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Re: Paps after hysts From: Anna Meenan, MD (annam@uic.edu) Mon Jan 29 16:07:00 2001 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Richard Chudacoff, MD: "Re: Lunelle/contraception coverage" Previous message: Richard Chudacoff, MD: "Re: A good deed" In reply to: Joanne Bulley: "Paps after hysts" Next in thread: Joanne Bulley: "Re: Paps after hysts" Reply: Joanne Bulley: "Re: Paps after hysts" What exactly do you consider predating the sexual revolution? And which sexual revolution are we talking about? The most recent studies I've seen are from AJOG 1995 and NEJM 1996 and both conclude routine paps after hyst not warranted if there was no CA or dysplasia before the hyst. Natural hystory of vaginal dysplasia unknown and it's extremely rare in women who never had dysplasia before the hysterectomy anyway. And yes, there are low-risk women out there. Lots of them in my neck of the woods (rural Illinois), including myself (hence my earlier question about annual paps in low-risk women on OCP's). I discuss risk factors with women (I never assume that all my patients are lying to me about their lifestyle or that they all have scumbag partners who are lying to them.) and together we decide whether we need to continue paps, though I always continue them if there is any history of dysplasia, Koilocytes, HPV, whatever. Pearce et al did their study on 9610 papsmears collected from women at Charity Hospital in NOLA who were avg. age 52, 83% African-American, and 99% at or below poverty level in 1993 and 1994, a fairly high-risk population if you ask me. Found 0.05% mild to moderate dysplasia and no malignancies after a mean lag time of 19 years since hysterectomy. I'm just not seeing anything but anecdotal evidence that we need to keep doing paps on them. Just my humble opinion. -- Anna Meenan, MD At Sun, 28 Jan 2001, Joanne Bulley wrote: > >Well - to be a devil's advocate... > >All the studies giving oipinions on Paps after hysts predate the era of >the sexual revolution, the endemic nature of HPV and the senior citizen >who has had 5 or more sexual partners and how ever many partners her >partners have had. > >So if we don't do Paps on hyst patients - but they carry the HPV at the >vag vault, then their immune system is down a bit - say from their COPD >or other illness - we will not catch their disease early. > >I DO have senior citizens that had hysts and I did spend our taxpayer's >money to do Paps q 3 years anyway - and I have found Moderate Dysplasia >of the Vagina in these ladies - usually with evidence of HPV. As I >recall - one was widowed, one was still married. > >With the widespread nature of HPV in the current generations - is it >still valid to NOT do Paps after hysts? > >Anyone have any papers done with folks 60-80 years old who were sexually >active since 1960? How many of our patients are truly LOW RISK these >days? That is - first sex after 18, life long mutually monagamy, and >never smoked? (and do we count tobacco and pot differently?) > >Obviously from this and other posts of mine - I can not say to the woman >on Medicare (65 in the USA) that she suddenly needs a Pap of her cervix >only every 3 years (just cause that is all the government will pay for) >- nor can I say the woman who is 40 and had a hyst (but has had God know >how many partners) should never have another Pap... > >OK, I know, I am an outlier, but I have seen so much HPV that it does >not make any educated sense to ignore that anatomy... > >-- >Joanne Bulley, MD, FACOG >Keene, NH, USA > Next message: Richard Chudacoff, MD: "Re: Lunelle/contraception coverage" Previous message: Richard Chudacoff, MD: "Re: A good deed" In reply to: Joanne Bulley: "Paps after hysts" Next in thread: Joanne Bulley: "Re: Paps after hysts" Reply: Joanne Bulley: "Re: Paps after hysts"

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