Annuals and New PAP Smear Guidelines

All of us have been touched in some capacity by cancer. Regarding cervical cancer, public education programs and PAP smear screenings have us on the victorious side of prevention. It is understandable that given years of education to women on the importance of annual cervical cancer screenings, there is confusion and concern over the newer guidelines.

First, let me say that the changes in cervical cancer screening recommendations are very well founded in significant advances in our technological capability. These recommendations are more than just a financial analysis of societal cost/benefit ratios (dig at conflicting breast cancer screening guidelines). Our newer technologies allow us to perform sensitive testing for Human Papilloma Virus (HPV) strains that are causative in the development of cervical cancer. If a woman has normal appearing cells, and she is free of high-risk strains of HPV, her risk of developing a cervical cancer is almost zero over the next few years. Second, let me emphasize that the PAP smear is only one aspect of care given at an annual exam and women should continue to have a yearly preventive check-up with their gynecologist. With that in mind, the newer PAP smear guidelines are as follows. 

Women age 21 and under are not recommended to have PAP smears. These women should have annual health check-ups to include screening for STD’s as indicated, initiation of the HPV vaccine, birth control counseling as indicated and complete health maintenance. If a woman under the age of 21 has not become sexually active, she does not need to have a pelvic exam, and time will be spent on other important aspects of a young woman’s health care.

Women age 21-29 should have an annual exam, well, every year! PAP smears should be obtained as part of that exam every 1-2 years. HPV testing is recommended for those women whose cellular analysis reveals atypical cells on the PAP. Annual health check-ups include blood pressure and weight screening, breast and pelvic exam, STD screening, contraceptive care and family planning.

Women age 30-65 should have an annual exam, you guessed it, every year! During these years many important health screenings will be conducted in addition to a pelvic exam. Women will have blood pressure, cholesterol, thyroid and diabetes screenings. Women will have regular breast exams and referrals for annual mammograms starting at age 40. Family planning, STD testing and contraceptive care is also included.  The PAP smear with HPV testing will be conducted every 3-5 years depending on the woman’s individual risk profile.

Women age 65 and older will follow current Medicare guidelines. In some women, PAP smears may be discontinued entirely, while others will have a PAP smear every 2 years. Women with HIV and/or a prior history of cervical cancer may be considered high risk and undergo annual PAP smear testing.

To summarize, all women should have an annual gynecological exam…every year! Many important aspects of woman’s health will be reviewed during that exam. Not sure what you should do? Starting last fall, women’s annual preventive exams are covered at 100% by commercial insurers, so give us a call at 512-836-2536 to schedule your exam. Our practice will have extra open exam slots for those patients needing to schedule before the end of the year. We are also offering a program for women who are without insurance to be able to get a preventive exam, PAP smear and gonorrhea/chlamydia testing.

Visit our website at or call us at 512-836-2536 if you have any questions or to schedule your annual exam. You can also learn more from ACOG Practice Bulletin 131 “Screening for Cervical Cancer”.

Pap and a Piece of Chocolate

I am going to let you in on a little secret. I have been practicing obstetrics and gynecology for over ten years now, I have cared for thousands of women through all manner of women’s medical issues, I have been pregnant and delivered two wonderful daughters, and I still dread going to the ob/gyn for my exam.

Will my ob/gyn use the plastic or the metal speculum? Did I shave too much or too little? Oh, fiddlesticks! I just realized I totally forgot to shave my legs, and I will have to leave my socks on because I am way overdue nail polish on my toes. Oh please Lord let my deodorant be working extra hard today because I can’t stop thinking about plastic or metal and now I am beginning to perspire and my
appointment isn’t until this afternoon. Yes, ob/gyn’s dread their own ob/gyn exams, too.

A few years ago my young girls became accomplished statisticians. They had concluded with reasonable probability that if we were going to visit the pediatrician, one or both of them would be statistically likely to receive a shot. Not wanting them to dread (read violently resist) going, I proposed that if they
received a shot, we would go for a treat of their choice afterwards. It worked!

Then I had a wonderful thought! What if my patients were to receive a small treat to ease the anxiety of coming to the ob/gyn? Something sweet and thoughtful that acknowledges that you might not have really wanted to, but you came in to take care of yourself? Sitting in a jar on the table you will ALWAYS find an assortment of small chocolates. Please help yourself, and we won’t tell anyone if you take two pieces.
We know, we understand; you were very brave.

To schedule an appointment with Capital Ob/Gyn Associates of Texas – Home of Pap and a Piece of Chocolate – please visit or call 512-83-OB-JEN.