Re: Adolescent pap guidelines
From: Andrew Folley (agfolley@hotmail.com)
Wed Oct 25 17:32:30 2006
Barb you could always skip the pap and colposcope her at the time of the IUD
insertion as a possible solution to your dilema.
My take of ACOG is to "leave those kids alone" ie they all have HPV and
most of it will resolve on its own as long as we arent putting our 16-22
year olds through conizations and leeps. How many times have we seen
"abnormal pap,to colpo, leads to leep or conization???" all before the age
of 21?
>From: "Lynn Montgomery" <apgar10@qwest.net>
>Reply-To: ob-gyn-l@obgyn.net
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>Subject: RE: Adolescent pap guidelines
>Date: Wed, 25 Oct 2006 16:21:40 -0500
>
>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
>
