Study objectives: To determine the feasibility of Pap screening and follow-up of urban emergency department patients and the prevalence of cervical dysplasia and carcinoma in this group. Design: During a four-month period, Pap smears were added to pelvic examinations performed in the ED. Follow-up, including repeat Pap smear or biopsy, was attempted on all abnormal smears. Setting: Urban county hospital-based ED. Interventions: Pap screening and follow-up. Results: Dysplasia was present in 8% of screening Pap smears. Eighty-two percent of patients with dysplasia on screening Pap smear returned for follow-up. Four percent of screened patients received a confirmed diagnosis of CIN 1 or more following repeat Pap smear or biopsy. Two invasive cervical cancers were identified. Conclusions: There is a high prevalence of cervical dysplasia among women screened with Pap smears in an urban ED. Routine Pap screening in urban EDs can be an important component of cervical cancer control programs for high-risk women.