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Re: Adolescent pap guidelinesFrom: Lynn Montgomery (apgar10@qwest.net)Wed Oct 25 16:19:52 2006
First of all, she is not at "quite low risk for HPV", she is at high risk given that she is sexually active - being recently postpartum. I have always adhered to the practice of doing the first pap at age 18 or when they become sexually active. Given the extremely high number of abnormal paps I see in 14 through 18, I would not want to wait until age 21, and I live in a "low risk" community. I don't think this has anything to do with lawyers, it has to do with the fact that the prevalence of HPV is very high and it is our role to apply appropriate screening to assure that cervical lesions don't go undetected. Lynn -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Barbara Nicol MD Sent: Wednesday, October 25, 2006 3:11 PM To: Multiple recipients of list OB-GYN-L Subject: Adolescent pap guidelines 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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