Do You Still Need Pap Smears After a Hysterectomy?

swab for pap smear after hysterectomy
Do you need a Pap smear after a hysterectomy?. Istockphoto.com/PhotoQueen123

A hysterectomy refers to the surgical removal of the uterus and sometimes the cervix. In most cases, a hysterectomy is performed for benign (non-cancerous) conditions like uterine fibroids or dysfunctional uterine bleeding. But sometimes it's done to treat cancer.

Knowing why you had a hysterectomy is important, as is knowing whether your cervix was removed with your uterus and whether you have a history of cervical cancer or any abnormal Pap smears.

This is because these factors determine if you need to continue Pap smears after your surgery.

While your doctor should have all this information, it's best for you to know it too—this way nothing slips through the cracks, and even better, you can feel good about being on top of your health.

Pap Smear After Total Hysterectomy

Women who have undergone a total or complete hysterectomy (which means the uterus and cervix were both surgically removed) do not need to undergo any more pap smears—unless, and this is a big caveat, the hysterectomy was performed as a treatment for cervical pre-cancer or cancer.

In this case, there still could be cervical cells present at the top of the vagina, so screening for cervical cancer according to regular guidelines should still be done. 

A second caveat is that even if a woman has undergone a total hysterectomy, she still will need to undergo Pap smears if she a history of cervical cancer or a history of cervical cell changes, specifically cervical intraepithelial neoplasia II or III (called CIN2 or CIN3)—a moderate to severe abnormal cell growth on the cervix.

CIN2 or CIN 3 are diagnosed during a colposcopy by biopsy (when your doctor takes a sample of your cervix and looks at it under a microscope).

According to the American College of Obstetrics and Gynecologists (ACOG), a woman with a history of cervical cancer or cervical cell changes (CIN2 or CIN3) should continue pap smears for 20 years after the time of her hysterectomy.

Pap Smear After Subtotal Hysterectomy

On the other hand, women who undergo a hysterectomy in which the cervix is left in place (referred to as a partial hysterectomy, subtotal hysterectomy, or supra-cervical hysterectomy) should follow the pap smear guidelines as usual. 

In other words, for those who have a subtotal hysterectomy, the guidelines are the same as a woman who has not had a hysterectomy, since the cervix is still present.

How Pap Smears Are Done When the Cervix Has Been Removed

A Pap smear is a highly effective means of cervical cancer screening, even when the cervix has been removed. During a Pap smear, after the cervix has been removed, the doctor collects a sample from the vaginal cuff, the upper vagina where the cervix was once located.

While this may be hard to wrap your head around (and that's OK), the bottom line is that even if your cervix was removed, cervical cells (which are not visible) may linger at the top of the vagina—and like any cell, they can change and become cancerous, so testing them regularly is key.

Annual Pelvic Exams Are Still Needed After a Hysterectomy

The annual pelvic exam, also referred to as the well-woman visit, is a time for doctors to not only perform the Pap smear but also screen for other gynecologic problems, both cancerous and not.

For example, during the well-woman visit, a doctor will likely perform a breast exam, as well as an exam on the ovaries, called a bimanual exam.

In addition, the well-woman visit provides the opportunity for doctors to counsel on living healthily, administer necessary immunizations, and discuss any worries or concerns a woman may have (for example, abnormal vaginal bleeding or pain with sexual intercourse). 

A Word From Verywell

Remember, your doctor is your best source of health information. After a hysterectomy, ask whether your cervix was retained or removed. Although your doctor may have clarified this prior to surgery, there are times when the doctor decides to remove or retain the cervix during the actual surgery.

Also, do not worry if you are unsure if your cervix was removed. Your doctor can do a pelvic exam to check.

In the end, be empowered and proactive and see your doctor for your well-woman visit, cervix present or not. 

Sources:

American Cancer Society. (2012). Cervical Cancer Screening Guidelines.

American College of Obstetrics and Gynecologists. (2016). Cervical Cancer Screening.

American College of Obstetrics and Gynecologists. (2016). Committee Opinion: Well-Woman Visit.

Feldman S, Goodman A, Peipert JF. Screening for cervical cancer. Goff B, Elmore JG, eds. UpToDate. Waltham, MA: UpToDate Inc.

Sawaya GF. Re-envisioning the annual well-woman visit. Obstet Gynecol. 2015 Oct;126(4):695-96.

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