The American College of Obstetricians and Gynecologists has issued new guidelines recommending no Pap smear screening before age 21, every two years until age 30 and every three years after that if one has had negative results for three tests in a row.

 

My residency chief who practiced in the era before the common use of the Pap smear told his residents about the wards filled with young woman even in their 20's dying a miserable death from cervical cancer. Those wards were closed as the Pap smear gained acceptance. Those who support the new guidelines say that women do not die from cervical cancer before age 21. They ignore the fact that early detection before age 21 can avert this terrible disease and death. In the medical brave new world is death the measure of the need for screening? We have already heard about new mammogram guidelines. I expect next week’s headlines to include the PSA test for prostate cancer and colonoscopies.

 

Also important is that this sends the wrong message to many women who equate the “Pap smear” with the entire gynecologic evaluation. The previous recommendation suggested a Pap smear (and thus the full gynecological evaluation) within three years from when they become sexually active or at age 18, whichever comes first. More important than the Pap is the opportunity for the doctor or nurse practitioner to check for gynecologic abnormalities, test for sexually transmitted diseases and discuss issues such as contraception, safe sex habits and general health issues related to smoking, drug and alcohol use and other life-style issues.

 

So what does this have to do with fertility? As Dr. David Meldrum and I point out in our book, “Conceptions & Misconceptions,” women can do a lot to preserve their fertility when they are young by following good general health habits such as preventing sexually transmitted diseases, not smoking, maintaining a normal weight and having someone evaluate symptoms like severe menstrual cramps and irregular cycles which could indicate significant gynecological conditions that could result in infertility.

 

I believe that the Pap smear and mammogram guidelines, although technically accurate within a very narrow and subtle definition, send the wrong message. Many people will use any excuse to avoid an unpleasant and possibly uncomfortable examination. These new guidelines give them that excuse to avoid an examination which might improve their general health and quality of life and preserve their fertility.