Cervical cancer remains a public health problem in developed countries. Early detection of both premalignant lesions and cervical cancer through an appropriate screening programme may decrease its incidence and mortality. High rates of participation are essential to ensure the desired impact on the population. The aims of this study were to assess the use of Pap smears in Spain in 2009 to identify factors associated with screening adherence (predictors) and assess the trend from 2003 to 2009. We included women surveyed in the European Health Interview Survey for Spain. Cervical cancer screening included self-reported Pap smears over the last 3 years. The target age range was 25–64 years. The following independent variables were analysed: sociodemographic variables, chronic conditions, and lifestyle. Predictors of Pap smear adherence were explored using multivariate logistic regression. The screening coverage in the target population was 66.1% (95% confidence interval: 64.8–67.4). Undergoing Pap smears was associated positively with the following: being married, higher levels of education and income, having visited a general practitioner in previous weeks, and suffering from musculoskeletal disease. Belonging to an older age group (55–64 years) and obesity were associated with nonadherence to Pap smears. We did not find significant differences when we compared cervical cancer screening adherence over time since 2003. Adherence to cervical cancer screening in Spain does not seem to be improving. An effort must be made, and the implementation of population-based programmes instead of opportunistic screening could be considered, to recruit women who are less likely to undergo screening.