Pap Smears, HPV Vaccination, and Gynecology Visits: Is my daughter too young?
My daughter isn’t sexually active, when does she need her first Pap smear?
The old rule used to be either once one became sexually active or at age 18. Current guidelines state the first Pap should be performed three years after the first sexual intercourse or 21 years of age, whichever comes first. There is also a movement pushing towards not performing a Pap smear at all before age 21, but this has not yet been universally accepted.
This means your daughter doesn’t need this procedure performed if she is simply being started on birth control pills for control of her menses. This is often a source of fear for both parents and children. Pap smears are performed as a cervical cancer screening test and are not a requirement for adolescents that aren’t sexually active.
The reason for the change in the aforementioned guidelines is because we now know the primary cause of abnormal Pap smears and cervical cancer is the Human Papilloma Virus or HPV. This virus is sexually transmitted and there are numerous strains in existence. Groups of the differing strains also cause different problems for young women. Some strains, including types16, 18, 31, 33, 35, 39, 45, and 51 (there are more) cause abnormal Pap smears, cervical dysplasia and cervical cancer. While other strains such as types 6, 11, 26, 42, 44, 54, 70, and 73 are responsible for genital warts.
Strains 16, 18, 6 and 11 are important because there are vaccines available that help prevent infection with these strains. Strains 16 and 18 are responsible for 70% of cervical abnormalities including abnormal Paps, dysplasia, and cervical cancer. Types 6 and 11 are responsible for 90% of the cases of genital warts. The two vaccines available either protect against strains 16, 18, 6 and 11 or just 16 and 18. I tend to lean towards the vaccine with more coverage.
When should we get the HPV vaccine?
Ideally these vaccines should be initiated before sexual activity occurs, and therefore, before exposure to HPV. The vaccine can still be given after sexual activity has occurred. But it’s important to note that HPV exposure may have also occurred, and therefore its benefit may be limited.
Condom use is not completely protective against HPV, as this is one of several viruses that can be spread by skin to skin contact. Condoms have a limited area of coverage and do not cover the whole genitalia. You are still at risk of exposure even when using condoms consistently.
The earliest that the vaccine can be given is 9 years of age. Most are being given between the ages of 11 and 13 years. The latest age that the vaccine is currently recommended to be given is 26, but it has been given in older women. The data however, is limited regarding its benefit. There are currently several trials underway researching this population. Boys and/or young men may also receive the vaccine as they can be carriers of HPV and may also develop genital warts.
What is the best age to have the first visit to the gynecologist?
The American Congress of Obstetricians and Gynecologists (ACOG) recommends that an adolescent’s first visit with a gynecologist should be between the ages of 13-15. This does not mean they will need a Pap smear or that they will be subjected to a pelvic exam. This should be used as an opportunity to introduce a young woman to a routine that will be a big part of the rest of her life. This would also be an excellent time to address questions and concerns regarding the vaccine and start the vaccination process. So do your child a favor and talk to your Gynecologist about HPV vaccination.
Dr. Wilcox is a board-certified Obstetrician/Gynecologist practicing in Belmont, North Carolina.