By Raine Kane
Back in 2010, the American College of Obstetrics and Gynecology, together with the Centers for Disease Control, developed new guidelines for when a woman should be receiving her routine gynecologic care. Recently, there have been efforts made by both organizations to raise awareness about these recommendations.
The guidelines previously stated once a woman becomes sexually active she should begin seeing an obstetrician/gynecologist or certified nurse midwife on a yearly basis. However, with advancing technologies and outcomes of recent research in women’s health, the old model of yearly screening with the onset of sexual activity is not necessary.
A woman who needs to have her birth control prescription refilled may not be required to undergo a full exam. Instead, we would review with her the benefits and risks of all birth control options. But if she expresses satisfaction with her current method, we can refill her prescription after updating medical history and evaluating vital signs. A pap smear or other tests may not be necessary.
The new guidelines designate the type of care a woman should receive based on her age. For women ages 20 to 29 years old, we would discuss with them the significance of self-breast exams, but the likelihood of a healthy individual developing breast cancer at an early age is low enough that we can conduct a breast exam every two years.
Based on research of the human papilloma virus (HPV) that established a strong link between HPV, abnormal pap smears and cervical cancer, the new guidelines state a woman starts pap screening at age 21. Any screening prior to age 21 would be for the purpose of detecting a sexually transmitted infection. It is common for sexually active women up to the age of 30 to have one or more strains of HPV. Most women clear this virus on their own without requiring any treatment.
When a woman turns 30, the new recommendation is to either continue with a routine pap smear every two years, or to do a pap smear with HPV co-testing every three years. If a woman has remained in a monogamous relationship, even if she previously had been exposed to a high-risk HPV, the virus will likely have resolved spontaneously. Women can be confident that these new screening intervals are not compromising their health care because cervical cancer is not a rapidly progressing cancer.
Two strains of HPV have been linked to cervical cancer. This identification between HPV and cervical cancer led to the development of vaccines to protect against some strains most likely to cause cervical cancer in women. The HPV vaccine is recommended for girls and boys age 11 through 26. By vaccinating both young girls and boys, we hope to decrease the incidence of cervical cancer in the United States.
Our message would be to have women seek gynecologic care when a problem develops, such as changes in menstrual cycle, breast concerns, exposure to possible infections, pelvic pain, abnormal vaginal discharge or any issue with their method of birth control. Frequency of gynecologic exams and health screenings should be a decision made between a woman and her gynecologic provider.
Raine Kane, CNM is a certified Nurse Midwife with Brattleboro OB/GYN and Four Seasons Midwifery, a member of BMH Physician Group. She can be reached at 802-251-9965.