Pap test and pelvic exam facts

The Pap test

What is a Pap test

The Pap test (or pap smear) is a test that looks for early changes in the cells of the cervix that may need treatment so that cervical cancer never gets a chance to develop. It may also look for the presence of human papilloma virus (HPV).

When to get a Pap test

A person with a cervix should have their first Pap test at age 21, and then every three to five years.

How Pap tests are done

The clinician will insert a speculum into the vagina in order to see the cervix. Cells are then gently scraped from the opening of the cervix, placed in a collection jar and sent to the lab for testing.

What to expect after a Pap test

Most Pap test results will be normal. If your Pap test is abnormal, you may need to come back sooner to repeat the test. You may receive a phone call, or a letter asking you to return to the clinic in the next year. Often the changes to the cells will have gone back to normal at the time of the repeat Pap test and you won’t need any treatment. If the changes are more serious and/or do not go back to normal, we may need to refer you for more testing.

More about the Pap test

• The cells on a cervix go through normal changes with age. The Pap test is looking for abnormal cell changes, which are usually due to the human papillomavirus (HPV). There are many types of HPV and only a few cause changes to the cervix. Most sexually active people have already been exposed to HPV, but only a few of these people develop these abnormal changes.
• There is an HPV vaccine recommended for those ages 9-26 that is effective at preventing warts and cervical cancer. At City Clinic, we have this vaccine for uninsured people through age 26 and for some patients through age 45 based on a conversation between the patient and clinician.
• A pelvic exam is not the same as a Pap test, and Pap tests are not done at every pelvic exam

The pelvic exam

What is a pelvic exam

Our clinic staff may offer you a pelvic exam to address certain symptoms you may be experiencing, like changes in your discharge, bleeding outside of your period, or pain during sex.

A pelvic exam is a check-up of the vulva, vagina, and cervix (opening of the uterus, inside the vagina). During the exam, we may put a metal or plastic speculum inside your vagina to get a better look at any symptoms you may be having.

If you are due for a Pap test, the clinician may perform the pap at this time.

If you are having symptoms, some vaginal fluid (discharge) will be collected and looked at under the microscope in the clinic to check for infection (yeast, trichomonas, bacterial vaginosis). This procedure is called a wet mount exam.

If needed, your clinician may also do a bi-manual exam after the speculum exam. The clinician will put two fingers into the vagina and press with the other hand on your belly to feel the uterus and ovaries. This part of the exam can help to evaluate pain, abnormal bleeding, infections and other symptoms.

How STI testing works during the exam

Your clinician may do tests for STIs. This is most often done from a swab of the vaginal wall, but can also be done from a urine specimen. Tests for herpes or syphilis may be done if sores are present. Further testing for syphilis and HIV (if needed) is done with blood samples, not from specimens collected during the pelvic exam.

How the Pap test and pelvic exam are different

A Pap test looks for abnormal cells on the cervix that are usually caused by an infection of human papillomavirus (HPV). These abnormal cells might develop into cervical cancer one day if they are left untreated or do not get better on their own.

A pelvic exam does not always include a Pap test. A pelvic exam is a more detailed exam that:

• Looks for other cancers the Pap test cannot (like uterine or ovarian)
• May include STI testing

This information is provided by San Francisco City Clinic.

Visit our homepage at sf.gov/cityclinic.

Information last revised October 2025