Lately, I have noticed a number of my patients asking about when it would be time to bring their adolescent daughters in for their first GYN visit. The old recommendation of onset of sexual activity, or age 18, for the first PAP smear, is no longer recommended. Why the change? Our understanding of the virus that causes precancerous and cancerous changes to the cervix, human papilloma virus, or HPV, has expanded in the last few years. We now recognize that exposure to HPV is extremely common with the onset of sexual activity, and that evidence of these changes is routinely seen in sexually active adolescent girls. We have also learned that in the majority of cases, the immune system controls the virus over time, and these changes to the cervix revert to normal.
In the past, these young women would get PAP smears, which would come back abnormal, and the physician would then treat the abnormality. In a small percentage of these women, there would be permanent damage to the cervix, resulting in premature delivery and miscarriage. The majority of these same women, if left untreated, would have seen the changes on their cervix revert to normal over the next few years.
Some of you may be asking, “Yes, but what about the rare woman who’s cervix does not revert to normal, and progresses to a more serious lesion? Aren’t you going to miss that?”. That possibility has been taken into consideration, and the recommendation that women get their first PAP at age 21 is specifically to identify the rare woman who does not revert to normal. “Is that soon enough?”. Current estimates are that it can take 7-10 years for a precancerous lesion to progress to malignancy, making age 21 more than an adequate amount of time for identification of a precancerous lesion.
Some caveats. Although the average young women can avoid a pap smear until they are 21, there are a number of other reasons that one might need a pelvic exam, particularly if she is experiencing any problems. A visit to a gynecologist at a young age is often beneficial for a young woman for STD screening and education, birth control discussion, and general education about puberty and sexuality. Finally, the PAP smear recommendations are for the typical patient, and do not apply to certain individuals, such as those with HIV, or other immune disorders. Always check with your own gynecologist for specific recommendations for your own situation.