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Question: I've heard there's a self test to check for cervical cancer. I hate getting Pap smears. Is this a safe alternative?
I hear you: Pap smears are not fun. At best, they're uncomfortable. At worst, they can be deeply upsetting for people who've experienced sexual or medical trauma.
As a primary care doctor, I also know how important it is that my patients get checked for early signs of cervical cancer, the most common gynecological cancer worldwide. Traditionally, a doctor would do this with a Pap smear, which involves collecting a sample of cells from your cervix.
But a new approach is starting to be available. You can get tested for HPV — or human papilloma virus — which causes cervical cancer. In fact, new recommendations out this month from the American Cancer Society say that patients can safely swab their own vaginas to collect samples for the test, rather than undergo an invasive pelvic exam.
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But the new approach isn't widely available yet. Here's what you need to know.
How HPV testing works to detect cancer risk
HPV is like the common cold of sex. If you've ever had sex, you've almost certainly been exposed.
"I say, 'You know, it's human papillomavirus, so everybody who's a human is going to get it at one point or another,'" said Dr. Rebecca Perkins, an OB/GYN at Tufts University. "We just need to worry about it if it doesn't go away."
Just like most people fight off unpleasant winter colds, the immune system is also great at fighting off HPV.
But if your body can't, your risk of cervical cancer increases. That's why testing for high-cancer-risk strains of HPV is a good way to identify people who could go on to develop cancer. (It's also why doctors' groups like the American Academy of Pediatrics recommend all kids get vaccinated for it between the ages of 9 and 12.)
If you do test positive for high-risk HPV, you'll need follow up testing — either with a repeat HPV test or a procedure called a colposcopy, which allows a clinician to examine the cervix under a microscope and take biopsies if needed.
HPV testing is more effective
HPV testing detects 90% to 95% of pre-cancerous abnormalities, according to Perkins. She is the lead author of new guidelines from the American Cancer Society that help doctors decide how and when to test their patients for cervical cancer. Pap smears, Perkins added, only detect about 70% to 80% of pre-cancers.
Let's break down the difference.
In a Pap smear, a patient undergoes a genital exam with a doctor or nurse. The clinician puts a speculum inside the patient's vagina so she can see the patient's cervix — the bottom of the uterus — and twirls a plastic brush around to collect cervical cells. Those cells are then transported to a lab, where they're evaluated under a microscope to look for abnormalities that can be an early sign of cancer.
An HPV test can be done by a doctor or a patient herself. If a doctor does it, it's similar to a Pap smear and involves a speculum exam. That's called a "clinician-collected" test. But a vaginal self-swab is exactly what it sounds like. The patient puts a swab into her own vagina to collect a sample that then is sent to a lab.
Many people prefer to swab themselves. It can feel less invasive than an exam done by a doctor, and there's no speculum, which can be uncomfortable.
The American Cancer Society's new guidelines include vaginal self-swab as a safe and accurate form of cervical cancer screening. They say anyone who has a cervix should get HPV testing between the ages of 25 and 65. If a doctor does the swab, it should happen every five years. If a patient does it herself, it's every three.
Self-swabbing is not yet widely available
In May of 2025, the Food and Drug Administration approved the first at-home kit for HPV testing. It's proprietary and can only be used through a telehealth company called Teal Health, which charges $99 in addition to billing a patient's insurance plan. Your primary care doctor can't order it for you.
That means that most patients still have to go into brick-and-mortar clinics for cervical cancer screening, even if the patients are doing the swabbing themselves. There, they could undergo either a clinician-collected test or swab themselves in a clinic restroom. At this point, not all doctors offer the self-swab option, but ask yours if they do.
I asked Perkins why I couldn't just order a vaginal self-swab test for my patients and tell them to do it at home rather than making them come in.
The answer comes down to transportation.
"Imagine you have someone in rural Texas in July [who] does their self-swab, sticks it in the mailbox. The mailbox now hits 200 degrees," says Perkins. "Then it's in the mail truck, then it gets to the lab. It has to still be valid."
As of now, Teal Health is the only company that offers a test proven to be accurate under such a wide range of circumstances.
A self-swab done in a doctor's office restroom, on the other hand, involves different equipment that will be transported to a lab right away and be kept at a stable temperature.
Even if it still means a trip to the clinic, many people prefer this to a speculum exam. It can be less painful and it can give the patient a sense of control.
Insurance often doesn't cover it
Many doctors still do Paps instead of HPV-only testing — including me! That's because HPV-only testing requires specific equipment — and even though it's better, it isn't covered by most health insurance plans.
If it's better, why won't insurers pay for it? It's mostly because HPV-only testing is not yet recommended by the U.S. Preventive Services Task Force, a government body that issues guidelines about primary care. Perkins says that the USPSTF tends to follow the American Cancer Society recommendations eventually — it just lags by a few years.
It's also worth noting that their recommendations about cervical cancer screening are currently being updated. Many experts, including Perkins, expect the new guidelines will include HPV-only testing, although it's unclear when they will be issued.
But many insurers only pay for what the UPSTF recommends, says Perkins.
Keep up your screenings in your 50s and 60s
Older women typically don't see gynecologists as frequently as patients in their peak reproductive years. These patients may miss recommended screenings, so if doctors do find cervical cancer, it tends to be more advanced.
Older women tend to have much higher mortality from cervical cancer compared to those who are younger.
Perkins is optimistic that self-swab options will eventually make cervical cancer screening more accessible for this age group.
Perkins says the older screening guidelines are also partially to blame for older women missing screenings — they're unnecessarily complicated. In those guidelines, frequency of testing follows an algorithm based on past test results, which can be hard to track down if a patient switches doctors or goes several years without care.
Perkins hopes that a move to simplified HPV-only testing will make it easier for older patients to get screened, with clinician-collected testing at age 60 and again at age 65 regardless of past results.
Dr. Gordon works at Cooper Medical School of Rowan University. She writes the Substack newsletter "Your Doctor Friend."
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