We left off discussing what happens after we get the result of an abnormal pap smear.
It really depends on what the pap shows. Some abnormalities require nothing more than repeating the test in one year. And remember why that is? Because in most people, HPV is transient. That means if we give your body enough time, your body will clear the virus on its own.
We now have the technology of performing HPV testing. Some physicians do HPV testing only if the pap is abnormal (called reflex testing). Others do the HPV test automatically with the pap smear (called co-testing). And still others only check for HPV types 16 and 18 (remember from my last blog, these are the two most dangerous subtypes).
Some pap findings, however, require further testing, typically in the form of colposcopy. Colposcopy is the technique of looking at the cervix with a big magnifying glass and taking biopsies and a scraping inside the opening, if indicated. The results of colposcopy then dictate the decisions we make regarding treatment.
Now, on to the guidelines…
Pap smears should start at 21 years of age.
In women 21 – <30, cytology (pap smears alone) should be done every 3 years if negative.
In women 30-65, cytology alone should be done every 3 years if negative OR every 5 years if negative cytology and HPV co-testing.
Remember, these are guidelines only. In women with a history of abnormal pap smears, unusual symptoms, or other medical conditions, we may deviate from these recommendations. Also, women who have had a hysterectomy (with removal of the cervix) for benign reasons may not continue to get pap smears at all. Many women want to continue to get annual pap smears. Insurance is currently still paying for this. As I stated in my first blog, we try to be respectful of your choices, and as long as you know the recommendations, we will be open to your wishes.
After these basic guidelines, things get quite convoluted. We will discuss your particular result with you and explain the next step, as each patient’s situation is unique.
An important point to remember is that even if you follow these guidelines and do not get an annual pap smear, you still need to see your gynecologist every year. We discuss preventative care, examine your breasts and your pelvic organs, discuss contraception and bone health, and refill medications, among other things.