Blog: Women's Health

Dr. Ko Says: What to Expect at Your Annual Pelvic Exam

Submitted by softcup_mary on Mon, 11/21/2011 - 7:16pm

You may have hear about the dreaded "annual exam" from your mother while growing up. What does this exam consist of and why is it so dreaded?

The annual gynecological exam consists mainly of a manual breast exam by the physician and a pelvic exam, which is made up of two parts—the speculum exam with Pap smear and a manual examination of the uterus and ovary areas by the physician. Other testing, like a mammogram or test for STIs (sexually transmitted infections) may be recommended and included depending on your age and risk factors.

Today I will talk more specifically about the Pap smear. It is basically a screening test for cervical cancer. It is performed by placing a special instrument called a speculum into your vagina. This helps open your vagina so the doctor can see your cervix, which is the knobby opening to the uterus. Then another instrument is used to collect a light scraping of cells in the cervix, which is then sent to the lab for evaluation. In the past Pap smears were recommended starting at age 21, or within three years of becoming sexually active, whichever came first, and the pap was performed yearly. But as of 2010 the guidelines for pap smears have changed.

***** New Pap Recommendations as of 2010:

The American Academy of OB/GYN (ACOG) changed the recommended pap schedule in 2010 and here is why:

Recent research has concluded that cervical cancer is almost exclusively caused by certain strains of HPV (Human papilloma virus), which is sexually transmitted. Although the rate of HPV infection is high among sexually active adolescents, invasive cervical cancer is very rare in women under age 21. The immune system clears the HPV infection within one to two years among most adolescent women. Because the adolescent cervix is immature, there is a higher incidence of HPV-related precancerous lesions (called dysplasia). However, the large majority of cervical dysplasias in adolescents resolve on their own without treatment. Therefore:

Women should have their first screening Pap smear at age 21.
Women in their 20s should have a Pap smear every two years.
Women age 30 and older who have had three normal Pap smears in a row should have a Pap smear every three years.
Women who have had a hysterectomy should no longer have Pap smears if the hysterectomy was for non-cancerous reasons and they don’t have a history of severely abnormal Pap smears. If you have had a hysterectomy but still have your cervix, you will need to continue routine Pap smears.
Pap smear screening can be stopped in women 65-70 years old and above who have had three or more normal Pap smears in a row.
These guidelines should be followed whether you have or have not had the HPV vaccine.

One thing that should be clarified is that you should still go in for a yearly exam to check for other gynecological issues other than cervical cancer.

Dr. Christine Ko is a Board Certified Family Practice physician with more than 15 years of medical experience. Her interests and focus are in women's health, integrative medicine, and sports medicine, and her approach to clinical care centers on knowledge of the disease process as well as the individual. Dr. Ko is a champion of integrated and holistic medicine, and in addition to her traditional medical training, she is trained in both medical acupuncture and mesotherapy.

comments (2)

Anonymous Says:

my understanding is that if you are not sexually active you can't get HPV and your liklihood of having cervical cancer is ALMOST zero. So I, in my early 30's, still haven't gotten a pap and don't intend to unless/until i become sexually active. and if I as a virgin were to marry a man who also was a virgin i believe that also would pretty much eliminate HPV and therefore cervical cancer. Is there information out there on liklihood of getting cervical cancer w/out having HPV?

softcup_mary Says:

In most cases HPV infection is the cause of cervical cancer, but it is not the sole factor. We are not sure of all the risk factors for cervical cancer, but genetic make-up, lifestyle and environment play a role. The American Academy of Obstetrics and Gynecology (ACOG) recommends that all women should initiate routine pap smears starting at age 21, whether you are a virgin or not.

-Dr. Ko