How Often Do You Need a Pap Smear? A Pelvic Exam?

 The Low Down on What’s Down Below!

Aviva Romm, Physician, Midwife, Herbalist

Sun, 03/18/2012 – 11:08

The times are a-changing ladies! Routine annual pelvic exams have been thrown out the window because they are virtually useless, and as of last week, paps are now recommended only every 3-5 years if you have a normal pap/HPV history.  And no paps before age 21 — ever!

The aim of pap smears is to identify high-grade precancerous cervical lesions and early-stage asymptomatic invasive cervical cancer. They can be very effective for this. But until recently, we were told we needed a pap annually, from the first time we opened our legs for a gynecology appointment in our teens or early 20s, until in our 60s. The awkward annual ritual of feet in stirrups followed by cervical scraping and probing fingers was believed to be a critical life-saving part of our all-important annual gynecology exams. In reality, for most of us, it wasn’t. And for many, more harm was done than good.

For decades, those of us challenging the ob-gyn status quo, particularly midwives, observed an alarming phenomenon: many young women who’d previously been subjected to LEEP procedures and Cone biopsies to burn, freeze, or cut out potentially pre-cancerous cells after “a bad pap” (Note: false positives were notoriously high with the older version of the pap smear) went on later to have difficulty with cervical dilatation during labor when they had babies. This was due to cervical scarring and stenosis as a result of the forementioned procedures. Many of these women ended up with cesareans because of “failure to progress” as a result. The failure was not in the women at all, but in an imperfect and often over-zealous gynecology system that tended to slash and burn first, ask questions later. I’d like to think the intentions were good, and some were, but big money has been made in the name of cancer prevention.

Well, ladies, it seems that in the past few years, someone’s been asking better questions and the low-down on pap and pelvics has been changing, practically in front of my very eyes. It’s about time!

First, a few years ago, the relationship between invasive cervical procedures and later problems with childbirth was recognized and acknowledged, along with the fact that most women under the age of 21 will spontaneously revert to a normal pap and will naturally clear the HPV virus (several strains of which are associated with cervical cancer) without any treatment. The risk of the pap leading to an invasive procedure leading to later childbirth problems outweighed the benefit of the pap — so women under 21 years of age, even if they’ve had a prior “bad pap” were told not have another pap until after their 21st birthday.

At around the same time The US Preventative Task Force (USPTF), the group that makes guidelines for medical practices, determined that paps every 2 years for women 21-29, and every 3 years for women 30-65 were adequate for early detection of cervical cancer, providing a history of normal paps and negative HPV viral testing. Then, somewhere in between, a solid evidence based review of the literature demonstrated  that annual pelvic exams were obsolete in generally healthy people. They just didn’t provide enough useful information to justify being done.

And now the latest. The USPTF released a bulletin on March 12, 2012 stating that:
Screening women ages 21 to 65 years every 3 years with cytology [pap smear] provides a reasonable balance between benefits and harms. Screening with cytology more often than every 3 years confers little additional benefit, with large increases in harms. HPV testing combined with cytology (co-testing) every 5 years in women ages 30 to 65 years offers a comparable balance of benefits and harms, and is therefore a reasonable alternative for women in this age group who would prefer to extend the screening interval. 

So gals, you can stop worrying about the shave and a haircut, and your Sunday best panties every time you go in for your annual physical (and frankly, that might not be entirely necessary either) Most of you will be keeping your britches on. Of course, if you have concerning symptoms such as abnormal vaginal bleeding, signs of infection, a history of highly suspicious cells on your past paps, or persistent HPV, speak with your primary care provider about appropriate screening and follow-up. Cervical cancer screening is an effective tool for detecting cervical cancer. When used appropriately, the benefits outweigh the harms. Overused, the harms outweigh the benefits.

To summarize:
Under Age 21: no pap smear, no HPV testing
Age 21-29 Pap every 3 years
Age 30-65 Pap + HPV every 5 years

Details and full report at: