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Re: Adolescent pap guidelines From: Efrain Ramirez (eramirezt@coqui.net) Wed Oct 25 18:02:06 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Larry Glazerman: "Re: Office Ablation" Previous message: Andrew Folley: "Re: Adolescent pap guidelines" In reply to: Barbara Nicol MD: "Adolescent pap guidelines" Next in thread: Garry E. Siegel, M.D.: "Re: Adolescent pap guidelines" Reply: Garry E. Siegel, M.D.: "Re: Adolescent pap guidelines" They are guidelines - not rules.. I would not hesitate to perform a Pap smear.. Ef >At Wed, 25 Oct 2006, Barbara Nicol MD wrote: > >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 > -- “ The greatest obstacle to knowledge is not ignorance, it is the illusion of knowledge.” Daniel J. Boorstin - Historian Next message: Larry Glazerman: "Re: Office Ablation" Previous message: Andrew Folley: "Re: Adolescent pap guidelines" In reply to: Barbara Nicol MD: "Adolescent pap guidelines" Next in thread: Garry E. Siegel, M.D.: "Re: Adolescent pap guidelines" Reply: Garry E. Siegel, M.D.: "Re: Adolescent pap guidelines"

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