A woman’s first visit to the gynecologist can be intimidating. It’s important to take the time to walk her through the entire process, show her a speculum, explain what the brushes are collecting, and let her know it’s necessary for cervical cancer screening. But at what age should you get your first Pap smear?
It used to be the first exam was at least three years after first sexual activity or by 21 years old, whichever came first. Now, the American College of Obstetricians and Gynecologists (ACOG) published in the online version of Obstetrics and Gynecology the recommendation to start at 21 years old regardless of the age of their first sexual encounter, unless they have a compromised immune system, then start earlier.
This change is due to research that shows HPV in the cervical cells of teenagers rarely become cancerous. In fact, the majority convert back to normal cells within one year.
In 2009, ACOG recommended women between 21 and 30 years old have a Pap smear every two years, with women 30 and older go every three years. They still advocate for a physical and breast exam every year.
With this new information out on the web, I asked a few colleagues if they agreed with the recommendation. We all agree that younger women generally have strong immune systems and can convert an abnormal pap to normal within a year more easily than a woman older than 30. However we are concerned with society’s current trends in sex and sexual activity that women are having intercourse at an earlier age with more partners. The same holds true for young men. I remind all of my patients that HPV is not sexually transmitted like we think of chlamydia but instead is skin-to-skin contact. This means you can contract HPV without actual penetration as long as his skin is touching your skin.
Some of my teenagers have had 20+ sexual partners or started having intercourse at 13 and 14 years old and this concerns me from an HPV standpoint. If someone first had sex at 14 years old and waited until 21 years old to have their first Pap…a lot can happen in seven years! I generally take a detailed history and question my teens and twenty-somethings about their sexual practices and use of contraception.
While no young woman wants to get her first Pap, I believe the age at which she begins should do more with her sexual practices than her age – good immune system or not.