When I was 18, my mother made me an appointment to see her gynecologist to have my first Pap smear. I was not yet sexually active but my mom wanted me to have an exam before I left for college. Many years later, working as a Women's Health Care Nurse Practitioner, I would similarly tell my patients that age 18 is when a girl who is not sexually active should come in for her first pelvic exam and Pap smear. I would also tell moms that if their daughter was younger, but sexually active, she needed to be seen even sooner for a Pap smear. Back then, this was thought to be the right thing to do; now, most girls no longer need to have this test performed at such an early age.

A Pap test (officially called a Papanicolau test or smear) has been around for decades; its development was a huge breakthrough in the detection of cervical cancer. Prior to the advent of the Pap smear, cervical cancer was a common cause of cancer deaths among women. The Pap smear allowed for early detection of pre-cancerous cells and treatment before cervical cancer was present, leading to a very significant decrease in the cervical cancer rates in the US.

Cervical Cancer

Since most cervical cancers are caused by the Human Papilloma Virus (HPV)—which is transmitted through sexual contact—we would recommend that any girl who is sexually active come in for an annual Pap test to look for early evidence of cervical cancer. Often, the results in young women would indicate that they had some abnormal cells on their cervix, and we would aggressively follow and treat these abnormalities. Not only was it expensive to follow these abnormal tests, the testing and treatment could have long-term side effects for the young woman. Over the years, we have been fortunate enough to gather enough information to know that most young healthy girls who have these cervical abnormalities will totally clear the abnormality within two years with no treatment at all. We have also learned that cervical cancer in girls under the age of 21 occurs very rarely.

New Guidelines for a Pap Test

As a result of these new findings, the guidelines regarding when a girl should have a Pap smear have changed. Now, no girl under the age of 21 needs a Pap test, even if she has been sexually active. Now, this doesn't mean your daughter does not need to be seen by a gynecologist, especially if she is sexually active, but the Pap test is no longer thought necessary for a girl that young.

After years of the experts examining these facts, the American College of Obstetrics and Gynecology (ACOG) changed the guidelines to recommend that the earliest Pap test should be at age 21, then every two years after that. ACOG guidelines also include that a healthcare provider may still use their medical judgment in deciding to do Pap test earlier or more often, but it is generally not necessary.

Although many teens who end up at a gynecologist's office will not have a Pap test, it is still important to start establishing gynecological care for young women so that they can learn about their body and care for it appropriately. Often these visits don't require exams, but they are great opportunities to assess a young girl's health needs as well as provide them with accurate, reliable education. If they are sexually active, they will need screening for sexually transmitted infections. These early visits can help build rapport between your daughter and a healthcare provider so that when it is time for a Pap, they will already have a relationship with that person.

Remember the Pap test changed the lives of women by decreasing the rates of cervical cancer, but it is important to acknowledge that these important guidelines now tell us not to start doing them too early.

Janine Sherman, RN, MSN, WHNP-BC, is a Woman's Health Nurse Practitioner who specializes in the care of adolescent patients. She currently works in a busy OB/GYN office in Houston. She is also the co-author of Start Talking: A Girls Guide for You and Your Mom About Health, Sex, or Whatever.