To Pap, or Not to Pap...

When I was in medical school (not THAT long ago), there was no question about when women should get Pap smears. We knew that this valuable test to screen for cervical cancer saved lives, and every woman should be tested at her annual exams. Subsequently, we learned that all cervical cancer comes from HPV- the Human Papilloma Virus, which is transmitted by intimate skin-to-skin contact, primarily through sex. With that knowledge, we modified the Pap requirements to only those women who had become sexually active.
Now we know that the majority of HPV infections occur upon initiation of sexual activity, and that most of these infections are cleared by the immune system within a couple years, and do not result in cancerous changes. We also realize that invasive cervical cancer is very rare in women younger than 21, and so the current guidelines tell us that women should start having Pap smears when they turn 21 (and have had intimate relations.)
Happily, we also have vaccines to help our immune systems fight off the HPV more effectively, so with Gardasil and Cevarix immunizations, we should be seeing even less cervical cancer!
What if you are over 21? Women aged 21-29 without high risk factors (HIV, organ transplant patients, DES exposure or previous abnormal Pap smears that showed early cancerous changes) should get screening Pap tests every other year in their twenties, and every third year beyond their 30's.
Women over 30 will be tested with both the traditional Pap test and a specific test that checks for the strains of HPV that cause cancer. If you test positive for these high risk strains, your screening will be more frequent (annually.)
When can we STOP? By 70, if you have had a decade of normal results, you are done. Yea!
BOTTOM LINE: Pap tests do not need to be an automatic part of your annual pelvic exam- but YOU STILL NEED ANNUAL PELVIC EXAMS to check for sexually transmitted diseases and other gynecologic concerns (ovaries, etc.)

Does PAP = "Pelvic" ?

You may be aware that in 2010, the recommendations for Pap smears (to detect cervical cancer) have changed. Many women grew up being told that they should have a Pap smear once they started menstruating, or perhaps before they head off to college. It turns out, what MATTERS is simply whether or not you have had sex.

Cervical cancer is caused by a virus- the human papilloma virus, or HPV for short. We know that the vast majority of people who have sex will at some point in their life be infected with HPV. Certainly, the more partners you have, the higher the risk of contracting it. If two people are together, and neither has ever had their clothes off and been intimate with anyone else, there should be no risk of HPV. Otherwise, even if only one partner has had previous intimate contact with another person, there is risk, and most of the time this is a silent disease.

The GOOD news is that most people who are infected never develop adverse consequences. The BAD news is that over a million Americans see their doctors for genital warts each year, and that 12,000 women per year develop cervical cancer (not to mention the other cancers also caused by HPV.) More GOOD news, though- we have vaccines that can help. Gardasil protects against the strains that cause 90% of genital warts (types 6 & 11) and those that cause 70% of cervical cancers (types 16 & 18). Cevarix protects against the cancer causing strains as well.

So, back to the Pap smear. Yes, we recommend them, and the timing has changed (first Pap now recommended at age 21.) However- this is ONLY the recommendation for PAP SMEARS that screen for cervical cancer. If you wait several years to get ANY pelvic exam, and you have had new sexual partners, you risk developing complications from numerous other sexually transmitted diseases such as chlamydia, gonorrhea, trichomonas, syphilis, HIV and herpes.

BOTTOM LINE: MOST SEXUALLY TRANSMITTED DISEASES can be SILENT, so do not wait till it's time for your Pap smear to get a pelvic exam and/or get tested (which may only be a urine and blood sample)!