Australian Government Department of Health
National Cervical Screening Program
Photos of Women

Frequently Asked Questions

Answers to commonly asked questions about cervical cancer and Pap smears.

  1. What causes cervical cancer?
  2. Who is at risk of cervical cancer?
  3. What are the symptoms of cervical cancer?
  4. What is a Pap smear?
  5. How effective are Pap smears?
  6. Should I have a Pap smear?
  7. Should lesbians have Pap smears?
  8. When should I start having Pap smears?
  9. Where can I go to have a Pap smear?
  10. How much does a Pap smear cost?
  11. What does a Pap smear feel like?
  12. When I have a Pap smear, it is quite painful. Is this normal?
  13. Does an abnormal result mean that I have cancer?
  14. If I have an abnormal Pap smear result, how do I know am getting the best advice on what to do?
  15. What is HPV?
  16. How do I know if I have HPV?
  17. Can HPV be treated?
  18. Is there a vaccine for HPV?
  19. Will I still need Pap smears if I have the vaccine?
  20. I’ve been through menopause. Do I still need to have Pap smears?
  21. I’ve had a hysterectomy. Do I still need to have Pap smears?
  22. When is the best time during my menstrual cycle to have a Pap smear?
  23. Am I able to have a Pap smear during pregnancy?
  24. Am I at greater risk of cervical cancer if I take drugs that suppress my immune system?
  25. Do I require more frequent testing if I have been exposed to diethylstilboestrol (DES) in utero?
  26. What if I can’t remember when to have my next Pap smear?
  27. What about women who do not speak English?
  28. Can ovarian cancer be detected by having a Pap smear?

1. What causes cervical cancer?

Long term infection with certain types of a virus is now known to be the cause of almost all cervical cancers. Almost all abnormal Pap smear results are caused by HPV (human papillomavirus).

Anyone who has ever had sex can have HPV - it’s so common that four out of five people will have had HPV at some time in their lives. In most cases, it clears up by itself in 8 to 14 months. In rare cases, if the virus persists and is left undetected, it can lead to cervical cancer. This usually takes about 10 years.

While HPV is very common, most women with HPV will not develop cervical cancer.
Top of page

2. Who is at risk of cervical cancer?

All women with a cervix who have ever had sex are at risk of cervical cancer. About half of the new cases of cervical cancer diagnosed each year are in women over 50 years of age.
Top of page

3. What are the symptoms of cervical cancer?

In the early stages of cervical cancer, there are usually no symptoms at all. The best way to detect changes to the cervix before cancer develops, is through regular two-yearly Pap smears.
Top of page

4. What is a Pap smear?

A Pap smear is a quick and simple test in which a number of cells are collected from your cervix and sent to a laboratory where they are tested for changes. No drugs or anaesthetics are required and a doctor, nurse or health worker can easily do it. It only takes a few minutes and is the best protection against cervical cancer.
Top of page

5. How effective are Pap smears?

A Pap smear every two years can prevent the most common form of cervical cancer in up to 90% of cases and is your best protection against cervical cancer.
Top of page

6. Should I have a Pap smear?

If you are over 18 and have ever had sex, you should have regular Pap smears, even if you no longer have sex. This includes male to female, and female to female sex.

There is no need to have Pap smears earlier than 18, even if you start having sex earlier. At age 70 your doctor may advise that it’s safe to stop having Pap smears if you have had two normal Pap smears within the last five years.
Top of page

7. Should lesbians have Pap smears?

Yes. HPV infection is transmitted through direct skin-to-skin contact, most often during vaginal or anal sex. The infection can also be transmitted through other types of sexual activity such as oral-genital and manual-genital contact, although this may be less common.
Top of page

8. When should I start having Pap smears?

All women who have ever had sex should start having Pap smears between the ages of 18 and 20 years, or two years after first having sex - whichever is later.
Top of page

9. Where can I go to have a Pap smear?

You can make an appointment for a Pap smear at a general practitioner, community or women's health centre, family planning clinic, sexual health clinic or Aboriginal Medical Service. When you call you can advise the health service that the purpose of your appointment is to have a Pap smear. It may help to find a practitioner who does Pap smears frequently, and it is fine to ask about this at the time of making an appointment. You can also request that a female doctor or nurse undertake the procedure if this is your preference.
Top of page

10. How much does a Pap smear cost?

Two costs are involved – the doctor’s consultation fee and the Pap smear pathology test. Some doctors, clinics and health centres ‘bulk bill’ and if so, there are no out of pocket expenses for women.

If a fee is charged, the cost to you will be the difference between the Medicare rebate and the doctor’s and laboratory fees. In some cases you may be required to pay the full cost for the consultation and laboratory fee and then claim the rebate from Medicare.

Ask what the cost will be when you make an appointment.
Top of page

11. What does a Pap smear feel like?

A speculum is inserted into the vagina to allow the person taking your Pap smear to see the area of the cervix where they need to sample the cells. The cells are sampled by rotating a sampling spatula or brush over the cervix. You may feel some dull pressure while this is being done. If it is too uncomfortable or hurts, tell your doctor, nurse or health worker straight away.

Sometimes having a Pap smear can feel a little embarrassing. Remember, for the person taking your smear, this is just part of their everyday work.
Top of page

12. When I have a Pap smear, it is quite painful. Is this normal?

While a Pap smear can be uncomfortable, it should not hurt. There are various ways to make the procedure more comfortable. You may want to practice some relaxation techniques for a few weeks before going to an appointment for a Pap smear, so that you can use these techniques during the appointment. Some women find deep breathing, guided visualisation or meditation useful.

Also, before you commence the procedure, talk to the practitioner about any difficulties you have had with this procedure in the past and what you think may make the process more comfortable for you. Each woman is the best expert on her own body, and any information you can share with the Pap smear provider will help them in making the experience more comfortable for you.

Some examples of things that may make Pap smears very uncomfortable include vaginal dryness, particularly in post-menopausal women; anxiety, which can cause tensing of the muscles; or a retroverted (tilting backwards or upwards) uterus, which can make the cervix difficult to reach if a woman is lying in a particular position. If your practitioner is aware of your needs, they can help find out what works best for you. It may be useful to speak to the practitioner on the phone a week or so before your appointment, as sometimes there are things you can do to prepare some days in advance.
Top of page

13. Does an abnormal result mean that I have cancer?

No. Occasionally, results show changes in the cells of the cervix. Most of these changes are due to HPV infections which usually clear up naturally without any need for treatment.

In a small number of women, these changes may develop into a highgrade abnormality. In an even smaller number of women, highgrade changes may progress to cervical cancer.

When detected early by a Pap smear, these changes can be treated and cured. That is why having a Pap smear every two years is so important.
Top of page

14. If I have an abnormal Pap smear result, how do I know I am getting the best advice on what to do?

In July 2006, the National Health and Medical Research Council (NHMRC) released an updated version of the publication titled Screening to Prevent Cervical Cancer: Guidelines for the Management of Asymptomatic Women with Screen Detected Abnormalities.

The revised Guidelines are based on scientific evidence, giving up-to-date recommendations on the best way to manage abnormal Pap smear results. You can read our section on the revised Guidelines for more information.

Your doctor will consider the Guidelines and your individual circumstances and discuss options with you.

Click on the flow diagram below to view a higher quality version (PDF 440 KB) which shows the recommended pathways for the management of abnormal Pap smear results.

Pathway for the management of abnormal Pap smear results - low and high grade

Top of page

15. What is HPV?

Human papillomavirus (HPV) is a very common virus, with four out of five people having it at some stage of their lives. In some cases, it can increase a woman’s risk of cervical cancer. However, most women with HPV do not develop cervical cancer. HPV is passed on through genital skin contact and is so common that it could be considered a normal part of being sexually active.

After entering the body, HPV will behave in one of two ways: either remaining dormant (inside the body’s cells), or becoming active. When active, warts can develop or it can affect cervical cells. It can take many years for the virus to become active and its presence is usually short-lived. In most cases the body takes between 8 to 14 months to clear the virus naturally.

Most people will have HPV at some time in their lives and never know it. You may become aware of HPV if you have an abnormal Pap smear result, or if genital warts appear.

Once you have been exposed to a particular type of HPV, you are unlikely to catch it again, as the body usually becomes immune to that type.

For more information, see the brochure The link between cervical cancer and HPV.
Top of page

16. How do I know if I have HPV?

Most people will have an HPV infection at some time in their life and never know it. The body's immune system usually clears the virus in around 8 to 14 months..

A Pap smear checks for changes to the cells of the cervix. Abnormal results are most likely to be minor changes caused by HPV that will either disappear by themselves or can be easily treated before they become more serious.

Although a Pap smear does not specifically test for HPV, some Pap smear results will show that cells of the cervix have been affected by HPV. The Pap smear does not indicate the type of HPV or whether it is still present in the body.
Top of page

17. Can HPV be treated?

There is no treatment for HPV. Only changes to cervical cells or warts that result from HPV can be effectively treated. If you have visible warts your doctor can suggest the treatment most suitable for you.

Women whose Pap smear results indicate that cells of the cervix have been affected by HPV should have more frequent Pap smears. This is to monitor the cervix and ensure that it returns to normal. If it doesn't return to normal within a set time, your doctor may suggest further tests.
Top of page

18. Is there a vaccine for HPV?

The Australian Government is funding an ongoing human papillomavirus (HPV) vaccination program for girls aged 12-13 years. For more information on the program, please visit the Immunise Australia Program website.
Top of page

19. Will I still need Pap smears if I have the vaccine?

Yes, Pap smears are essential, as the vaccine does not protect against all cancer-causing types of HPV.
Top of page

20. I’ve been through menopause. Do I still need to have Pap smears?

Yes. If you have ever had sex, even with only one partner, it is important to keep having Pap smears. A Pap smear every two years until you are 70 years old, even after menopause, is your best protection against cervical cancer.
Top of page

21. I’ve had a hysterectomy. Do I still need to have Pap smears?

Following a hysterectomy, women should discuss their ongoing need for cervical screening with their doctor. Women who have had a hysterectomy usually do not require further Pap smears. However, in some cases, Pap smears may still be needed.

Women who have had a total hysterectomy, that is, the uterus and cervix removed, and have ever had treatment for severe changes on the cervix, are recommended to continue to have smears taken from the upper vagina (known as vault smears). Women who have had a hysterectomy but have never had a Pap smear should also have a vault smear. Women who have had a partial hysterectomy, where the cervix is not removed, should still have a Pap smear every two years.

Many women do not know exactly what type of hysterectomy they had. If you are not sure, it is important to find out. If your doctor has no records of the operation, an internal examination or a cell sample may be needed.
Top of page

22. When is the best time during my menstrual cycle to have a Pap smear?

The best time to have a Pap smear is in the middle of your cycle, a few days after you have finished your period and up to about a week before the next one is due.

For example, if you have a 28 day cycle, with day 1 being the first day of bleeding and day 28 being the last day before your next period, a good time to have your Pap smear would be from day 9 (or two days after bleeding has stopped) to day 20.

It can be difficult for women with irregular periods to predict the best time to have a Pap smear. It is still possible to have a Pap smear at other times of the menstrual cycle, but having it mid-cycle does increase the likelihood of the sample being satisfactory for testing at the laboratory.
Top of page

23. Am I able to have a Pap smear during pregnancy?

The National Cervical Screening Program recommends that every woman presenting for antenatal care should be offered cervical screening by Pap smear if they have not had cervical screening within the past two years.

Pap smears can generally be undertaken during pregnancy, ideally before 24 weeks gestation. You many have some spotting and minor bleeding following the Pap smear. Your doctor should be able to advise you what is normal following a Pap smear and address any specific concerns you may have about having a Pap smear during pregnancy.

The Royal Australian and New Zealand College of Obstetricians and Gynecologists advises that women should be reassured there is no evidence that a properly collected Pap smear causes any pregnancy problems.

More information on cervical screening during pregnancy
Top of page

24. Am I at greater risk of cervical cancer if I take drugs that suppress my immune system?

In general, immunosuppressed women are at greater risk of developing cervical cancer. It is recommended that if an immunosuppressed woman has a screen-detected abnormality (even if the lesion is low-grade) she should be referred for a colposcopy.
Top of page

25. Do I require more frequent testing if I have been exposed to diethylstilboestrol (DES) in utero?

DES-exposed women should be offered annual Pap smears and have a colposcopic examination of both the cervix and the vagina. Screening should begin any time at the woman’s request and continue indefinitely.
Top of page

26. What if I can’t remember when to have my next Pap smear?

If you forgot when your next Pap smear or follow-up investigation is due, you can ask the doctor, nurse or health worker who did you last Pap smear.

Alternatively, each state and territory has a confidential system called a cervical screening register that records the results of your Pap smears and associated tests. The register provides an important safety net by sending you a letter if it appears your Pap smear or follow-up treatment is overdue. You can choose if you want to receive the reminder letters or not. Further information and contact details for cervical screening registers in each state and territory can be found on our Cervical Screening Register page.
Top of page

27. What about women who do not speak English?

You can view our Non-English information page that contains translated material on Pap smears and what an abnormal result means.

If you have difficultly communicating in English, you can ring Translating and Interpreting Services for assistance on 13 14 50. When you make an appointment for a Pap smear, you can ask to have an interpreter present, and the person booking your appointment will organise that for you. It is also fine if you want to take a friend or family member with you.

28. Can ovarian cancer be detected by having a Pap smear?

No. There are different tests and procedures for diagnosing ovarian cancer. For more information, you can go to the National Breast and Ovarian Cancer Centre website.

Help with accessing large documents

When accessing large documents (over 500 KB in size), it is recommended that the following procedure be used:

  1. Click the link with the RIGHT mouse button
  2. Choose "Save Target As.../Save Link As..." depending on your browser
  3. Select an appropriate folder on a local drive to place the downloaded file

Attempting to open large documents within the browser window (by left-clicking) may inhibit your ability to continue browsing while the document is opening and/or lead to system problems.

Help with accessing PDF documents

To view PDF (Portable Document Format) documents, you will need to have a PDF reader installed on your computer. A number of PDF readers are available through the Australian Government Information Management Office (AGIMO) Web Guide website.

Page currency, Latest update: 14 May, 2011