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Re: Adolescent pap guidelines From: Zachariah Newton (zbnewton@bellsouth.net) Wed Oct 25 16:50:53 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Barbara Nicol: "Re: Adolescent pap guidelines" Previous message: Barbara Nicol: "Re: Adolescent pap guidelines" Maybe in reply to: Barbara Nicol MD: "Adolescent pap guidelines" Next in thread: Barbara Nicol: "Re: Adolescent pap guidelines" Not addressed in ACOG Pap policy is the secondary information routinely observed and reported, non-HPV related cellular abnormalities, HPV related abnormalities for sub-types not included in DNA profile and including malignancies, such as clear cell or Fallopian tube malignancy. The reassurance that can only be dispensed in the absence of abnormal findings is of weak derivation without the Pap report. The station of the gyn is the voice of ultimate authority irt assessment of health status. This bestows an imperative to do a Pap on a patient such as described in your scenario. As an aside, an erstwhile and endeared member of the list from Sweden used the phrase "sexual debut." Elegant. Zach Newton Z. B. Newton, III, M.D. (retired ob/gyn) Flowery Branch, GA --- >----- Original Message ----- From: "Barbara Nicol MD" <blnicol@ix.netcom.com> To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net> Sent: Wednesday, October 25, 2006 5:10 PM 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 > Next message: Barbara Nicol: "Re: Adolescent pap guidelines" Previous message: Barbara Nicol: "Re: Adolescent pap guidelines" Maybe in reply to: Barbara Nicol MD: "Adolescent pap guidelines" Next in thread: Barbara Nicol: "Re: Adolescent pap guidelines"

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