Pap Smear After Hysterectomy: Who Still Needs Cervical Screening

ByThe PartialHysterectomy.net Editor

Whether you still need Pap smears after a hysterectomy depends on two questions: was your cervix removed, and have you ever had cervical precancer or cancer? If the cervix was taken out and the surgery was for a benign reason such as fibroids, endometriosis or heavy bleeding, U.S. guidelines say you can stop cervical cancer screening altogether.[1][2][3] If your cervix is still there, or you have a history of high-grade cell changes, screening continues. This guide explains each situation, how to find out what was removed, and what still matters for your health after surgery.

The short answer, by situation

  • Cervix removed, surgery for a benign condition, no history of high-grade precancer: no more Pap or HPV tests are needed.[1][2][3]
  • Cervix kept (supracervical or “partial” hysterectomy): keep screening on the same schedule as any woman your age.[3]
  • History of CIN 2, CIN 3, adenocarcinoma in situ (AIS) or cervical cancer: testing continues, using cells taken from the top of the vagina, usually for many years.[1][5]
  • Not sure which of these applies to you: do not stop on your own. Check your operation records or ask your gynecologist first.

First, find out whether your cervix was removed

Many women are not sure exactly what was taken out, and the word “partial” adds to the confusion. Doctors use “partial” or “supracervical” hysterectomy to mean the uterus was removed but the cervix was left in place. Some people, though, say “partial” when they mean the ovaries were kept, which is a different question. Our guide to partial vs total hysterectomy explains the terms in detail.

Three reliable ways to check:

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  • Your operative report and pathology report. The pathology report lists every organ the lab received and examined. You can ask the hospital or your surgeon’s office for copies, or look in your patient portal.
  • Your gynecologist. A short look with a speculum shows whether a cervix is present or whether the vagina ends in a closed, healed top (the vaginal cuff).
  • Why the surgery was done. Ask whether it was for a benign condition or for precancer or cancer of the cervix. This matters as much as what was removed.

Total hysterectomy for a benign condition: you can stop

A Pap smear looks for abnormal cells on the cervix, and an HPV test looks for the high-risk types of human papillomavirus that cause almost all cervical cancers. Once the cervix is gone, there is no cervix left to develop cancer. That is why the U.S. Preventive Services Task Force recommends against screening women who have had a hysterectomy with removal of the cervix and who have no history of a high-grade precancerous lesion or cervical cancer.[1] A draft update the Task Force published in December 2024 keeps the same advice.[4] The American Cancer Society and the National Cancer Institute say the same in plain terms: after a total hysterectomy done for reasons other than cancer or precancer, you no longer need cervical cancer screening.[2][3]

You may wonder whether a test of the vagina is still worthwhile “just in case.” Cancer of the vagina does exist, but it is rare: it makes up only about 1% to 2% of cancers of the female genital tract.[8] Routine testing in women at low risk finds very little and can lead to false alarms, extra procedures and worry. Despite this, many women keep being tested. A CDC analysis found that 58.7% of U.S. women aged 30 and over who had had a hysterectomy reported a Pap test in the previous three years in 2010, down from 73.3% in 2000.[7] An earlier study in JAMA came to a similar conclusion: a large share of women without a cervix were still being screened.[6]

If your doctor still offers a Pap after a total hysterectomy, it is reasonable to ask why. There may be a good reason in your history that you did not know about, or it may simply be habit.

Cervix kept: keep screening as before

After a supracervical (partial) hysterectomy, your cervix can still develop precancer and cancer like any other cervix, so routine screening continues.[3] This type of operation is often done by keyhole surgery; our guide to laparoscopic hysterectomy covers how it differs from removing the cervix.

Your schedule is the same as for women who never had surgery. The two main U.S. guidelines differ slightly:

  • American Cancer Society: from age 25 to 65, an HPV test every 5 years is preferred. An HPV test plus Pap (co-testing) every 5 years, or a Pap alone every 3 years, are acceptable.[2] Since late 2025 the ACS also accepts an HPV sample you collect yourself with a vaginal swab, repeated every 3 years if negative.[9]
  • U.S. Preventive Services Task Force: a Pap every 3 years from 21 to 29; from 30 to 65, a Pap every 3 years, an HPV test every 5 years, or both together every 5 years.[1] The December 2024 draft update would make the HPV test, collected by you or by a clinician, the preferred choice from age 30.[4]

Some women with a remaining cervix also have light monthly spotting after a supracervical hysterectomy, because a small amount of lining can remain at the top of the cervix. That is a known effect of the operation, but any new or heavier bleeding should still be checked.

Hands in pink gloves spreading a sample from a thin blue brush onto a glass slide on a white table, next to a second brush and a sample container with a blue lid
In a traditional Pap smear, cells collected with a small brush are spread on a glass slide for the lab. Today most samples go into a vial of liquid instead, and the same sample can be tested for HPV.

History of precancer or cervical cancer: testing continues

If you have ever had a high-grade abnormality of the cervix (CIN 2, CIN 3, also called HSIL, or adenocarcinoma in situ), the risk does not fully disappear with the cervix. Abnormal cells can rarely return in the upper vagina. For this reason the 2019 ASCCP guidelines, which U.S. gynecologists use to manage abnormal results, recommend:[5]

  • If the hysterectomy itself was the treatment for the abnormal cells: three HPV-based tests, one a year, for three years.
  • After that, and for anyone treated for CIN 2, CIN 3 or AIS: HPV-based testing every 3 years for 25 years, whether or not you have had a hysterectomy.
  • Once those 25 years have passed with normal results, routine screening is generally no longer needed.

Without a cervix, the sample is taken from the top of the vagina, using the same speculum and brush. If you had a LEEP or other treatment for cervical dysplasia at any point, even years before your hysterectomy, tell your gynecologist, because it can change your follow-up plan.

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If you had a hysterectomy for cervical cancer, follow-up is planned by your cancer team and is not the same as routine screening. Our article on radical hysterectomy for cervical cancer explains the treatment and what comes after.

Stopping at 65 if you still have a cervix

Both guidelines let women with a cervix stop screening after 65, but only after a run of normal results. According to the American Cancer Society, you can stop at 65 if your last two HPV tests or co-tests were normal, or your last three Pap tests were normal. If your screening history is unknown or incomplete, keep going until you have that record.[2][9] The ACS also notes that people with a history of cervical precancer may need a different plan.[2]

What still matters after you stop Pap smears

Stopping cervical screening does not mean stopping gynecologic care. Regular check-ups are still the place to talk about menopause symptoms, bladder and pelvic floor problems, sexual health, bone health and breast screening. If you kept your ovaries, they can still develop cysts and other problems; see our guide to ovarian cysts after hysterectomy.

See your doctor promptly, without waiting for a routine visit, if you notice:[10]

  • Vaginal bleeding once you have healed from surgery, especially after sex
  • Unusual vaginal discharge
  • A lump or mass you can feel in the vagina
  • New pain during sex, or ongoing pain in the pelvis or lower belly

These symptoms are much more often caused by something harmless, such as an infection or thinning of the vaginal tissue after menopause, but they should always be checked. Our article on vaginal cancer after hysterectomy has more detail.

Frequently asked questions

I had a total hysterectomy for fibroids. Why did my doctor do a Pap anyway?

Ask. Sometimes there is a reason in your records, such as an old abnormal result you may not remember. If there is no history of high-grade cell changes, current U.S. guidelines say the test is not needed.[1][2]

Does a hysterectomy get rid of HPV?

Not necessarily. HPV infects the skin of the genital area, including the vagina, not only the cervix. That is why women with a history of high-grade changes keep being tested after surgery. For women without that history, the risk of a problem in the vagina is low enough that routine testing is not recommended.[1][5]

I don’t have my records and my old doctor retired. What should I do?

Contact the hospital where you had surgery for your pathology report. If that is not possible, a gynecologist can usually tell from an exam whether you still have a cervix. Until you know, it is safer to keep screening than to stop.

Can I do the self-collected HPV test if I have no cervix?

Self-collection was approved and studied as a screening test for women who have a cervix and are at average risk.[9] If you need follow-up testing because of past precancer, your clinician will take the sample during an exam. For more questions about surgery and recovery, see our hysterectomy FAQ.

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Sources

  1. US Preventive Services Task Force; Curry SJ, Krist AH, Owens DK, et al. Screening for cervical cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018;320(7):674–686. uspreventiveservicestaskforce.org
  2. American Cancer Society. The American Cancer Society guidelines for the prevention and early detection of cervical cancer. cancer.org
  3. National Cancer Institute. Cervical cancer screening (Pap and HPV testing). cancer.gov
  4. US Preventive Services Task Force. Draft recommendation statement: Cervical cancer: screening. December 10, 2024. uspreventiveservicestaskforce.org
  5. Perkins RB, Guido RS, Castle PE, et al. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. Journal of Lower Genital Tract Disease. 2020;24(2):102–131. pubmed.ncbi.nlm.nih.gov
  6. Sirovich BE, Welch HG. Cervical cancer screening among women without a cervix. JAMA. 2004;291(24):2990–2993. pubmed.ncbi.nlm.nih.gov
  7. Centers for Disease Control and Prevention. Cervical cancer screening among women by hysterectomy status and among women aged ≥65 years — United States, 2000–2010. MMWR. 2013;61(51). cdc.gov
  8. American Cancer Society. Key statistics for vaginal cancer. cancer.org
  9. Perkins RB, Wolf AMD, Church TR, et al. Self-collected vaginal specimens for human papillomavirus testing and guidance on screening exit: an update to the American Cancer Society cervical cancer screening guideline. CA: A Cancer Journal for Clinicians. 2026;76(1):e70041. pubmed.ncbi.nlm.nih.gov
  10. American Cancer Society. Signs and symptoms of vaginal cancer. cancer.org

This article is for general information and is not a substitute for medical advice. Screening needs depend on your surgery and your history of abnormal results, so always confirm your own plan with your gynecologist or doctor, and contact them or emergency services if you are worried about any symptom.

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