DEAR MAYO CLINIC: At what age should a teenage girl have her first Pap smear and gynecologic exam? Should this be done by a pediatrician or another provider?
ANSWER: Pelvic exams and Pap smears are not necessary in healthy, adolescent girls who are not sexually active and who do not have gynecologic symptoms or other concerns. The recommended age for young women who have not previously needed a Pap smear to begin having the test is 21. Primary care providers, such as those in family medicine or internal medicine, can perform that exam, or a gynecologist can perform the exam.
In the past, many health care providers used to recommend that teens have a Pap smear at 16 or 18. Now, however, the American College of Physicians does not recommend any routine gynecologic exams for teens at low risk of having the HPV or other sexually transmitted infections.
The purpose of a Pap smear — a procedure that collects cells from the cervix — is to check for changes in those cells that could be a sign of cancer and look for the presence of high-risk types of HPV that are known to cause cervical cancer.
HPV is the most common sexually transmitted infection in the U.S. Although most cases of HPV do not cause symptoms or lead to problems, certain strains of the sexually transmitted HPV are considered high risk, and can lead to cancer and potentially be deadly if left untreated. Two strains of the virus cause 70 percent of all cervical cancer. You can greatly reduce your risk of HPV infection and cervical cancer by getting the HPV vaccine. This anti-cancer vaccine most effectively builds immunity when it’s given between ages 9 and 14.
If you are not sexually active as a teen, in most cases there is no need for a Pap smear because your risk of cervical cancer is low, and you have no risk of HPV or other sexually transmitted infections. Once you begin having sex, a Pap smear may be appropriate. But even in many of those situations, Pap testing still may not need to begin until 21.
Traditionally, some health care providers required a pelvic exam — an evaluation of the vulva, vagina, cervix, ovaries, uterus, rectum and pelvis for any abnormalities — before they would prescribe contraceptives. Again, that is no longer the case. A pelvic exam is not needed to obtain birth control. For most healthy women, the first pelvic exam also can wait until 21.
For young women whose medical history puts them in a higher risk category for infection or cancer, a Pap smear or pelvic exam may be recommended at an earlier age. Those risk factors include a weakened immune system due to chemotherapy, organ transplant or long-term corticosteroid use; exposure to the medication diethylstilbestrol, also known as DES, before birth; and HIV infection.
Some symptoms also may trigger a pelvic exam, such as heavy, painful periods; pelvic pain or pressure; abnormal bleeding or discharge; and itching, pain or lesions in the vulva or vagina. In those situations, a pelvic exam may be necessary, but a Pap smear typically is not required.
When it is time to get a pelvic exam and Pap smear, it’s best to work with a health care provider you know and trust. Before the exam, ask your health care provider about what will happen during the exam and what you can expect. Some providers have anatomical models they can use to describe the procedures beforehand, so you can clearly see what will happen. These procedures are important exams, but they need not be a source of anxiety or fear. If you have questions or concerns, talk to your health care provider. — Dr. Sally Ann Pantin, Family Medicine, Mayo Clinic, Jacksonville, Florida