Gynecologist visit urged before first Pap test

Adolescent girls should make their first visit to an obstetrician-gynecologist at around 13 to 15 years of age, even though routine Pap testing doesn't usually start until they're older, according to a recommendation from the American College of Obstetricians and Gynecologists (ACOG).

Two years ago, the American Cancer Society changed its recommendations for when Pap testing, to screen for cervical cancer, should begin (see Reuters Health report, November 14, 2002). Their guidelines suggest that a first Pap test should be obtained within 3 years after a woman begins having intercourse or no later than 21 years of age.

ACOG fears that teenagers and their parents will interpret this to mean that routine gynecologic care is not necessary until then. They have therefore issued a committee opinion, advising physicians to stress that patients should visit an obstetrician-gynecologist before they become sexually active, and to inform them of the difference between a Pap test and a routine annual exam.

The recommendations are published in the journal Obstetrics and Gynecology.

Even if a pelvic examination does not take place at a patient's first visit, physicians can provide eduction about the need for testing for sexually transmitted diseases (STDs) when sexual activity begins.

The committee also recommends that physicians consider more than just age at first intercourse when considering Pap testing. A history of other STDs, multiple sexual partners, and the presence of an immune system disorder, put girls at higher risk of infection with human papillomavirus (HPV), a virus implicated in most cases of cervical cancer.

"Obtaining a complete and accurate sexual history is, therefore, critical," they warn.

The authors also note, however, that abnormal cervical cells may regress spontaneously, and that aggressive treatment may damage fertility.

Therefore, they suggest that patients with abnormal Pap test results should be counseled and monitored closely, with therapy reserved for those with high-grade cervical cell abnormalities.

SOURCE: Obstetrics and Gynecology, October 2004.