When to get a Pap smear and when it can wait
Don’t mistake a Pap test with an annual exam. Here’s what women need when.
Multiple times a day, I answer questions regarding Pap smear guidelines and when to get a Pap smear. I understand why: They are evolving and we, as women, have it ingrained in many of our minds that “we must get a Pap smear every year.”
It can sometimes seem like each time you arrive for your annual appointment, the recommendation has changed. Even more confusing is when different providers seem to give different advice. It is not uncommon for me to get referrals from non-gynecological providers who are not familiar with the current guidelines.
In 2012, international experts met to update the guidelines, based on many evidence-based studies and the results of millions of women.
Pap smear vs. annual exam
It is important to differentiate between an annual exam and a Pap smear. A Pap smear only evaluates your cervix for whether or not pre-cancerous or abnormal cells are present. The annual exam examines your whole body: breasts, ovaries, uterus, vagina and vulva. It’s a great time to discuss contraception needs, sexual health, menopause symptoms or urinary incontinence.
A yearly exam by a gynecologist is recommended for most women. Those guidelines have NOT changed. However, for most women, the interval between Pap smear screenings is longer.
Essentially all cervical cancer is caused by the human papilloma virus. HPV is transmitted through sexual contact, and is pretty universal. The chance of coming in contact with it at some point in our lives is quite high. But not everyone exposed to HPV has an affected cervix, and if HPV does cause changes in your cervical cells, this takes a long time to evolve. The chances that your body will clear the virus all on its own, without any intervention other than surveillance, is quite high.
The reason Pap smear screening is so successful and life-saving is because there is so much time to intervene between a slightly abnormal Pap and a diagnosis of cancer.
How often do most women need a Pap test?
- The first Pap should be collected at age 21, but not before. It doesn’t matter if you are sexually active prior to that age.
- Between the ages of 21 and 30, a Pap should be collected every three years. Again, you should still go each year for your annual exam.
- Starting at age 30, an additional test is added to your Pap looking for HPV. If your Pap is normal and your HPV is negative, you do not need a Pap collected for five years. But you should still see your gynecologist to have the rest of your female organs evaluated.
- After a hysterectomy, you usually don’t need a Pap smear, but you still need an annual exam.
- Most women can stop having Paps at age 65.
The guidelines will vary based on your specific history. Make sure to discuss your specific recommendations with your gynecologist, and remember, almost every woman should have a yearly appointment with her gynecologist.
This post was written by Shana Dowell, M.D., a board-certified obstetrician and gynecologist at Vanderbilt Center for Women’s Health at NorthCrest Medical Center.