Changes in Your Well-Woman Exam



Let’s be honest… a “well woman” exam is not especially fun. Typically, these visits have included lab work to check thyroid and cholesterol levels, a breast exam and a Pap smear. A Pap smear is a screening test used to detect the presence of abnormal cells in the endocervical canal of the female reproductive system. Until recently, annual Pap smears were recommended as part of a well woman exam for most women. However, new guidelines recently released by the U.S. Preventive Services Task Force may make the annual Pap smear a thing of the past.

Why Pap Smears?

The Pap smear was invented by prominent Greek physician Georgios Papanikolaou, who was among the first to discover cancerous cells through the use of a vaginal smear in the early 1920s. In a conventional Pap smear, a sample of cells are collected from the cervix with a brush, smeared onto a microscope slide and checked for abnormalities in a lab. Some clinics use liquid-based cytology, where the sample is placed in a bottle of preservative for transport to the lab for examination. The Pap smear remains a widely used and effective tool for detecting cervical cancers and infections of the endocervix.

Updated Guidelines

While annual screening has long been the norm, new guidelines released in March of 2012 introduced several changes. The new guidelines recommend Pap screening no earlier than age 21, regardless of sexual history. Furthermore, the new guidelines recommend against routine testing for Human Papillomavirus (HPV) in women younger than 30. For the past decade, HPV testing has often gone hand-in-hand with regular Pap tests. HPV is a sexually transmitted disease that may be found in up to 80 percent of all women by the age of 50 and is the leading cause of cervical cancer. While many women under 30 get infected with HPV, most will eliminate the virus without any intervention. HPV testing should be used in certain cases where women receive atypical test results from a Pap smear.

Women who have an abnormal Pap are often referred for other procedures such as colposcopy, in which a magnifying device is used to examine the cervix for abnormalities. If abnormalities are visible, a tissue sample may then be obtained for biopsy. While the procedure has few risks, repeated biopsies can damage the cervix, as can some of the procedures that are done when the biopsy results reveal high-grade abnormalities. In such cases, laser excision or cryotherapy may be used to remove the tissue, which can further damage the cervix. Cervical damage from these types of procedures can compromise fertility and increase the risk of miscarriage when a woman becomes pregnant. The new guidelines are aimed at preventing this type of cervical damage.

Your Annual Exam

Think you’re off the hook for the annual exam? Not so fast! These new guidelines, while a welcome relief for some, do not apply across the board. In fact, many women will still need to have annual Pap smears. Catherine Gardner is an Edmond Nurse Practitioner specializing in Women’s Health. After 23 years in practice, she is approaching the new guidelines with caution. “These guidelines apply mostly to healthy women in monogamous relationships or those who are not sexually active,” she notes. In addition, women who have undergone a hysterectomy no longer require Pap smears. “I would hate for the average woman to hear these guidelines and think they don’t have to go in for a well woman exam.”

In fact, the old rules will still apply for any sexually active woman with multiple partners or a history of abnormal Pap results. Even in those who do not require annual Pap testing, “it’s important to understand that an annual exam is still necessary for all women, including a breast and pelvic exam.” A pelvic exam can detect many tissue abnormalities, which can be a sign of sexually transmitted disease or the presence of cancerous or precancerous cells. “A Pap smear only checks for cervical changes, but it’s possible for a patient to get vaginal cancer or to have symptoms of an STD that have gone unnoticed,” says Gardner. Her biggest concern is that women will hear these guidelines and feel they can skip the appointment altogether. “Patients have to be seen annually to refill prescriptions such as hormone replacement or contraceptives, so everyone still needs an annual exam,” she says.

So what’s the take-home lesson? There’s a lot more to an annual well woman checkup than a Pap smear. While some women may be able to get by with less frequent Pap smears, an annual exam is still important. As such, the ritualistic dread that goes along with an impending pelvic exam will continue for many women, but consider the benefits. Prevention is the key to optimal health.

Shannon Fields is a freelance writer from Edmond and a Certified Pharmacy Technician at Innovative Pharmacy Solutions.

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