Pelvic Exam vs. Pap Smear: What’s the Difference?

Do you know the difference between a pelvic exam and a Pap smear? You might confuse them for being the same thing, but there are important differences between the two.

Purpose of both a pelvic exam and a Pap smear

A pelvic exam, sometimes called a gynecological exam, is a routine exam to look for any potential medical issues involving your:

• Vulva
• Vagina
• Cervix
• Pelvic organs
• Pelvic floor muscles

A Pap smear is a screening test that detects HPV infection or changes in cells on the cervix that might indicate cervical precancer or cancer.

“You can think of a pelvic exam as a general physical examination of your pelvic organs, while a Pap smear is a specific exam to screen for cancer,” explains gynecologic oncologist Johanna Kelley, MD. “But when you need a Pap smear, it happens as part of a pelvic exam.”

Key differences between them

Let’s take a deeper look at a few ways that pelvic exams and Pap smears differ from one another.

One is a broad exam; the other is specific

During a pelvic exam, your healthcare provider uses a few different methods to examine your external genitalia, vagina and pelvic organs. After you’ve given them your consent, they’ll do this by:

• Visual inspection: They’ll take a look at your vagina and vulva for any signs of infection, irritation or skin changes (like lesions or precancerous or cancerous changes).
• Bimanual exam: Your provider will feel for any abnormalities or tenderness of your vagina, cervix, uterus, fallopian tubes or ovaries.
• Speculum exam: Your provider will use a small tool called a speculum to see inside your vagina to your cervix. During this time, they may perform a Pap test and/or an HPV test.

“A routine pelvic exam involves an internal exam, as well as an exam to visualize or look at the cervix,” Dr. Kelley summarizes. “Then, depending on your age, history and health, a Pap smear would be performed at the same time.”

To perform a Pap smear, your provider uses a small plastic spatula and brush to collect cells from your cervix — the canal that connects your uterus and vagina. Then, those cells are taken to a laboratory, where they’re examined under a microscope to look for any abnormalities.

They can reveal different things about your health

A Pap smear specifically looks for abnormal cervical cells, but a pelvic exam takes a broader look at your gynecological health.

“A Pap smear only takes cells from the cervix to test them further,” Dr. Kelley clarifies. “It’s not a screening test for other types of cancer. A pelvic exam is important to evaluate the health of the vulva, vagina, uterus and adnexa (the structures next to the uterus).”

A pelvic exam can help detect problems like:

• Vaginal infections, including bacterial vaginosis, yeast infections and sexually transmitted infections (STIs)
• Early-stage vulvar, vaginal, cervical, uterine and ovarian cancer
• Cervical polyps
• Ovarian cysts
• Pelvic inflammatory disease (PID)

Both pelvic exams and Pap smears are often just the first step in diagnosing health concerns. More testing may be needed.

A Pap smear isn’t a standalone test

You don’t need a Pap smear every time you have a pelvic exam. But if you’re having a Pap smear done, it’s done as part of a pelvic exam — not on its own.

“A Pap smear alone isn’t enough for an overall evaluation,” Dr. Kelley notes. “Your provider also needs to do a pelvic exam to look at your vulva for any changes or lesions. And they’ll ask you about any symptoms you’re experiencing.”

When and why you may need both of them

You need a well-woman visit every year. But you don’t need a Pap smear at every annual appointment.

Here’s a general look at guidelines for each one — though you should always check with your healthcare provider to see what they recommend for you.

Pap smear guidelines

Current guidelines recommend Pap smears starting at age 21 and continuing until age 65. From ages 21 to 29, most women should have a Pap smear done every three years (though there are some exceptions, which we’ll discuss momentarily).

Once you’re 30, your provider will do HPV testing as part of your Pap smear. The results of both tests will determine how often you need to be tested going forward:

• If your Pap smear is normal and your HPV test is negative, you can start having Pap smears every five years until age 65.
• If your Pap smear is abnormal and/or your HPV test is positive, your provider will make recommendations for any further evaluation. They’ll also tell you how often you need to be tested going forward.

You’ll need Pap smears more often if you have certain conditions that need to be closely monitored, like if you’ve had high-risk precancerous changes on past Pap smears, are HIV-positive or were exposed to a medication called diethylstilbestrol (DES) in the womb.

“Keep in mind that the age cancer screening ends also depends on your history of abnormal Pap smears,” Dr. Kelley explains. “So, if you have a history of abnormal Pap smears, you will need more frequent testing.”

If you do need a Pap smear, your healthcare provider will perform a pelvic exam, too.

When do you need a pelvic exam?

Your provider will want to do a pelvic exam if you’re experiencing gynecological symptoms, including:

• Irregular vaginal bleeding
• Unusual vaginal discharge
• Vaginal or vulvar discomfort
• Pain with intercourse
• Vaginal itching
• Any other concerns related to having sex or peeing

But there are other times when your provider may recommend a pelvic exam, like if you:

• Are attending your annual well-woman visit during a year when you need a Pap smear
• Are pregnant and attending your first prenatal appointment
• Are undergoing a pelvic procedure, like an intrauterine device (IUD) insertion
• Have a history of gynecological conditions that need to be monitored by your healthcare provider

The bottom line for your gynecological health

Whether or not you need a pelvic exam or Pap smear, you do need a routine gynecological visit (aka a well-woman visit) every year.

“Share with your provider any issues you’re having,” Dr. Kelley urges. “This helps make sure that we fully address your concerns and promptly address any issues so that we can maximize your quality of life.”

So, ask your provider when you should have a pelvic exam — and talk with them about whether (and when) a Pap test is appropriate for you based on your age and history.