Do I Really Need a Pap?

I’ve heard this question over and over again as a women’s health provider. Women usually ask this question because we’re hoping to avoid getting undressed, feeling physical or emotional discomfort, and dealing with “that cold thing”: the speculum. There’s plenty of good news in the form of scientific evidence for women who feel this way. The bad news is that women who diligently show up for their well-woman exams are still getting too many Pap Smears.  Some doctors and women’s health practices have been slow to adopt updated recommendations, sticking to the old given of a Pap every year. In reality, most women don’t need a yearly Pap or even a yearly pelvic examination. Read below for information according to your age.

Are you in your teens or twenties?

Pap Smears should not be started until a woman turns 21, regardless of sexual activity. This doesn’t mean that young women shouldn’t have regular checkups. Screening for sexually transmitted diseases is critical for sexually active women in their teens and twenties, and these tests aren’t included in a Pap. A painless urine sample can check for some of the most common infections. Other issues to be addressed at the yearly exam include screening for violence, eating disorders, weight concerns, and a review of birth control options. All young women should know what to do in the event of a broken condom or an act of sexual violence. Savvy women’s health providers talk ahead with their young patients about future fertility plans (or lack thereof). All reproductive-age women should get enough folic acid to reduce the risk of neural tube defects, and be aware of lifestyle factors that could impact their ability to become pregnant. From toxic exposures to toxic stress to obesity, there’s more to think about than there used to be.

Are you a midlife woman?

More controversy. Just last year, the American College of Physicians (ACP) recommended against routine yearly pelvic exams in the absence of specific symptoms or pregnancy. This advice applies to all age groups. The American Congress of Obstetricians and Gynecologists (ACOG) disagrees, but admits there is no compelling evidence for or against pelvic exams in asymptomatic, low-risk patients. The bottom line: it’s between you and your women’s health provider.

Pap screenings (cytology) can be done every 3 years as long as results are normal. Women over 30 can be screened every 5 years if HPV testing is obtained with a Pap and is negative. Too many Paps lead to unnecessary procedures, causing anxiety and expense. On the other hand, women with a history of Pap Smear abnormalities, HPV infection, or outright gynecological cancer must be diligent about keeping follow-up appointments and shouldn’t postpone tests and treatments.

Feeling burned out or chronically exhausted seems to be epidemic in midlife women. Be aware of changes in your body and report them at your visit, even if you’re not sure that they’re important. If your breasts feel different, say so. If you’ve had abdominal pressure, bloating, or changes in bowel or bladder habits, speak up! Many factors including stress can trigger these symptoms, but so can potentially deadly conditions like ovarian cancer. Don’t accept statements that dismiss your concerns such as, “it’s all in your head” or “this is normal in a woman your age”. Be persistent until you are satisfied that you’ve been heard.

Are you menopausal?

Pap Smears can be discontinued at age 65 for most women. If you have a history of gynecological cancer, ask for recommendations tailored to you. Clinical breast exams should be continued. Your women’s health provider should ask about bladder and bowel function and whether you have concerns about intimacy or intercourse. She should also assess your risk for osteoporosis, cardiovascular disease, and other age-associated conditions. Evaluating mood, sleep, and memory are important, with a fine-tuned awareness for early signs of dementia. See my prior post about menopausal brain fog if this concerns you; it should be reassuring to most readers.

As always, consult your trusted women’s health provider for individualized care recommendations.

Leave a Reply