The Guidelines May Have Changed, But Annual Exams Still Prudent

“I’ll see you next year for your pap smear.” This is a phrase I have said many times, in the past as I completed a woman’s annual gynecologic visit.

As women, most of us were taught as teenagers that the key to taking care of our gynecologic health was to get our annual pap smear. However, in December 2009, the American College of Obstetricians and Gynecologists published new guidelines for pap-smear screening that changed the recommended interval of screening and made many women question—do I still need my annual visit?

The revised guidelines recommend initiating pap smear screening at age 21. Pap smears are then performed every two years for women aged 21-29 years. Women age 30 years and older, with three consecutive normal pap smears and no history of treatment of moderate or severe dysplasia of the cervix or uterine or cervical cancer, may be screened every three years with a pap smear.

The decision to extend the pap smear screening interval requires a careful review of a woman’s pap smear, gynecologic and medical history by her physician. Pap smear screening can be discontinued at age 65 if the patient has had three consecutive normal pap smears in the past decade.

Why did the guidelines change? In short, because we have learned so much about what causes abnormal pap smears and cervical cancer. Exposure and infection with the human papillomavirus, a sexually transmitted virus, is the essential factor in the development of abnormal pap smears and ultimately, cervical cancer. Knowledge of the process and timeline over which this development occurs has resulted in the new guidelines and the extension of the pap smear interval for many women.

So… do I still need my annual visit? Absolutely.

The pap smear only gives information about the health of the cervix. The annual gynecologic exam is an assessment of a woman’s health with a focus on the breast and pelvic exam. The pelvic exam remains an important part of the annual exam. Although the pap smear may not be necessary each year, a thorough assessment of the pelvic organs can give information about conditions such as ovarian cysts, uterine fibroids and prolapse.

The annual exam is also an excellent opportunity for preventative health maintenance. Depending on a woman’s stage of life, issues such as STD screening, safe sex practices, contraception, pre-conceptual counseling, breast health, bone health and exercise and nutrition are addressed. Most importantly, the annual exam also gives a woman the opportunity to address concerns that she has about her own health including abnormal periods, incontinence, sexual difficulties and menopausal symptoms.

The change in the pap smear guidelines may take some getting used to for most of us women whose mothers and physicians taught us to get our pap smear every year. However, the importance of the annual gynecologic exam has not changed. So after years of telling patients that I would see them next year for their pap smear, I have changed my wording. “I’ll see you next year for your annual exam.”

- Mary Parks Lamb, M.D.