(NOTE FOR READERS: Content for this article is from answers at the McLeod Women’s Health Forum “Straight Talk” This article contains straightforward discussions of women’s health problems and is designed for mature readers.)
A national primary care physician group has said that women no longer need an annual exam and pap smear. McLeod Gynecologists Paul Chandler, MD and Brad Campbell, MD still recommend this continuing care for women – even for women who’ve had a hysterectomy, the removal of a woman’s uterus that can help with problems, such as bleeding and endometriosis. Here’s what they told women at a recent community forum:
Here is a summary of the remarks by Drs. Campbell and Chandler.
Paul Chandler, MD
There are other organs in your pelvic area other than your uterus, fallopian tubes and ovaries. You still have a vagina, vulva and breasts. Those all need to be checked.
There’s a lot of controversy right now about whether you need a Pap smear after you’ve had a hysterectomy? I get this question a lot. My answer is YES.
Vaginal cancer is rare. But I have seen pre-cancerous changes of the vagina in women after hysterectomy. So, I still do Pap smears. Not as often as I normally would, but I still do them.
There are other masses that can appear in the pelvis. You can get cancer of the vulva or the anus. You can get bladder cancer.
I had a patient come in not too long ago for her annual check up. During the normal exam, I found a huge mass on her upper abdomen. It turned out that she had renal cancer. There are a lot of things you can pick up on during the general examinations. So, I still recommend that women have an exam and Pap smear, even after a hysterectomy.
We have a professional organization – The American College of Obstetricians & Gynecologists, or ACOG, – that creates standards of care. They say that if a woman has had a hysterectomy, your chance of getting cancer of the vagina is really low. But I ask, “Do you want to be that one women, who gets it?”
They are sitting in their ivory tower, while most Gynecologists are in the trenches dealing daily with patients. We’re going to be the ones taking care of you. So, I still do Pap smears after hysterectomy.
Brad Campbell, MD
ACOG’s recommendation is that if you’ve had an abnormal Pap smear, you should have a Pap smear at least every other year for 20 years, following an abnormal Pap smear or after your hysterectomy.
In general, does a woman who is 65 years old, has never had a Pap smear in her entire life and had a hysterectomy last year need another Pap smear? Probably not. If they are with the same partner, her risks are extraordinarily low.
You have to take into account everything about the patient. Just because your doctor didn’t give you a Pap smear last year, doesn’t mean he was wrong and you need to find a new doctor.
Now, the professional organizations are also recommending that we space out your Pap smears at 3 or 5 years. They know – and the studies show – that with this recommendation the risk of cervical cancer is going to go up. They recommended it because it’s cost-effective.
Now, whether or not that is the right thing to do for you – is up to you and your doctor.
We have to take into account what these organizations say and apply them toward our patients individually, rather than consider everyone the same.
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