MN: At what age/what point in life should girls start going for Pap smears?
ACOG (The American College of Obstetricians and Gynecologists) and USPSTF (The United States Preventive Services Task Force) recommend cervical cancer screening in women age 21 – 29 via pap test alone every 3 years. For women age 30 – 65, the recommendation is for a pap test and HPV test (this is called “co-testing”) every 5 years – although pap test alone every 3 years is also acceptable in this age group.
MN: What are doctors checking for during a Pap smear?
Pap smears are for cervical cancer screening. The goal is essentially to catch cellular changes in the cervix that could lead to cancer before they progress to cancerous lesions. HPV (Human Papilloma Virus) is relevant in cervical cancer screening because an infection with this virus is responsible for most cases of cervical cancer. Of note, “high risk” HPV types are known to cause other types of cancer including cancer of the vulva, vagina, penis, anus, mouth, and throat.
MN: What does the exam entail? Is there any pain or discomfort girls should anticipate?
During a pap smear, a gynecologist inserts a speculum into the patient’s vaginal canal to visualize the cervix, which is located at the top of the vaginal canal. An instrument (a small brush), is then inserted into the cervix to obtain sample cells to be analyzed by a pathologist (‘cervical cytology’). The actual brushing of the cervix to obtain cells isn’t extremely painful (although it can cause some mild cramping). The biggest discomfort tends to be speculum insertion for visualization of the cervix in the vaginal canal.
MN: A story went viral recently about TI going to his daughter’s Pap smears to ensure her hymen is still in tact—are doctors able to see that from an exam? What are other ways hymens may break? Are parents even allowed in the room and to access their child’s information if under 18? What about over 18?
An intact hymen can be visualized on a pelvic exam but should not be used for “virginity testing” for many reasons including (though not limited to) the fact that there are numerous other causes in addition to sexual intercourse for a patient’s hymen to tear or stretch. Some examples: speculum exams, tampon or menstrual cup use (or insertion of any other items into the vagina), physical activities, etc.
A gynecologist can examine a patient without a parent in the room if he/she feels that it is at the best interest of the patient. As OBGYNs, we ensure patient comfort by including a ‘chaperone’ (i.e. another medical provider) during sensitive medical exams. A parent’s presence is not always required.
An adult patient’s medical information is protected under the HIPAA Privacy Rule (Health Insurance Portability and Accountability Act), but this gets a bit tricky for minors defined as individuals below the “age of majority”. This is the age of 18 in most states. Minors cannot legally exercise their rights under HIPAA and parents of minors have access to their medical records and serve as their medical representatives. However, there are some exceptions (e.g. safety concerns expressed by the provider, emancipated minors, court approval for care without parental consent, state-specific laws about a minor’s ability to consent for emergency, contraceptive, pregnancy-related, HIV or other STD, substance abuse, and mental health care without parental involvement, etc.).
Interesting fact: In a number of states, a pregnant minor can provide medical consent for her fetus or child but not herself.
MN: For parents who are worried about taking their daughter to get their first Pap smear, how would you advise them?
In my opinion, the key is to normalize the discussion of sexual health and to remove the stigma behind it in the home environment. It is so important for young girls and women to understand the human body and to learn its anatomy and physiology because this encourages them to ask the necessary questions and to make choices that lead to the best health outcomes. With less stigma and discomfort surrounding conversations about human physiology, sexual health can be promoted and normalized. It is also the parent’s responsibility to educate themselves about these things by obtaining the necessary information from health care professionals so that they can also serve as a resource for their child.
MN: What about girls who are worried about getting their first Pap smear, how would you advise them?
As a physician, I encourage patients to ask questions because that gives me the opportunity to educate them and decrease their anxiety level. They key is to ask medical professionals as opposed to relying on Dr. Google due to the amount of misleading and incorrect information on the internet. Also – a positive and encouraging relationship between a young girl or woman and her Obstetrician/Gynecologist is beneficial in so many ways, so it is important for young girls to communicate to their parents and play an active role in selecting the right doctor for them – one that listens and creates a safe space in order to provide the best medical care.