Dear Dr. Christina,
I am 50 years old and I had a hysterectomy ten years ago. I was told by my doctor that I did not need to have any more pelvic exams or pap smears. I just moved to another state and went to a new OB/GYN doctor who told me that I need a pelvic exam yearly and a pap smear, according to my particular risk factors. When I received a phone call from the doctor, I was told the result of my pap smear was abnormal and that I had precancerous cells. How can that be? I am confused as to why I was told by one doctor I didn’t need to be checked after my hysterectomy and then my new doctor says a pelvic exam should be done yearly, whether or not I have a uterus and/ or cervix. I did not know a woman is at risk of not only cervical cancer but of vaginal and or vulvar cancer. Why are we not told this to begin with?
I know how confusing this may sound to you but sometimes only the uterus is removed during a hysterectomy and not the cervix. (This is called a supracervical hysterectomy.) It is still vital to get a yearly pelvic exam in order for your doctor to check for any signs of vaginal, vulvar or anal cancer. When getting a hysterectomy done, it’s important to ask your doctor if you still have a cervix and/or ovaries after your operation. If you had a hysterectomy, like you have Molly, and you don’t know if it included your cervix and/or ovaries, be sure to ask your doctor.
There are many varying and controversial opinions regarding whether a pap smear screening is needed yearly, whether you have had a hysterectomy or not. It’s important for you to take note of what your doctor’s specialty is and when, what country, and how long ago he or she graduated from his/her residency.
Medical treatment options change as medicine progresses. For some patients, it depends on if you have had regular pap smear screenings that were all normal and you are not at high risk of cervical cancer.
It is always the best decision to ask your doctor. However, it is also just as important for you to keep up with the latest trends in women’s health care via the Internet in order to be your own best advocate in preventative medicine and so you can ask questions. If you are unsure about your own hysterectomy or information about medical treatment options, the best person to ask is an OB/GYN physician—for that is his or her specialty, just as you would ask a cardiologist a question regarding your heart condition.
A yearly periodic visit for your screening physical exam along with a pelvic exam is the most important aspect of maintaining your health and cancer prevention. To be most effective, the test performed for you must be tailored to your own individual risk factors, and not just according to a set of guidelines set up by an agency. These are simply guidelines, not global rules—for every one of us is unique and have varying risk factors.
The American College of Obstetricians and Gynecologists have set up many of these guidelines, which can vary due to the progress and research of medicine. This includes recommending yearly pap smears, beginning with the onset of sexual activity and no later than 21 years of age.
A pap smear is a very successful screening test to help find cervical cancer early. It is also a highly effective means of screening for cervical/vaginal cancer when the cervix is removed, for the sampling comes from the vaginal cuff (the area of the upper vagina where the cervix was located).
A pap smear is also the best tool to help doctors detect precancerous cells that can lead to cervical cancers. If detected early, cervical cancer can be cured. Don’t be afraid to tell your doctor that it has been 5 – 10 years since your last pap. You do not need a lecture from the doctor, for you are here now.
Half of new cases of cervical cancers are found each year with women over the age of 50. Many women over 50 die because either they have not gone to a doctor or they went and never had a pap test/pelvic exam for many years so their cervical/vaginal cancers were diagnosed too late. HPV (Human Papilloma Virus), a sexually transmitted infection, is the main culprit for these abnormal cells. Pap smears can help detect cervical/vaginal cancers and precancerous lesions. Without a pap smear, it is nearly impossible for your doctor to detect these unless it has advanced and actually grown into a visible physical mass.
Sometimes patients are told that they are too old to need a pelvic exam or that they do not need a pap test. This is so wrong!
You are never too old to have a pap test. No woman is exempt from having a pap smear, especially if you are sexually active, for no one is exempt from getting cervical/vaginal cancer.
How often you get a pap smear depends on your health history of normal pap smears and a negative HPV test (human papilloma virus).
Who Is At Risk?
1) All women with or without a cervix who have had sex at some time in their lives, even if it was monogamous. (The sexual relations do not have to be recent.)
2) Those with a weakened immune system due to HIV/Aids/Cancer/Elderly
3) Those with a history of in-utero exposure to DES (Diethystilbestrol), a medication taken by a mother to prevent miscarriages and pre-term births during the period 1938 -1971.
4) Any women who are at high risk of cervical cancer, meaning they have had abnormal pap smears with positive high risk HPV tests.
5) Any woman who has had multiple sexual male partners or exposure to males who have had multiple sexual partners. A male does not have to show any signs to be a carrier of the HPV virus.
7) Any woman who has had a hysterectomy due to cancer.
Many people ask: What are some of the symptoms or signs of cervical/vaginal cancer? Are they something I can look for myself?
1) There are no signs, unfortunately, for you to look for. Like the doctors, the only way for you (or they) to detect any changes in your risk or to find any indication of cancer is with a pap test.
2) If you experience abnormal vaginal bleeding, intermittent bleeding, bleeding after sex, or bleeding after menopause, this is something important to discuss with your doctor.
3) Abnormal or persistent vaginal discharge (pink, brown, red) should also be brought up during your next doctor’s visit.
4) Pelvic pain can also be an indication.
So, Molly, a woman needs gynecological care at every stage of her life, whether you have had a hysterectomy or not. A pelvic exam is needed annually as well as a pap smear as directed by your physician in order to annually check for abnormalities of your vagina, vulva, bladder, skin of your external genitalia, anus, and ovaries (if you have them). The other most important factor for you is your follow-up care, especially with an OB/GYN or if needed a Gynecologist Oncologist (a doctor who specializes in women’s pelvic cancer), now that you have had an abnormal pap.
Many times you may give up and stop pursuing the medical support you need due to your frustration, which I do not blame you for. I encourage you to please keep up with your follow-up treatment plan and ask questions to your doctor, as well as use the Internet so you can keep up with the latest treatments available.
I hope this letter helps you to realize that vigilance and education combined with being your own best patient advocate will help keep you safe!
I appreciate your letter to me, for you have brought up a great question and an important wake-up call to all of us who have had a hysterectomy.
My thoughts are with you as well as my best wishes for a good outcome.
- Posted By: DRC Editor
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