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Adolescent pap guidelinesFrom: Barbara Nicol MD (blnicol@ix.netcom.com)Wed Oct 25 16:08:45 2006
ACOG and ACS says not to do a pap smear until age 21 or 3 years after 1st intercourse (ref Oct 2004 ACOG committee opinion on cervical cancer screening in adolescents). They give pretty good reasons for this, too, so I try to adhere to it, while doing lots of STD tests in this population. So I have a patient, age 20, less than 3 years since starting sexual intercourse, presenting for her 2 week postpartum visit. She has never had a pap smear, because we are following the guidelines. She desires an IUD for contraception and is a good IUD candidate in every other respect, quite low risk for STDs, normal uterus, etc. Do I do a pap smear just because she wants an IUD, and normal paps are considered a prerequisite for IUD use? Or do I say that she doesn't need a pap yet, and is quite low risk for HPV given her social situation, and can have the IUD anyway? "Abnormal pap" is a contraindication for IUD use, but I haven't experienced "doesn't need a pap yet" and "wants an IUD" at the same time. Until now. What to do? Is the pap smear in this context only wasting money to ward off lawyers, or is there actual patient benefit?
-- Barbara Nicol MD St. Luke's Health Care Center San Francisco CA USA
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