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Does Your Teen Really Need A Pap Smear or Pelvic Exam?

Millions of young women have reportedly had intrusive and uncomfortable gynecological exams that they didn’t really need, according to researchers behind a new study published in JAMA Internal Medicine earlier this week. The study, conducted by researchers at University of California San Francisco and the Centers for Disease Control and Prevention, found that 2.6 million women (between 15 and 20 years old) received pelvic exams or pap smears over the last year and more than half (54.4 percent) of them likely weren’t necessary.

According to the study, these numbers are concerning as “pelvic examination is no longer recommended for asymptomatic, non-pregnant women and may cause harms such as false-positive test results, over-diagnosis, anxiety, and unnecessary costs.” Plus, the American College of Obstetricians and Gynecologists (ACOG) stopped recommending these examinations about a decade ago.

To understand a bit about why so many young people are continually undergoing this admittedly uncomfortable procedure before they need to and how parents can be more informed advocates for their teens navigating their reproductive health for the first time, SheKnows spoke with Dr. Julie Graves, a provider at telemedicine and reproductive healthcare start-up Nurx.

First of all, when is a pelvic exam or pap smear necessary?

“Over the past few decades, the United States Preventive Services Task Force, a group of clinicians and researchers, have studied the research evidence to learn which preventive care makes a positive difference,” Dr. Graves tells SheKnows.

For girls, she says that Pap smears for cervical cancer screening shouldn’t start until she’s 21 — after age 21, they’re recommended every three years and after age 30, it can go up to every five years (with HPV tests that don’t involve a pelvic exam). She does note that, in terms of preventative care, the HPV vaccine is seen as the thing that makes the biggest difference when it comes to reducing cervical cancer.

And when it comes to pelvic exams, she says that girls who are having normal periods (normal pain, bleeding) don’t need a pelvic exam. If they need STI tests, they also don’t need a pelvic exam (since blood tests and urine tests work just fine).

“They should only have the pelvic exam to evaluate medical problems — such as excessive pain and/or bleeding (which may mean endometriosis), or inability to insert a tampon, or to have an IUD inserted,” she adds.

Why are doctors still performing them on patients who don’t need them?

“For a long time, doctors believed that a pelvic exam was necessary at least every year during the teen years, once periods started. And it was awful for a lot of girls — painful, embarrassing, and sometimes even abusive,” Dr. Graves tells SheKnows. “Many women still suffer from the emotional trauma of this common practice, as they do from a lot of health care that was done to them over the decades when medicine was a man’s profession. It wasn’t ok then, and it’s not now. Doctors should be providing care that is based on research evidence and follow the standards of care, not just do what they learned years ago in medical school.”

Of course, this is connected to a larger problem of healthcare providers not having a wealth of time to spend with each patient, the costs of healthcare being prohibitive and a severe lack of education about our health (especially science-based education our sexual and reproductive health). It’s admittedly lot harder to practice good, thorough medicine and engage with your provider as an informed patient/partner in your health under these conditions.

Graves went on to say that, as a doctor and educator of medical students and residents over the years, she’s glad that the study is shedding light on the ways the medical community hasn’t totally kept up with itself. “I emphasize that they need to be life-long learners, that what is standard of care when they are in school and training will likely change. I’m angry that so many doctors were not following the current guidelines about pelvic exams,” she says. “We should be doing better for our patients. And I hope that this study opens a lot of eyes and leads to immediate change in practice, and gives patients the courage to say no to unnecessary tests.”

How can parents help their kids feel more empowered to get transparency about the procedures they need and don’t need? 

It’s hard enough advocating for your own healthcare and your own body when you’re at the doctor. And when it’s your child, their body and their potential discomfort that adds a whole new level of vulnerability. So what can you do to make sure they feel empowered to challenge procedures they’re unsure about or uncomfortable with?

“To feel more empowered, I hope patients will ask questions and go to evidence-based sources of information,” Dr. Graves says. “…I love it when my patients come in with information about their medical history and their family members’ medical history, their symptoms, their concerns, their questions, and what they’ve been reading, so we can have a thorough discussion about what works for them.”

Don’t go turning to Doctor Google for everything, though! She recommends using the CDC website and US Preventive Services Task Force (particularly their app — the EPSS) to learn about what tests are needed and why. You can also spend some time on the The American Academy of Pediatrics (AAP), the American College of Obstetricians/Gynecologists (ACOG), and the American Academy of Family Physicians‘ (AAFP) websites for even more information and research.

And, in the worst case scenario, if you feel like your concerns are no being heard, you are totally entitled to break-up with a doctor who isn’t listening to you: “All healthcare providers should respect their patients and offer shared decision-making after providing accurate information. When they don’t, it’s ok to say that this provider isn’t working out for you, and that you would like to see a different provider,” Dr. Graves says. “And it’s good, if you can, to say why (for me, writing it down is better — then my voice doesn’t shake).”

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