When Should I Have My First Pap Smear?

pap smear exam sheet
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Question: When should I have my first Pap smear performed?

I am 19 and have never had a Pap smear. Should I have my first pap smear done? Does it matter whether I have or haven't been sexually active, and at what age I became sexually active?

Answer: Women should have their first Pap smear at age 21

The answers to this question have changed in just the past few years, leading to confusion. Even people you have trusted for answers may be giving outdated advice.

If you tried to find the answer online, it's likely you ran into different answers depending on when they were last updated.

The American College of Obstetricians and Gynecologists (ACOG) revised their recommended cervical cancer screening schedule for women in 2009, with further revisions in 2012. The results of these updated recommendations are as follows: 

  • All Women should have their first Pap smear at age 21. Previous guidelines recommended women have their first Pap three years after they become sexually active or at age 21 -- whichever came first. Now it is recommended no earlier than age 21 regardless of when they became sexually active. Age 21 is the right age regardless of whether and when they have been sexually active.
  • Women who have had the HPV vaccine should follow the same screening guidelines.
  • Women between the ages of 21 and 30 should have a Pap smear every three years. This was revised from previous recommendations that it to be done annually and updated from recommendations that it be done every two years. For this age group, HPV testing is not used for screening, but may be used to follow up on an abnormal Pap test result.
  • Women between the ages of 30 and 65 should have both a Pap test and an HPV test at the same time, with five years between tests. If they have only a Pap test done, they should have one every three years.
  • Women over age 65 to 70 who have have had three consecutive normal Pap smear results and no abnormal findings in the previous 10 years can discontinue screenings altogether. If they have had a serious pre-cancer found (CIN2 or CIN3) they should continue testing for 20 years after that finding.
  • Women who have undergone a total hysterectomy due to a noncancerous condition and have not had previously abnormal Pap smears can also discontinue screenings.

The American Cancer Society's (ACS) recommendations varied somewhat from these guidelines in 2009, but by 2015 they agree with all of the schedules above. 

Both ACOG and ACS recommend that a woman should have a Pap smear by age 21. ACOG and ACS are both highly esteemed, trusted organizations. If you have further questions about how these guidelines apply to you, ask your doctor. He or she can make the best assessment of when you should start having Pap smears based on your personal health and sexual history.

Remember that regardless of how often you have a Pap smear, you still need to have an annual pelvic exam. This exam will screen for many other conditions that are important for your reproductive health as well as your overall health. Early detection of problems is your best way to protect your health.

Sources:

American Cancer Society. Cervical Cancer: Prevention and Early Detection. 12/11/2014. Accessed 12/7/2015.

American College of Obstetricians and Gynecologists (ACOG). Screening for cervical cancer. Washington (DC): American College of Obstetricians and Gynecologists (ACOG); 2012 Nov. 17 p. (ACOG practice bulletin; no. 131).

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