An Annual Check-in; Reasons to see your GYN Provider at Least Once a Year
It’s crazy to think that I’m currently completing continuing education articles for the 5 year renewal of my license. I can’t believe its already been 5 years! They say time flies when you’re having fun and in this case, “they” are right. I’ve loved getting to know my patient population, take part in hundreds of deliveries, and form relationships with my co-workers.
One of the hallmarks that drew me to midwifery in the first place was the continuity of care that far outstretched a woman’s labor and delivery experience in the hospital. Of course, that’s a very large part of what we do as CNM’s but not at all comprehensive. I wanted labor and delivery to be a moment I could continually refer back to and reflect on with a patient I would see years later. And for women who decide children are not a part of their life’s plan, I wanted to take part in their healthcare too.
Reading the title of this blog post you may have thought… “This is obvious, I should see a GYN provider every year for my pap smear.”…. and in which case you would be mistaken. I’ll be discussing why this is a common misconception and despite its misinterpretation, why you still should see a GYN provider on a yearly basis.
Let me preface this with a simple reminder that if you are dreading going to your GYN office because you don’t feel comfortable, heard, or an active participant in your care….find a new one.
Okay, because now you’re probably wondering… let’s quickly review what a pap test is and why we do it. A pap test is a collection of cells from the cervix- the lower anatomical aspect of your uterus. Think about a light bulb… the glass bulb is your uterus and the silver cap is your cervix. These cells are collected, examined in a laboratory setting and assessed for changes or irregularities in the form of cytology- or the examination of cells.
What might cause changes to the cells? HPV or Human Papilloma Virus. Without getting too medical, this virus is immuno-evasive – meaning it can express itself at certain times and not others but is always still present in the body after infection (think like the chicken pox). This virus particularly can cause changes to the cells (although very slow growing) that over time can result in abnormal pap results. The good part? We now have vaccines for the HPV virus that can help decrease, but not eliminate, this risk. There are certain strands that are higher risk than others, and these ones are targeted in the vaccine. It’s important to talk to your provider about your individual risk and your eligibility for this vaccine series.
The reason it is important to obtain Pap smear screenings is because changes to cervical cells over time, depending on the degree can lead to cervical cancer. In short, a Pap test is a routine screening done to prevent the incidence of cervical cancer in women around the world.
Now that we have reviewed what a pap test is and why we do it, let’s talk about when we collect it.
This first part is going to shock your grandma…. Gone are the days of performing pap tests prior to the age of 21. Despite childbearing, sexual activity, infections. etc. In granny’s day, Pap testing was started as soon as a woman became sexual active and done every year. That’s where the misconception comes from. This practice was proving to be doing more unnecessary harm than good in the long run. Remember, Pap testing is done to prevent cervical cancer. Although younger women typically have a higher rate of dysplasia (a fancy word for changes), they have a very very low rate of cervical cancer. This is in part because it typically takes a long time for the virus to make changes to the cells that would be concerning for cancer. This is also why some pap results lead to monitoring vs having a biopsy done right away. We won’t get into all the algorithms of test results and what they mean but your provider certainly will if necessary.
Now let me say here that new evidence is continually coming out and informing the way we as GYN providers provide care. It typically takes insurance companies about 15 years to catch up to common practices… ugh. Because of this, you may find that your insurance company still covers a yearly pap. I share this information so that you may have the knowledge you need to make an informed decision about your own testing and an evidence-based conversation with your provider.
Below you’ll find a graphic of the American College of Obstetricians and Gynecologists (ACOG’s) guidelines to Pap test screenings. These guidelines are for women who continue to have negative Pap result findings. If you personally have had any abnormal Pap test results, your care will be determined by your specific results in combination with your provider. You will also see additional health screening guidelines and their corresponding ages in the graph below.
*Please note, for specific screenings, including mammograms, continuing Pap testing after 65, and Bone Mineral Density, family or personal history can alter the initiation and frequency of screenings. This is yet another reason it’s important to seek out a provider who can comprehensively assess your specific history and construct a plan, in conjunction with you, going forward.
It’s important to note that alongside these screenings that are recommended, some on a yearly basis, (clinical breast exams) you should also be checking in with your GYN provider to discuss your overall gynecological health including your cycles, family/childbearing desires, nutrition & exercise habits as well as your sexual satisfaction to name a few. If you are not also seeing a primary care provider, your GYN provider may also be responsible for obtaining lab tests to assess for other parameters of health including thyroid function, lipids, vitamin deficiencies, and providing vaccines when appropriate.
I hope this post has been informative and encourages you to establish care and an open line of communication with your provider so that you feel empowered to receive evidence-based yet individualized care with someone you enjoy seeing every year. Cheers to knowing your Pap smears!
Stay well, you’re worth it!
Skyler Jacobs, CNM