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How often do I really need a Pap smear?

Speculating on how often you need to embrace the speculum? Even if you’ve been having Pap smears for years, new recommendations could mean changes to the way you should be getting tested. 

As personal as a Pap smear is, many women know surprisingly little about why they’re necessary or how often they should have one. So let’s start at the beginning. 

We sat down with Dr. Jennie Hauschka, a gynecologist at Tryon Medical Partners, to understand Pap smears and what to do when you get that call from your physician about irregular results.

What is the purpose of a Pap smear?

“The Pap smear is a screening test for cervical cancer. We collect cells from the cervix to test them and see if the patient has risk factors that increase the chance of cervical cancer in the future” Dr. Hauschka says. “It’s a way for us to see very early changes in cervical cells that could turn into cancer 10-15 years in the future.”

Cervical cancer was much more common in the 1940s-1950s before this test existed. There was often no way to detect cervical cancer until it was more advanced. Through a Pap smear, the early indicators of this slow-growing cancer can be found and monitored to make sure it never becomes cervical cancer. 

When can I start (and stop) getting Pap smears?

The short answer: your first Pap smear at age 21 and your last between ages 65 and 70.

Years ago, recommendations called for women to start getting Pap smears when they became sexually active or turned 18. This resulted in many women being called back into their doctor’s offices for unnecessary tests and procedures. 

Now, since doctors know more about HPV (human papillomavirus), the recommendations have been tailored to the patient’s age and risk factors. HPV is the most common sexually transmitted disease, which can cause genital warts and changes in cervical cancer cells that can result in cervical cancer. 

“Many women feel shame or embarrassment when they are diagnosed with HPV, but really everyone gets exposed at some point,” Dr. Hauschka says. “About 90% of people will have an HPV strain at some point in their lives. It’s one of those things that’s out there like the cold virus. This is a minor thing we follow and means nothing about the patient or her sexual activity. It won’t affect future fertility or the ability to have a normal sex life.”

HPV infections typically clear on their own in two to three years. This is why today, Pap smears are not recommended until age 21. Women can also stop getting Pap smears around age 70.

Can I stop getting Pap smears if I’m not sexually active or only have one partner?

No matter a woman’s sexual history, she should be getting Pap smears regularly between the ages of 21 and 70. Women who have not yet become sexually active are at lower risk of having HPV, but the virus can still be spread through other sexual activities. 

Even if women have stopped being sexually active or only have one consistent partner, Pap smears should continue as HPV can stay dormant in the body and become active later in life. 

How often should I get a Pap smear?

New recommendations suggest that women should get a Pap smear every three to five years unless they have had an abnormal Pap smear. Once a woman has had an abnormal test, she should have annual Pap smears for the next 20 years to monitor. 

“Plan to visit your gynecologist annually, but a Pap may not be necessary every year,” Dr. Hauschka says.

What if my Pap smear results come back as abnormal?

Abnormal results on a Pap smear mean the test has detected cells that could eventually develop into cervical cancer. Of all Pap smears, five to 10 percent will come back as irregular. The main thing to remember: “Don’t freak out,” Dr. Hausschka says. 

“On a worry scale of one to 10, this is a two. Come in for the additional testing, let a doctor explain it to you and it’s all going to be fine! It should not be on your mind or cause you any worry. Very few people make it through their reproductive years without having an abnormal Pap smear.”

After irregular Pap smear results, your physician will recommend that you come back to repeat the test or have a colposcopy. During a colposcopy, a physician uses a microscope to view the irregular cervical cells. Rarely, a LEEP procedure (loop electrosurgical excision) is performed to achieve a larger cervical biopsy. Most often, the cell changes are mild and you will just resume annual Pap smears to monitor for any further abnormalities.

Which of my doctors should perform a Pap smear?

Internal medicine and family physicians can perform your Pap smear if you are comfortable with them doing so. However, if you’ve had an abnormal Pap smear in the past, a gynecologist is best suited to perform your Pap smear and gynecological care, Dr. Hauschka says.

By discussing your health history with a trusted gynecologist, together you can create the best plan for your Pap smear testing. With a physician from an independent practice like Tryon, the focus is on you, the patient. Begin the patient-doctor relationship that will result in your best health today.