Pap smear (Pap test): a complete guide – what it is, how it’s done and what your results mean

01What is a Pap smear and what does it show?

A Pap smear is a screening test that checks the cells of the cervix for abnormal changes. It is not a test for ovarian or womb (uterine) cancer, but for the cervix – the lower part of the uterus that opens into the vagina.

The name comes from the Greek physician Georgios Papanikolaou, who developed the method in the 1940s. That is why you will hear it called a “Pap test”, “Pap smear”, “smear test” or “cervical cytology”. They all refer to the same examination.

Definition: Cervical cytology is the microscopic examination of cells taken from the surface of the cervix, to detect abnormal cells (dysplasia or precancerous lesions) and, more rarely, cancer cells.

What a Pap smear can show:

• whether the cells of the cervix are normal
• mild changes, often linked to HPV infection, which frequently clear on their own
• more significant (precancerous) changes that need follow-up or treatment
• occasionally, signs of inflammation or infection, which your doctor assesses separately

What a Pap smear does not show:

• it does not detect ovarian cancer
• it is not a test for sexually transmitted infections (these need specific tests)
• it does not replace a gynaecological visit or ultrasound when you have symptoms

A Pap smear can be done the conventional way (cells are spread on a glass slide) or as liquid-based cytology (cells are placed in a vial of preservative fluid). The liquid method also allows an HPV test to be run on the same sample if your doctor requests it.

02Why is a Pap smear important? Preventing cervical cancer

A Pap smear matters because cervical cancer is one of the few cancers that can be almost entirely prevented: precancerous changes can be found and treated years before they become cancer.

Key figures from the World Health Organization (WHO):

• around 604,000 new cases and around 280,000 deaths from cervical cancer worldwide in 2024
• almost all cases are caused by persistent infection with oncogenic types of HPV (human papillomavirus); HPV types 16 and 18 cause about 76% of cases
• in women with a normal immune system, progression from a precancerous lesion to cancer usually takes 15–20 years – this is the “window” that screening and the Pap smear use

The WHO Global Strategy to eliminate cervical cancer, adopted in 2020, aims to bring the disease below 4 cases per 100,000 women per year. To get there, every country should reach the “90–70–90” targets by 2030:

1. 90% of girls fully vaccinated against HPV by age 15
2. 70% of women screened with a high-performance test by age 35 and again by 45
3. 90% of women with precancer or cancer receiving treatment

In Albania, according to the Institute of Public Health (ISHP), cervical cancer is among the most common cancers in young women. That is why there is a national public screening programme, and the HPV vaccine has been added to the national vaccination calendar for girls. The Pap smear, HPV test and colposcopy are the tools that make this prevention real for every woman.

03When should you have a Pap smear and how often? Who needs one

Short answer: a Pap smear (or HPV test) is recommended for women who have had sexual contact, starting at the age your doctor advises and at an interval based on your age, previous results and individual risk. There is no single “universal frequency” – guidelines differ between countries and have been updated in recent years.

What international guidelines say (as general orientation):

• WHO recommends a high-performance HPV test as the main test for the general population, starting at age 30, every 5–10 years; for women living with HIV, from age 25, every 3–5 years.
• The American College of Obstetricians and Gynecologists (ACOG, 2026): ages 21–29, Pap smear every 3 years; ages 30–65, primary HPV testing every 5 years is preferred, while co-testing (Pap + HPV) every 5 years remains acceptable.
• Most guidelines do not recommend a routine annual Pap smear for women with normal results and no risk factors.

Albania has a national public cervical cancer screening programme based on the HPV test, offered free of charge at health centres for the age groups the programme covers. To find out whether you are in an invited age group, ask your family doctor or the health centre where you are registered.

When more frequent checks may be needed (always as your doctor advises):

• previous abnormal results or a positive HPV test
• previous treatment of cervical lesions
• a weakened immune system (e.g. HIV, immunosuppressive therapy, transplant)
• symptoms: bleeding after sex, bleeding between periods or after menopause, unusual discharge

Important: symptoms don’t wait for your screening date. If you have unusual bleeding or pain, book a gynaecological visit regardless of when your last Pap smear was.

04Pap smear or HPV test? The difference, and what co-testing is

The key difference: a Pap smear looks for cells that have already changed, while an HPV test looks for the virus that causes those changes. Both are collected the same way, with a small brush from the cervix – often from the same sample.

Pap smear (cytology):

• examines the shape of cells under a microscope
• shows whether there are mild or significant changes
• is particularly useful in younger women, in whom HPV infections are very common and often clear on their own
• is also used as “triage” after a positive HPV test, to decide whether colposcopy is needed

HPV test:

• detects high-risk HPV types (e.g. 16, 18 and others)
• is more sensitive for identifying women at risk of precancerous lesions
• a negative result gives reassurance for longer, so the interval can be longer
• is recommended by WHO as the primary screening test from age 30 and is the core test of Albania’s national programme

Co-testing:

• a Pap smear and an HPV test at the same time
• gives the fullest information in a single visit
• your doctor may recommend it depending on your age, history or previous results

A positive HPV result does not mean cancer. It means the virus is present and follow-up is needed: usually a Pap smear (if not already done), a repeat test after an interval, or colposcopy. At Klinika Gjata, your doctor decides which test or combination you need, based on your age, previous results and current recommendations.

05How is a Pap smear done? What happens during the test

A Pap smear is done in the gynaecology room as part of a routine visit, and the sampling itself takes just one or two minutes.

What is used:

• Speculum: a smooth plastic or metal instrument that gently opens the vaginal walls so the doctor can see the cervix. It comes in different sizes, including small ones.
• Cervical brush or spatula: a soft brush that collects cells from the surface of the cervix and the cervical canal.
• Vial or slide: the sample goes into a vial of preservative fluid (liquid-based cytology) or is spread on a slide (conventional method) and sent to the laboratory.

In the laboratory, a cytology specialist examines the cells under a microscope and classifies the result using the international Bethesda system. If the sample is liquid-based, an HPV test can also be run on the same sample.

The Pap smear is often combined with a full gynaecological visit: a conversation about your cycle, contraception and symptoms, a clinical examination and, when needed, an ultrasound. If the doctor sees something on the cervix that needs attention, colposcopy may be recommended.

06Pap smear step by step: how the visit goes

This is how a Pap smear usually goes, from arrival to result:

1. Short conversation: the doctor asks about the date of your last period, contraception, pregnancies, previous Pap or HPV results and any symptoms.
2. Getting ready: you undress from the waist down in a private area and lie on the examination couch with your legs supported.
3. Relaxing: the doctor explains what will happen. Slow breathing and relaxing your pelvic muscles make the examination easier.
4. Inserting the speculum: the speculum is inserted gently and opened slightly so the cervix is visible. You may feel pressure, but not sharp pain.
5. Taking the sample: a soft brush collects cells from the cervix – this takes a few seconds.
6. Removing the speculum: the instrument is removed straight after the sample is taken.
7. Labelling and sending: the sample is labelled and sent to the laboratory for cytology (and HPV testing, if requested).
8. After the test: you get dressed and can return to your normal activities straight away. Light spotting is possible and normal.
9. The result: when it arrives, your doctor explains it and tells you clearly what happens next – routine check, repeat test, HPV test or colposcopy.

If you feel anxious, say so at the start. You can ask for a smaller speculum, stop at any moment or bring someone with you.

07How to prepare for a Pap smear: timing in your cycle and what to avoid

Short answer: have your Pap smear when you are not on your period, and avoid sex, douching and vaginal products for about 48 hours beforehand. This keeps the sample clean and the result more reliable.

Best time in your cycle:

• ideal: around 10–20 days after the first day of your period (mid-cycle)
• avoid days with bleeding; heavy blood can make the sample inadequate for reading
• if your cycle is irregular, choose a day without bleeding

What to avoid for about 48 hours before the test:

• sexual intercourse
• vaginal douching or internal washing
• vaginal creams, gels, pessaries or lubricants (unless prescribed – let your doctor know)
• spermicides or tampons

Practical points:

• you can eat, drink and drive normally
• a normal external shower is fine
• bring previous Pap or HPV results if you have them
• if you have an active infection (discharge, itching, burning), tell your doctor; sometimes it is better to treat the infection and do the test later

If you forgot and had sex the night before, call the clinic: the doctor will decide whether to go ahead or reschedule.

08Does a Pap smear hurt?

For most women a Pap smear does not hurt. It feels like discomfort, pressure or a mild “cramp” for a few seconds, while the speculum is inserted and the sample is taken.

Why some women feel more discomfort:

• tension and anxiety, which tighten the pelvic muscles
• vaginal dryness, especially after menopause or while breastfeeding
• a first test or a difficult previous experience
• vaginismus, endometriosis or an active infection

What helps:

• tell your doctor if you are afraid or in pain – a smaller speculum and a slower pace can be used
• slow, deep breathing; relax your shoulders and legs
• empty your bladder before the test
• after menopause, your doctor may suggest local oestrogen treatment for a few weeks beforehand if dryness is significant
• you can stop the examination at any moment

After the test, light spotting or slight discomfort is common and settles within a day. If bleeding is heavy or lasts, contact your doctor.

09Pap smear in pregnancy, after menopause, after the HPV vaccine and if you’ve never had sex

Pap smear in pregnancy Yes, a Pap smear can be done safely during pregnancy and does not harm the baby. It is often done at the first visits if you don’t have a recent result. The soft brush may cause light spotting because the cervix has more blood vessels in pregnancy – this is usually not a concern, but tell your doctor. If the result is abnormal, colposcopy can still be done during pregnancy, while treatment of lesions is usually postponed until after birth, as your doctor judges.

After giving birth If a Pap smear is due after birth, it is usually done once the postnatal period is over (around 6–12 weeks), when the cervix has recovered.

After menopause Screening continues after menopause until the age your doctor confirms it can stop, based on your previous results. Hormonal changes can cause dryness and “atrophic” cells, which sometimes make reading harder. In these cases your doctor may recommend an HPV test or a repeat after local treatment. Any bleeding after menopause should be assessed promptly – it does not wait for screening.

After the HPV vaccine The HPV vaccine protects against the most dangerous types of the virus, but not all of them. Vaccinated women should therefore continue screening with a Pap or HPV test as their doctor recommends.

Women who have never had sexual intercourse (virgins) HPV is mainly transmitted through sexual contact, so the risk in women who have never had any sexual contact is very low and routine screening is usually not needed. However, if you have symptoms (unusual bleeding, discharge, pain), you should have a gynaecological visit. Your doctor decides with you whether any examination is needed and chooses the most suitable and gentle method.

After a hysterectomy If the uterus and cervix were removed for a benign reason, a Pap smear is often no longer needed. If surgery was for precancerous lesions or cancer, vaginal follow-up may be needed – ask your doctor.

10How to read Pap smear results: normal, ASC-US, LSIL, HSIL and next steps

Most Pap smear results are normal. Even when a result is abnormal, in most cases it is not cancer but changes that need follow-up. Results are reported using the international Bethesda system.

Key terms:

• NILM (negative for intraepithelial lesion or malignancy): a normal result. Continue screening at the interval your doctor sets.
• ASC-US (atypical squamous cells of undetermined significance): very mild changes, often due to HPV, inflammation or hormonal changes. It does not mean cancer. Usually an HPV test or repeat Pap smear follows; if HPV is positive, colposcopy may be recommended.
• LSIL (low-grade squamous intraepithelial lesion): mild changes, usually linked to HPV, which clear on their own in many women. Your doctor may recommend colposcopy or follow-up, depending on age and HPV result.
• ASC-H (atypical squamous cells, cannot exclude HSIL): requires colposcopy.
• HSIL (high-grade squamous intraepithelial lesion): more significant, precancerous changes. Requires colposcopy and usually a biopsy. It is not cancer, but it should be treated so it does not progress.
• AGC (atypical glandular cells): changes in glandular cells; requires full assessment (colposcopy and further tests).
• Unsatisfactory (inadequate) sample: the laboratory cannot read the sample (e.g. too few cells, blood or inflammation). It does not indicate a problem – the test is simply repeated, usually after a few weeks.

Possible steps after an abnormal result:

1. HPV test (if not already done), to assess risk.
2. Repeat Pap smear or HPV test after an interval set by your doctor.
3. Colposcopy: a magnified examination of the cervix, using special solutions, which shows areas that need a closer look.
4. Biopsy: a tiny piece of tissue taken during colposcopy for a histological diagnosis (e.g. CIN1, CIN2, CIN3).
5. Treatment, if needed: precancerous lesions are treated with minor procedures that remove the affected area.

What matters is not only the result but its context: age, HPV test, previous results and pregnancy. That is why interpretation is always done by your doctor, not by a table.

11Why have your Pap smear at Klinika Gjata in Tirana?

At Klinika Gjata, a Pap smear is not an isolated sample but part of a complete prevention pathway: Pap test, HPV test, colposcopy and biopsy, all under the care of the same doctor.

Why this matters to you:

• Assoc. Prof. Dr. Elinda Gjata, MD, Dr. Sc., is an obstetrician-gynaecologist with over 25 years’ experience and an Associate Professor at the University of Medicine, Tirana.
• She trained in colposcopy in Paris, Lyon and Ascoli Piceno – the examination that follows when a Pap or HPV test is abnormal.
• She is a co-author of research on cervical cancer awareness and prevention, Pap smear prevalence and HPV vaccine uptake in Albania (2024–2025), so she knows first-hand the real barriers Albanian women face with screening.
• The clinic has been operating since 2009 on Rruga Hasan Sufa, Tirana.

What you can expect:

• a clear explanation before the test and time for questions
• a gentle approach, especially for a first test, for anxious women or after menopause
• an explanation of your result and a clear follow-up plan, not unclear terms on a sheet of paper
• colposcopy and biopsy in the same clinic when needed

To book: call +355 4 234 0059.

12How much does a Pap smear cost in Tirana? What affects the price

The price of a Pap smear depends on the type of test and what the visit includes. For the current price at Klinika Gjata, call +355 4 234 0059.

Factors that affect cost:

• Pap smear alone, or Pap smear plus HPV test (co-testing)
• method: conventional cytology or liquid-based cytology
• whether a full gynaecological visit and/or ultrasound is included
• whether further tests are needed: colposcopy, biopsy, infection tests
• the laboratory that analyses the sample

Is there a free Pap test in Albania? The national public cervical cancer screening programme offers the HPV test free of charge at health centres for the age groups included in the programme, with follow-up for positive cases. For current details (age, invitations, where it is done), ask your family doctor or the health centre where you are registered.

Many women choose a private clinic when they are outside the programme’s age range, want a Pap and HPV test in the same visit, need prompt colposcopy after an abnormal result, or want the whole process followed by the same doctor.