Women's Health; Your Pregnancy Matters

Pap smears are safe – before, during and after pregnancy

Based on your medical history, you may need a Pap smear during your pregnancy. But there's no need to worry – Pap smears are perfectly safe.

Pregnancy induces changes in your body and your mind. Many mothers-to-be experience anxiety, which can lead some to second-guess their most routine medical procedures. While this mindset is understandable, one thing you can definitely cross off your “worry list” is the myth that Pap smears are not safe during pregnancy.

It is normal to experience some spotting after a Pap smear, even when you are pregnant. However, this natural response has caused some misconceptions that the Pap smear, a potentially life-saving procedure, isn’t safe during pregnancy.

The truth is that getting a Pap smear is safe for you and your baby; it will not cause a miscarriage.

Whether you’re pregnant or not, the Pap smear is the gold standard for screening for cervical cancer. It allows us to collect cells from the surface of the cervix and examine them for abnormalities.

Cervical cancer and abnormal Pap smear results are almost always caused by the human papillomavirus (HPV), a sexually transmitted disease currently infecting around 80 million people in the United States. Though the virus is common, the likelihood of it causing cancer is much less common. In fact, most infections go away on their own. Cancer develops when the infection isn’t detected and managed appropriately, which is why Pap smears are so important.

Data from the Centers for Disease Control and Prevention (CDC) show that cervical cancer deaths have decreased over the last several decades as a result of increased Pap smears. If you follow up on your Pap smear results as recommended by your provider, we almost always will catch the cancer.

What’s even more encouraging is that the HPV vaccine, which the CDC recommends for all children ages 11 or 12, can prevent cervical cancer from developing. We still recommend routine Pap smears for people who receive the vaccine, but we are finding very low rates of abnormal Pap smears within this vaccinated population.

As more people recognize the importance of regular Pap smears, questions about the procedure continue to swirl. We’ve answered the most common ones below.

How often should I get a Pap smear?

We recommend a Pap smear every three years for women between the ages of 21 and 30. If your results are normal and you are negative for HPV, you can extend that to every five years from ages 31 to 65. Higher-risk populations, such as people who have an autoimmune disease, should discuss more frequent testing with their provider.

Do I need a Pap smear when I’m pregnant?

Reviewing your Pap smear history is an early, important step during prenatal care. If you received a normal test result within the last three years, you likely don’t need a Pap smear while pregnant.

We realize, however, that many newly pregnant people are seeing a doctor for the first time in quite a while – maybe their first time ever as an adult – and haven’t had a Pap smear before, or for several years. To support a healthy pregnancy, we want to rule out the possibility of cervical cancer development as soon as possible.

If I do need one, is it safe?

Pap smears while pregnant are safe for you and your baby. Any suggestion that it might cause a miscarriage is false. It is normal to experience minor bleeding after a Pap smear when you are pregnant because blood flow to the uterus increases, which causes the cervix to bleed more easily when touched.

Any type of bleeding is understandably alarming while pregnant, but in this case the blood is coming from the outside of your cervix – not inside the uterus, where the baby is safe and developing.

What happens if I have an abnormal Pap smear?

The next step may be to perform a colposcopy, which allows us to look more closely at the cervix and take a small tissue sample to test the abnormal cells for cancer. The colposcopy is safe during pregnancy – the only cells we touch are on the outside of the cervix, not the inside near your baby.

Generally, we divide these test results into what we call low-grade or high-grade “dysplasia” – the existence of abnormal cells:

  • Low-grade dysplasia doesn’t usually progress to cancer, so we just watch it and will likely encourage you to come back in a year for another Pap smear.
  • High-grade dysplasia has an increased chance of progressing to cancer, so we will likely recommend a loop electrosurgical excision procedure (LEEP) after delivery.

LEEP removes the outside portion of the cervix containing the abnormal cells, and it can increase the risk of pregnancy complications like preterm birth or losing the baby in the second trimester. Because cervical cancer is a slow-growing disease, we can usually postpone the procedure until after delivery and watch the area closely, performing a colposcopy every trimester to monitor the dysplasia’s progress.

Pregnancy weakens the immune system, which can increase the likelihood of abnormal results, so sometimes the high-grade dysplasia resolves itself after pregnancy. If it does progress to cancer, we will work with you to develop a personalized treatment plan that incorporates your specific health conditions and needs. As an academic medical center, we can streamline your access to some of the best oncologists in the U.S., right here at UT Southwestern.

If you need a Pap smear, it is safe to get one during pregnancy. Along with the HPV vaccine, Pap smear is a vital tool that helps make cervical cancer preventable – and it will give you one less thing to worry about as you prepare for the healthy birth of your baby.

To visit with an Ob/Gyn or certified nurse-midwife, call 214-645-8300 or request an appointment online.