You might need fewer (or more) Pap tests than you’re getting

Who should have a Pap test and how often? What used to be a fairly straightforward question has become a little tougher to answer with new guidelines from the American Congress of Obstetricians and Gynecologists (ACOG).

Before the new guidelines, a Pap test typically was part of a woman’s annual exam, which also includes a breast and pelvic exam—two important screenings that you still need, even though you probably do not need an annual Pap test.

The best way to find out how often you should be having this important cervical cancer screening is to talk to your healthcare provider. In the meantime, here is a look at the basics of the guidelines:

  • The age at which you get your first Pap is 21.
    Formerly, women were advised to get their first Pap within three years of becoming sexually active. But HPV is a virus that leads to most abnormal Paps. Although certain strains of this virus lead to cervical cancer, most go away on their own. Your body naturally fights them off. Waiting until you are 21 gives your immune system a chance to work its magic and prevents unnecessary procedures.
  • Any woman who no longer has a cervix because of a hysterectomy (removing the cervix isn’t always part of a hysterectomy) and who has never had an abnormal pap smear doesn’t need Paps anymore. However, if you have your ovaries, you still need to have a pelvic and breast exam every year.
  • Women between the ages of 21 and 30 you need to have a pap every two years. Remember, this does not mean you can skip a yearly exam, which also includes a pelvic and breast exam, and a chance to address other female issues.
  • Around age 65-70, you may be able to stop having Paps. If you have had three normal Paps and no abnormal Paps in the past 10 years, you might be able to stop. Talk to your healthcare provider.

Running through a few examples

Suzy Q, age 40, has not had a Pap smear since she had her last child. She thinks she had an abnormal Pap time many years ago. What should she do?

Suzy Q, you need a pap smear along with an annual exam. Don’t be afraid to get back on the right track and get your annual exam, which does include a Pap, breast exam, and pelvic exam. Make sure you ask your healthcare provider about the HPV test in addition to your regular Pap smear. If you have your ovaries, you need a pelvic exam every year so that they can be checked. Or, you can get old records so we can better advise you. Also Suzy, you need to start having regular mammograms, and we can get you started on those.

Greta, age 65, wonders whether she needs to continue having regular Pap smears.

Greta, ACOG says that between ages 65 and 70, if you have had three normal Paps and never any with HPV (abnormal) in the past 10 years, maybe you can be done with Pap smears. Please talk to you healthcare provider about this.

Suzy Zinny really wants a Pap smear every year. Can she still have one?

The answer to this question is most likely yes. So far, I have not seen insurance companies say no to this test. But, as usual, I would check with your insurance company to make sure.

Zelda asks about the HPV vaccine: If I have had the vaccine, do I really need to have Pap smears at all?

The answer to this is yes, you do. The vaccine is not perfect. There is a vaccine called Gardisil and one called Cerverix. These are immunizations for the HPV virus that causes most of the abnormal Pap smears. They are recommended for girls ages 9 to 26. Gardisil is also recommended for boys ages 9 to 26. Talk to your healthcare provider about this vaccine and if it would be appropriate for you. Again, you will still need Pap smears, but you do cut down on your chances of an abnormal Pap.

Mary Poppins asks: I went to the ER for pelvic pain and they did a Pap smear in the ER.  Can I just get those results?

Very rarely does a routine Pap occur in the ER. They probably took cultures for other diseases through a procedure that mimics a Pap smear but is not a Pap smear. Usually, in the ER you may get a pelvic exam and some testing for infections like chlamydia and gonorrhea but not a Pap smear. Women often confuse the tests.

If you have questions about Pap tests — or any other health concern — you can call 317-338-4-HER to talk to a registered nurse or use this form to talk to me directly.

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