) the preferred approach for this age group. Your provider may also offer self-collected HPV testing, where you take the sample yourself rather than having it collected during a pelvic exam.
When You Can Stop Screening
You can stop getting screened at age 65 if your recent results have been consistently normal. The specific threshold depends on which test you’ve been using. If you’ve been doing HPV testing or cotesting, your last two tests need to have been normal. If you’ve been getting Pap smears alone, you generally need three consecutive normal results within the prior 10 years, with the most recent within the last 5 years.
Once you’ve met those criteria and stopped screening, you don’t restart it even if you get a new sexual partner.
Screening After a Hysterectomy
If you’ve had a total hysterectomy (where the cervix was removed along with the uterus) for a reason that wasn’t cervical cancer or precancer, you no longer need Pap smears. There’s simply no cervix left to screen. If your hysterectomy was related to cervical cancer or serious precancerous changes, your provider will likely continue monitoring you on an individualized schedule.
If You Have HIV or a Weakened Immune System
People with HIV follow a more intensive screening schedule because their immune systems are less able to clear HPV infections. Screening still starts at age 21, but Pap smears are done annually at first. After three consecutive normal annual results, you can shift to every three years. For those 30 and older with HIV, either a Pap alone or cotesting is acceptable, again starting annually and spacing out after three normal results.
One major difference: screening for people with HIV doesn’t stop at 65. It continues for life because the ongoing immune suppression means the risk of cervical cancer doesn’t drop off the way it does in the general population.
What the Test Actually Involves
A Pap smear takes about one to two minutes during a pelvic exam. Your provider inserts a speculum, then uses a small brush to gently collect cells from your cervix. Most people describe it as mildly uncomfortable rather than painful. If HPV testing is being done at the same time, it uses the same cell sample, so there’s no additional procedure.
Results typically come back within one to three weeks. A normal result means no concerning cell changes were found. An abnormal result usually leads to either a repeat test in a year or a closer look at the cervix through a procedure called colposcopy, depending on what the lab found. Most abnormal Pap results do not lead to a cancer diagnosis.