Most people with a cervix get their first Pap smear at age 21, whether or not they have ever had sex. That is the start age used by the U.S. Preventive Services Task Force (USPSTF). The American Cancer Society (ACS) recommends a slightly different plan: start at 25 with an HPV test instead of a Pap test. Both say screening can usually stop after 65 if past results have been normal.
In the video above, family physician Dr. Richard Honaker answers when young women should start Pap smears and pelvic exams. He says 21 for sure, and earlier if they are sexually active, and that either milestone is a good time to start a relationship with a physician who can talk about sex, infections and birth control. Current screening guidelines don’t start Pap tests earlier for sexually active teens, but an earlier visit can still be useful for those other reasons. The video page covers the first gynecology visit in detail. This article focuses on the age rules.
Pap smear age guidelines at a glance
These schedules are for people at average risk whose results have been normal.
| Age | USPSTF (2018) | American Cancer Society (Dec. 2025) |
|---|---|---|
| Under 21 | No screening | No screening |
| 21 to 24 | Pap test every 3 years | No screening yet |
| 25 to 29 | Pap test every 3 years | HPV test every 5 years (preferred); other options below |
| 30 to 65 | Pap test every 3 years, or HPV test every 5 years, or Pap plus HPV test (co-test) every 5 years | HPV test every 5 years (preferred); other options below |
| Over 65 | Stop if past screening was adequate and you are not at high risk | Stop if you have been screened regularly and recent results are normal |
The ACS options from 25 on: a provider-collected HPV test every 5 years (preferred), a self-collected HPV test every 3 years, a co-test every 5 years, or a Pap test alone every 3 years if HPV-based tests aren’t available. The ACS stresses that getting screened regularly matters most, no matter which test you get.
Why do the USPSTF and the American Cancer Society differ?
The two groups agree on the big picture: no screening before 21, regular screening through 65, and stopping after that for most people. They differ in two ways:
- Start age. The USPSTF starts at 21 with a Pap test. The ACS starts at 25.
- Which test. The USPSTF does not recommend HPV testing for people in their 20s and offers three choices from 30. The ACS prefers a primary HPV test from 25 onward and keeps the Pap test alone only as a backup.
The ACS guideline was last updated in December 2025 and also allows a self-collected sample. You take it yourself with a soft vaginal swab, but a provider still has to order it, and only FDA-approved tests and collection devices should be used. The USPSTF recommendation dates from August 2018, and its page says the topic is being updated, so its advice may change.
Some health systems still describe the 21-start schedule; Cleveland Clinic, for example, lists Pap tests every 3 years from 21 to 29. Ask your own doctor which schedule they use; whichever you follow, the ACS point holds: getting screened regularly is what matters most.
What’s the difference between a Pap smear and an HPV test?
Both use a sample of cells from the cervix, the narrow lower end of the uterus. A Pap test looks for cell changes that could turn into cancer. An HPV test looks for the high-risk types of human papillomavirus (HPV) that cause those changes. A co-test runs both on the same visit.
When can you stop getting Pap smears?
According to the USPSTF, people over 65 can stop if they have had adequate screening and are not otherwise at high risk. “Adequate” means 3 normal Pap results in a row, or 2 normal co-tests in a row, within the last 10 years, with the most recent one within the last 5 years.
The ACS says that at 65 or older you can stop if your last 2 HPV-based tests (or co-tests) were normal, or your last 3 Pap tests were normal. If you don’t know when you were last screened, keep going past 65 until you have those normal results in a row. Screening can also stop at any age if life expectancy is limited.
Don’t stop on your own if you have had abnormal results, precancer or cervical cancer in the past. Talk with your doctor first.
Who may need a different schedule?
Cleveland Clinic says your provider may suggest more frequent screening if you have:
- HIV or a weakened immune system
- exposure before birth to the drug DES (diethylstilbestrol)
- a history of cervical cancer
- abnormal Pap results in the past
Do you still need Pap smears after a hysterectomy?
It depends on whether your cervix was removed and why you had the surgery.
- Cervix removed, surgery not for cancer or precancer: the USPSTF and ACS both say screening is not needed.
- Cervix removed, but you had high-grade precancer or cervical cancer: you still need screening. Cleveland Clinic adds that people who had a hysterectomy for ovarian, uterine or cervical cancer may still need checks of the vaginal tissue.
- Cervix kept (a partial hysterectomy): keep getting screened on the normal schedule.
If you aren’t sure what was removed, the USPSTF says your doctor can confirm it from surgical records or an exam.
How to get ready for a Pap smear
For the most accurate results, Cleveland Clinic advises avoiding these for 2 days before the test:
- vaginal sex
- tampons, vaginal creams or medicines, birth control foams or jellies, lubricants and douches
Try to book the test for after your period ends. If your period starts, call the office: some can still do the test near the end of a period when bleeding is light. Cleveland Clinic says it can take up to 3 weeks for your provider to get the lab results.
When to see a doctor sooner
Screening is for people with no symptoms. Don’t wait for your next routine test if you have unusual bleeding. Cleveland Clinic says any bleeding outside your period should be checked by a provider, including bleeding between periods, after sex or after menopause. It also lists bleeding with severe pain, fever, feeling weak or dizzy, and pelvic pain as symptoms to raise with a provider promptly. If you think you have a medical emergency, call 911.
Frequently asked questions
What age do you get your first Pap smear?
At 21 under the USPSTF guideline. The American Cancer Society instead recommends starting at 25 with an HPV test. Ask your doctor which plan they follow.
How often do you need a Pap smear?
With normal results, the USPSTF says every 3 years from 21 to 29. From 30 to 65, it’s every 3 years with a Pap test alone, or every 5 years with an HPV test or co-test. The ACS prefers an HPV test every 5 years from 25. Abnormal results can mean more frequent tests.
Do virgins need a Pap smear?
Yes. Cleveland Clinic says you still need screening from 21 even if you have never had sex, because not all cervical cancers are linked to sexual activity.
Does a Pap smear hurt?
It shouldn’t hurt, but it can be uncomfortable. Cleveland Clinic says you may feel pressure from the speculum, and light bleeding afterward is possible; tell your provider if discomfort lasts more than a few minutes or bleeding lasts longer than 24 hours. In the video, Dr. Honaker describes the exam as uncomfortable, especially at first, but not painful.
Do you need a Pap smear after a hysterectomy?
Not if your cervix was removed and the surgery wasn’t for cancer or precancer. If you kept your cervix, or had precancer or cervical cancer, you still need screening.
Do you still need Pap smears if you had the HPV vaccine?
Yes. The ACS says its guideline still applies to vaccinated people, because the vaccine greatly lowers the risk of cervical cancer but doesn’t remove it.
Find a doctor
Family physicians and OB-GYNs provide Pap tests and HPV tests. Doctors on Best Docs Network include:
- Dr. Richard Honaker, family medicine, Dallas-Fort Worth
- Dr. Patrick Allen, OB-GYN, Dallas-Fort Worth
- Dr. Maryann Prewitt, gynecologist, Dallas-Fort Worth
Sources
- USPSTF: Cervical Cancer: Screening
- American Cancer Society: Cervical Cancer Screening Guidelines
- Cleveland Clinic: Pap Smear
- Cleveland Clinic: Vaginal Bleeding
This article is for general information only and is not medical advice. Talk with a qualified health professional about your own situation. If you think you may have a medical emergency, call 911.
