Attractive Hispanic Mother and Daughter Studio Portrait.This question comes up a lot. (And it is usually Mom asking the question and not the daughter.) If there is some confusion about the initial pap, it is no wonder. The recommendations keep changing. Moms often believe the first pap should be at age 16 or 18 and every year after that.

Actually, the current recommendations advise women to start pap tests at age 21 and not before. Being sexually active has no bearing on age of first pap; it is still 21.

And here is why. Abnormal pap tests are caused by the pesky human papilloma virus. And the body is able to clear the virus very often. In fact, after 18 months, 65% of women will clear the virus and after 36 months, 75% will have resolution of HPV.

What about the woman who doesn’t clear the virus? When HPV persists, it requires many years to turn to cancer. Advancing abnormalities of the cervix don’t peak until the late 20’s. More than 10 years are needed for the abnormality to become invasive. So regular screening, even at the longer intervals, will pick up these abnormal changes.

And we know now that over-screening (doing too many paps too early) has consequences. There are emotional effects that come with labeling a young woman with a sexually transmitted infection like HPV. It affects self-image and sexuality. Some of the more invasive treatments (like LEEP) can possibly increase risk of preterm birth when the woman becomes pregnant in the future. Any invasive procedures carries risks like infection. And treatments are expensive.

The American College of Ob/GYNs (ACOG) states “Screening women under 21 may be harmful and lacks benefit. Don’t begin until 21, regardless of age at first intercourse.”

After 21, ACOG guidelines recommend pap tests every two years until age 30. Other groups, like the American Society of Clinical Pathology, recommend a pap test every three years from age 21 to 30.

From 30 to 65, a woman can have a pap every three years or a pap test + HPV test every five years. Women over 65 who have a history of normal pap tests do not need any further paps.

Keep in mind…A pelvic exam does not always include a pap test. Women seen in the emergency room for gyn problems often report that a pap was done in the ER. In fact, pap tests are never part of an ER exam.

A pelvic exam is advised when a woman becomes sexually active, even if she is under 21.

A pap test is a screening test for cervical cancer. It does not provide information about chlamydia, gonorrhea, herpes, HIV or other sexually transmitted infections. If there is concern about sexually transmitted infections or a woman wants to be screened, she will need separate tests apart from the pap test. These can be done at the same visit.

Women are more than their cervix. A regular health exam is important in maintaining wellness and for disease prevention. We have become zealous about our pap test and sometimes over-zealous. But the number one killer of women is not cervical cancer. It is heart disease. Regular exams are important as we track our weight, blood pressure, cholesterol. Just because we don’t need pap tests every year doesn’t mean we should not have regular exams.