A Pap smear (or Pap test) is an important tool for women to help detect and treat cervical cancer in its early stages. However, these exams are usually not needed when women are specifically requesting birth control pills from their doctor, according to Dr. Jennifer Barkley, a double-board certified internal medicine and pediatrics doctor with Sharp Rees-Stealy Medical Group.
“Pap smears and birth control are both really important women’s health issues, but they’re actually two separate issues,” she says. “Hopefully a woman has a close enough relationship with her doctor to stay current on both issues. But if she happens to be late on a Pap smear, that shouldn’t mean she can’t get her birth control.”
Dr. Barkley adds that in some cases, requiring a pelvic exam or Pap smear before prescribing birth control may even cause more harm than good. “We don’t recommend Pap smears for sexually active teenagers anymore, because studies have shown that most abnormalities in teenagers go away on their own. It turns out that the interventions used to treat these were doing more harm than good, even causing future pregnancy complications for something that the body would take care of on its own.”
Additionally, Dr. Barkley says that a pelvic exam can be a barrier to getting birth control for many young women. “If a young woman is anxious about having her first pelvic exam, she may put off getting birth control and risk having an unplanned pregnancy. Preventing unwanted pregnancies is important for a woman’s emotional, physical and financial health.”
Dr. Barkley does encourage all teenagers — both girls and boys, sexually active or not — to get their HPV vaccines on schedule. These vaccines can help protect against cancers caused by HPV (human papillomavirus) infection.
Exams that should be done before getting birth control pills
According to Dr. Barkley, a woman’s doctor should conduct a basic medical exam that includes a blood pressure check and a discussion about any previous blood clots or history of smoking before prescribing birth control pills. “These are key risk factors that might make regular birth control pills a less safe option than other forms of birth control. If a woman has any of these risk factors, she should talk to her doctor about progesterone-only or non-hormonal forms of birth control.”
She also notes that many teenagers and adult women are choosing longer-acting and more effective forms of birth control like IUDs (intrauterine devices), so it’s important for a woman to talk with her doctor about all of her options to find the birth control method that works best for her.
When should a woman have a Pap smear?
“An annual Pap smear typically isn’t necessary because cervical cancer develops extremely slowly, typically over a period of many years,” says Dr. Barkley, “but it’s important to talk to your doctor to understand your own risk because every woman is different.”
A healthy woman should start receiving Pap smears at age 21 regardless of whether she’s sexually active, and repeat every three years in her 20s if her Pap smears are all normal.
Healthy women over 30 years old who have never had an abnormal Pap should have a Pap smear and HPV test every 5 years. If a doctor ever finds precancerous or cancerous cells on a Pap smear, or an HPV infection, a woman will likely need more frequent Pap smears than this routine screening.
At Sharp Rees-Stealy, we want to empower you to make well-informed choices about your testing and treatment options. That’s why we’ve made it our priority to support our doctors in helping you make smart and effective decisions by participating in Choosing Wisely®.
Choosing Wisely, an initiative of the ABIM Foundation, educates patients and doctors on selecting the most effective treatment available and avoiding unproductive, costly procedures. Sharp Rees-Stealy is the only medical group in Southern California to participate in this national campaign.