Do you have a medical question that you would like an honest answer from a doctor? Dr. Mara Gordon, a family physician in Camden, New Jersey, answers readers' health questions every month. Write to us at [email protected].
Question: I heard that there is a self-test for cervical cancer. I hate having Pap smears. Is this a safe alternative?
I hear you: Pap smears No fun. They are inconvenient at best. At worst, they can be deeply upsetting for survivors of sexual or medical trauma.
As a primary care physician, I also know how important it is for my patients to be screened for early signs of cervical cancer, most common gynecological cancer worldwide. Traditionally, a doctor would do this with a Pap smear, which involves collecting a sample of cells from the cervix.
But a new approach is starting to become available. You can get tested for HPV, or human papillomavirus, which causes cervical cancer. Actually, new recommendations This month, the American Cancer Society reports that patients can safely have vaginal swabs collected to collect samples for testing instead of undergoing invasive gynecological exams.
Ask your questions about health and medicine at [email protected] and we'll look at them for the next Real Talk with the Doctor column.
But the new approach is not yet widely available. Here's what you need to know.
How HPV testing helps identify cancer risk
HPV is like a sex-related cold. If you've ever had sex, you've almost certainly been exposed.
“I say, 'You know, this Human papillomavirus, so every person will become infected with it at one time or another,” said Dr. Rebecca Perkins, OB/GYN at Tufts University. “We just have to worry about it if it doesn’t go away.”
Just as most people fight off nasty winter colds, the immune system is also great at fighting off HPV.
But if your body can't do this, your risk of developing cervical cancer increases. That's why testing for HPV strains with a high risk of developing cancer is a good way to identify people who may develop cancer. (This is why physician groups such as the American Academy of Pediatrics recommend All children are vaccinated against it between the ages of 9 and 12.)
If you test positive for high-risk HPV, you will need follow-up testing—either a repeat HPV test or a procedure called colposcopy, which allows your doctor to look at your cervix under a microscope and take a biopsy if necessary.
HPV testing is more effective
According to Perkins, HPV testing detects 90% to 95% of precancerous abnormalities. She is the lead author of new American Cancer Society guidelines that help doctors decide how and when to screen their patients for cervical cancer. Pap smears, Perkins added, detect only about 70 to 80 percent of precancerous lesions.
Let's look at the difference.
During a Pap smear, the patient undergoes a genital examination by a doctor or nurse. The doctor inserts a speculum into the patient's vagina so she can see the cervix (fundus of the uterus) and rotates a plastic brush to collect cervical cells. These cells are then transported to a laboratory where they are examined under a microscope for abnormalities that may be early signs of cancer.
The HPV test can be performed by a doctor or by the patient himself. If done by a doctor, it is similar to a Pap smear and involves a speculum examination. This is called a “physician-collected test.” But a vaginal swab is exactly what it sounds like. The patient inserts a swab into the vagina to collect a sample, which is then sent into the vagina.
Many people choose to take the pap smear themselves. It may seem less invasive than being examined by a doctor, and there is no mirror to be uncomfortable.
New recommendations from the American Cancer Society include a vaginal smear as a safe and accurate form of cervical cancer screening. They say anyone with a cervix should get tested for HPV between the ages of 25 and 65. If the smear is taken by a doctor, this should happen every five years. If the patient does this herself, then this is three times.
Do-it-yourself packing is not yet widespread.
In May 2025, the Food and Drug Administration approved the first home HPV testing kit. It is proprietary and can only be used through a telemedicine company called Teal Health, which charges $99 in addition to billing the patient's insurance plan. Your doctor cannot prescribe it for you.
This means that most patients still have to go to regular clinics for cervical cancer screening, even if patients take smears themselves. There, they could either get tested by a doctor or have a swab test done in the clinic's restroom. Not all doctors offer the option of self-swab testing at this time, but ask yours if they do.
I asked Perkins why I couldn't just order a vaginal smear for my patients and have them do it at home rather than have them come in.
The answer comes down to transportation.
“Imagine you have someone in rural Texas in July. [who] makes himself a swab, puts it in the mailbox. The mailbox now heats up to 200 degrees, Perkins says. “It is then put on a mail truck and then taken to the laboratory.” It must still be valid.”
Teal Health is currently the only company offering a test that has been proven accurate in such a wide range of circumstances.
On the other hand, taking a self-swab test in the doctor's office bathroom requires a variety of equipment that will be immediately transported to the laboratory and stored at a stable temperature.
Even if it still means a trip to the clinic, many people prefer this to a mirror exam. This may be less painful and give the patient a sense of control.
Insurance often doesn't cover this.
Many doctors still do Pap tests instead of just testing for HPV, including me! That's because testing for HPV alone requires special equipment—and while it's better, it's not covered by most health insurance plans.
If it's better, why don't insurers pay for it? This is mainly because Testing for HPV alone is not yet recommended US Preventive Services Task Force, a government agency that issues guidelines for primary health care. Perkins says the USPSTF has tended to follow the American Cancer Society's recommendations over time—just a few years behind schedule.
It's also worth noting that their recommendations for cervical cancer screening are currently being updated. Many experts, including Perkins, expect the new guidelines to include testing only for HPV, although it is unclear when they will be released.
But many insurers only pay for what the UPSTF recommends, Perkins says.
Keep watching movies into your 50s and 60s.
Older women usually do not visit gynecologists as often as patients during their peak reproductive period. These patients may miss recommended screenings, so when doctors find cervical cancer, it is usually in more advanced stages.
In older women, as a rule, much higher mortality from cervical cancer compared to those who are younger.
Perkins hopes the ability to self-smear will eventually make cervical cancer screening more accessible to this age group.
Perkins says old screening guidelines are also partly to blame for older women skipping screenings—they're unnecessarily complicated. In these recommendations, testing frequency is determined by an algorithm based on past test results that may be difficult to track if a patient changes doctors or goes several years without treatment.
Perkins hopes the move to simplified HPV-only testing will make it easier for older patients to get screened, with testing done by a doctor at age 60 and then again at age 65, regardless of past results.
Dr. Gordon is affiliated with the Cooper Medical School of Rowan University. She writes the Substack newsletter.”Your doctor friend“
