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Should I be performing Pap smears on teenage women who are not sexually active?

I have two questions about cervical cancer screening and adolescence.

  1. As a primary care provider, should I be performing Pap smears on women 18 and over who have never been sexually active?
  2. In a similar manner, should I be performing Pap smears on teenage women who are not sexually active, but want to begin birth control pills? Could you please also refer me to the evidence that will answer my questions?


The American College of Obstetrics and Gynecology (ACOG) prepared in 1998 their recommended screening procedures for women. With regard to the Pap test, their recommendation is that the first one be performed by age 18 or at an earlier age if sexually active. With regard to pelvic examinations, they recommend that pelvic exams be done "yearly when sexually active, or by age 18."

More and more institutions will permit a woman to initiate use of birth control pills without a pelvic examination and Pap smear. However, they encourage women who become sexually active (the reason most women start taking birth control pills) to obtain Pap smears annually. If a woman takes birth control pills for several years prior to becoming sexually active, to control dysmenorrhea, for example, a Pap smear would be less important than for a woman taking pills as a contraceptive. Here is a reference for you:
Precis, Primary and Preventive Care: An Update in Obstetrics and Gynecology.

The American Cancer Society (ACS) recommends that all women who are or who have been sexually active or who have reached age 18 should have an annual Pap smear and pelvic examination. After a woman has had three or more consecutive satisfactory normal test results, that Pap smear may be performed every 1 to 3 years at the discretion of her physician.

The Canadian Task Force (CTF) on the Periodic Health Examination recommends Pap smears every three years after two normal test results for women when they become sexually active or at age 18, then every five years, from age 36 to 74.

The United States Preventive Services Task Force (USPSTF) recommends Pap smears every 1 to 3 years beginning at age 18 or when a woman becomes sexually active.

An excellent resource on health care for women is as follows:
Carlson, K.J., MD, Eisenstat, S.A., MD, Frigoletto, F.D., MD, Schiff, I., MD. Primary Care of Women. St. Louis: Mosby, 1995.

Robert A. Hatcher MD, MPH
08/22/2000

Updated 1-2-2009

Robert A. Hatcher MD, MPH
Emeritus Professor of Gynecology and Obstetrics
Emory University School of Medicine
Atlanta, GA
---2009-01-2

The directors and owners of this website and any publications and information concerning health matters offered here advise a person with a particular problem to consult a primary-care clinician or a specialist in obstetrics, gynecology, or urology (depending on the problem or the contraceptive) as well as the product package insert and other references before diagnosing, managing, or treating the problem.
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