Cervical smear and HPV test: purpose, procedure, results
In brief
A smear test (cervical screening test) takes a sample of cells from the cervix. It is quick, causes little pain, and is used to detect precancerous changes before they turn into cancer. In France, women aged 25 to 29 have a cytology test (two tests one year apart, then every 3 years), followed by an HPV test every 5 years from 30 to 65. An abnormal result is common and rarely means cancer: depending on the INCa guidelines updated in 2025, it leads to an HPV test, a repeat test or a colposcopy.
What is a cervical smear test for?
A cervical smear (also called a Pap smear or cervical screening test) collects cells from the surface of the cervix. Analysing them detects changes caused by human papillomavirus (HPV), which can progress very slowly, over years, to cervical cancer. Treating these precancerous changes in time prevents cancer.
From the same sample, the laboratory can carry out two different analyses:
- cytology (the "smear" in the strict sense): a pathologist looks at the cells under a microscope;
- the HPV test: it looks for the DNA of high-risk papillomaviruses.
A smear test does not screen for womb (endometrial) cancer or ovarian cancer.
At what age and how often should I have a smear test?
In France, the guidelines of the French National Authority for Health (HAS), used by the national organised screening programme, apply to all women aged 25 to 65, whether or not they have had the HPV vaccine:
| Age | Test performed | Interval if the result is normal |
|---|---|---|
| Under 25 | No routine screening | — |
| 25 to 29 | Cytology | Two tests 1 year apart, then every 3 years |
| 30 to 65 | HPV test | Every 5 years, starting 3 years after the last normal smear |
| Over 65 | Screening stops if previous tests were regular and normal | — |
Why not before 25? At that age, HPV infections are very common and clear up on their own; screening would lead to unnecessary tests and treatments. Why an HPV test after 30? It is more sensitive: follow-up of four large European trials showed that it gave 60 to 70% better protection against invasive cancer than cytology, which allows tests to be spaced 5 years apart.
Testing may be more frequent if your immune system is weakened (HIV, transplant, immunosuppressive treatment), if you were exposed to diethylstilbestrol (DES, Distilbène) before birth, or if you have had a treated lesion. Between 30 and 65, vaginal self-sampling for an HPV test is an alternative for women who do not attend screening.
What happens during a smear test?
The sample can be taken by a gynaecologist, a midwife or a general practitioner. It takes a few minutes.
- You lie on your back with your knees bent and apart. A speculum is gently inserted into the vagina so the cervix can be seen.
- The doctor brushes the surface of the cervix and the opening of the canal with a small soft brush, to collect cells from the transformation zone, where most changes start.
- The brush is rinsed in a vial containing a preservative liquid (liquid-based cytology), so that cytology and HPV testing can be done on the same sample.
The test is usually painless or just slightly uncomfortable. Light spotting is possible in the hours afterwards.
When should it be done?
- Ideally not during your period.
- Avoid sex, pessaries, vaginal creams and douching in the 48 hours before.
- If you have a vaginal infection, it is better to treat it first.
- Pregnancy does not prevent a smear test: if one is due, it can be done during pregnancy check-ups.
What about self-sampling?
Vaginal self-sampling means inserting a swab into your own vagina, at home or at the practice, and then sending it to the laboratory. It only allows an HPV test, which is why it is reserved for women aged 30 to 65. Its reliability for detecting the virus is close to that of a sample taken by a health professional. If it is positive, a sample taken by a professional is then needed for cytology.
How do I read my smear test results?
Cytology results are written using the Bethesda classification. Here is what the most common terms mean:
| Result | Meaning | Usual next step |
|---|---|---|
| HPV test negative | No high-risk virus detected | Next test in 5 years |
| HPV test positive, normal cytology | Virus present, normal cells | Repeat HPV test in 1 year; most infections have cleared by then |
| HPV test positive, abnormal cytology | Virus present with abnormal cells (ASC-US or worse) | Colposcopy; after ASC-US with a normal, fully visualised colposcopy, repeat HPV test in 1 year |
| NILM | Normal smear (negative for intraepithelial lesion or malignancy) | Usual interval |
| ASC-US | Minor changes of undetermined significance | Ages 25 to 29: HPV test on the same sample; colposcopy if positive, repeat smear in 3 years if negative |
| LSIL | Low-grade lesion, often linked to a temporary HPV infection | Colposcopy as the first-line test |
| ASC-H | Changes where a high-grade lesion cannot be ruled out | Colposcopy |
| HSIL | Probable high-grade lesion | Colposcopy with biopsies |
| AGC | Abnormal glandular cells | Colposcopy and HPV test; assessment of the womb lining after age 45 |
| Unsatisfactory | Sample insufficient or obscured by blood or inflammation | Repeat sample |
Beware of a common confusion: the terms CIN 1, 2 or 3 do not apply to the smear but to biopsies. A smear only flags cells that need checking.
My smear test is abnormal: should I be worried?
An abnormal smear is a common result and, in the great majority of cases, it is not cancer. Most often it shows an HPV infection, which will clear on its own, or a precancerous change, which is monitored or treated.
The logical next step is a repeat test or a colposcopy, an examination carried out at the practice that looks at the cervix under magnification and allows biopsies if needed. Depending on the result, monitoring or a local treatment such as a cone biopsy (conisation) is offered. In France, these decisions follow the guidelines of the National Cancer Institute (INCa), updated in 2025 after the introduction of primary HPV screening.
The most important thing is not to stop the follow-up you are offered. Average waiting time for an appointment at the practice: one week to 10 days, except during holiday periods.
Does a smear test replace seeing a doctor if I have symptoms?
No. A smear test is a screening test for women without symptoms. See a doctor without waiting for your next screening date if you notice:
- bleeding after sex;
- bleeding between periods or after the menopause;
- unusual, persistent discharge;
- unexplained pelvic pain.
To find out what happens during the rest of the examination, read our article on what to expect at a gynaecology appointment.
Frequently asked questions
Is a smear test covered by health insurance?
In France, as part of organised screening, women aged 25 to 65 who have not been screened within the recommended interval receive an invitation letter; on presenting it, the laboratory analysis is fully covered by the Assurance maladie (French national health insurance), with nothing to pay upfront. Taking the sample is reimbursed under the usual conditions for a consultation.
Do I need a smear test if I have had the HPV vaccine?
Yes. The vaccine does not protect against all high-risk types of HPV. Screening is recommended in the same way for vaccinated and unvaccinated women.
Can I have a smear test if I have never had sex?
The risk is then very low. If you have never had any sexual contact, screening can be postponed; discuss it with your doctor.
My HPV test is positive: does it mean my partner cheated on me?
No, that cannot be concluded. The virus can remain silently present for years, and it is impossible to know when the infection was caught.
How long does it take to get smear test results?
The time depends on the laboratory. At the practice, your result is sent to you via Doctolib or by post, and you are phoned if a result is urgent. If you have not received your result, ask the practice or the laboratory.
Does a smear test hurt?
Usually not: the test takes a few minutes and is painless or just slightly uncomfortable. Light spotting is possible in the hours afterwards.
References
- Haute Autorité de santé. Évaluation de la recherche des papillomavirus humains (HPV) en dépistage primaire des lésions précancéreuses et cancéreuses du col de l’utérus et de la place du double immuno-marquage p16/Ki67 [Primary HPV testing for cervical screening]. Summary and recommendations. HAS, 2019. has-sante.fr
- Ronco G, et al. Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials.. Lancet, 2014. doi:10.1016/S0140-6736(13)62218-7 — PMID 24192252
- Brun JL, et al. [Management of women with abnormal cervical cytology: Update of INCa recommendations after the implementation of HPV screening]. Gynecol Obstet Fertil Senol, 2025. doi:10.1016/j.gofs.2024.11.006 — PMID 39884805 (update of the 2016 INCa guidelines, cancer.fr)
Dr Olivier KadochObstetrician-gynaecologist and gynaecological surgeon in Paris (16th and 5th arrondissements). Former chef de clinique-assistant (senior registrar) at the Paris public hospitals (AP-HP); individually accredited by the French National Authority for Health (HAS). RPPS 10003957809. Background and practice locations
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