Study shows unnecessary Pap smear and pelvic exams common in young women

Women under the age of 21 no longer need pelvic examinations or cervical cancer screenings such as Pap smear, a new study suggests.

pap smearImage Credit: Iryna Inshyna /

In the United States, there are about 1.4 million young women who get potentially unnecessary pelvic exams, while another 1.6 million undergo Pap smear or cervical cancer screenings each year that they do not need. The study, which was published in JAMA Internal Medicine, reveals that adolescent girls and young women are having pelvic exams which are not needed at their age.

Parents of teens and young women should know that cervical cancer screening is not recommended routinely or annually for their age group, says a team of researchers at the Centers for Disease Control and Prevention (CDC), and the University of California, San Francisco (UCSF).

Previous guidelines

The Centers for Disease Control and Prevention (CDC) has recommended in the past decade that cervical cancer examination should start at age 21, or within three years from their first sexual intercourse. National guidelines also recommend that after having a Pap smear each year for three consecutive years, and the test results are negative, the young woman can have her test every 2 to 3 years.

Current guidelines by the U.S. Preventive Services Task Force, the American Cancer Society, and the American College of Obstetricians and Gynecologists do not recommend cervical cancer screening for individuals below 21 years old. They do not recommend performing pelvic examinations in women who have no symptoms who are not pregnant.

Recent media reports have called attention to inappropriate gynecologic examinations in young women. Parents of adolescents and young women should be aware that cervical cancer screening is not recommended routinely in this age group. Pelvic exams are not necessary prior to getting most contraceptives and are often not needed to screen for sexually transmissible infections,"

Dr. George F. Sawaya, Professor of Obstetrics, Gynecology and Reproductive Sciences at UCSF

High rates of pelvic exams

There are millions of adolescents and young women undergoing pelvic exams and Pap smears each year in the United States alone. In total, there are about 3 million women undergoing these tests, and the researchers estimate a cost of $123 million each year.

Further, in the study spanning from 2011 to 2017, the researchers found that there were about 2.6 million young women who received a pelvic exam during the previous year, with more than half being unnecessary.

There were two types of pelvic exams identified by the researchers, those which were medically indicated and those that are potentially unnecessary. They noted that pelvic exams are dubbed as medically indicated when performed during pregnancy or related to the use of an intrauterine device (IUD), or in the presence of a sexually transmitted disease. Otherwise, the examinations were deemed unnecessary.

In the case of Pap smears, the team has found that about a fifth of females younger than 21 years old had a Pap smear in the past year. A majority or 72 percent of these were done because it's part of a routine exam. There were 1.6 million Pap smears performed in this age group.

"This study suggests that healthcare providers and young women need to communicate clearly and often about the best time for these tests. We want to ensure that guidelines are followed, and lives are saved," Dr. Jin Qin, an epidemiologist with the Division of Cancer Prevention and Control at the Centers for Disease Control and Prevention, said.

"This analysis found that more than half of BPEs and almost three-quarters of Pap tests performed among young women aged 15 to 20 years during the years 2011 through 2017 were potentially unnecessary, exposing women to preventable harms. The results suggest that compliance with the current professional guidelines regarding the appropriate use of these examinations and tests may be lacking," the researchers concluded in the study.

Journal reference:

Qin, J., Saraiya, M., and Martinez. G. (2019). Prevalence of Potentially Unnecessary Bimanual Pelvic Examinations and Papanicolaou Tests Among Adolescent Girls and Young Women Aged 15-20 Years in the United States. JAMA Internal Medicine.

Angela Betsaida B. Laguipo

Written by

Angela Betsaida B. Laguipo

Angela is a nurse by profession and a writer by heart. She graduated with honors (Cum Laude) for her Bachelor of Nursing degree at the University of Baguio, Philippines. She is currently completing her Master's Degree where she specialized in Maternal and Child Nursing and worked as a clinical instructor and educator in the School of Nursing at the University of Baguio.


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