Is a Papanicolaou (Pap) smear necessary after a hysterectomy?

From the Guidelines

After a hysterectomy, whether you need Pap tests depends on the type of hysterectomy and why it was performed, with the most recent guidelines from 2012 indicating that women who have had a hysterectomy with removal of the cervix and no history of high-grade precancerous lesion or cervical cancer do not require Pap tests 1. If you had a total hysterectomy (removal of both the uterus and cervix) for non-cancerous conditions, you generally don't need Pap tests anymore. However, if your hysterectomy was due to cervical cancer or pre-cancer, you should continue screening with Pap tests of the vaginal cuff (the top of the vagina where the cervix used to be) every 3-5 years for at least 20 years. Some key points to consider include:

• The type of hysterectomy performed: total (removal of uterus and cervix) or supracervical (removal of uterus, cervix remains)
• The reason for the hysterectomy: non-cancerous conditions, cervical cancer, or pre-cancer
• The presence of a history of cervical intraepithelial neoplasia (CIN) 2-3 or cervical carcinoma
• The patient's overall health and risk factors It's essential to discuss your specific situation with your healthcare provider, as they can provide personalized recommendations based on your medical history and risk factors, taking into account the guidelines from reputable sources such as the US Preventive Services Task Force (USPSTF) 1.

From the Research

Papanicolaou (Pap) Smear Necessity after Hysterectomy

• The necessity of a Papanicolaou (Pap) smear after a hysterectomy is a topic of discussion among medical professionals, with various studies providing evidence-based recommendations 2, 3, 4.
• According to the US Preventive Services Task Force, routine Pap smear screening is unnecessary for women who have undergone a total hysterectomy for benign disease and do not have a history of high-grade precancerous lesion or cervical cancer 3.
• Studies have shown that many women continue to receive Pap testing after a hysterectomy, despite the recommendations against it 2, 3, 4.
• The proportion of women reporting a recent Pap test after a hysterectomy has declined over the years, but many women are still being screened unnecessarily 2, 3.

Recommendations for Cervical Cancer Screening

• Leading national organizations recommend against Pap testing for women without a cervix following a hysterectomy who do not have a history of high-grade precancerous lesion or cervical cancer and for women older than 65 years with adequate prior screening and who are not at high risk 4.
• Cervical cancer screening guidelines suggest that women with a cervix aged 21 through 65 years should be screened for cervical precancer and cancer using HPV testing, and if HPV-positive, genotyping and cytology testing should be performed to assess the risk of cervical precancer and determine the need for colposcopy or treatment 5.
• For women who have undergone a hysterectomy for benign conditions, there is a need for continuing cytological follow-up, even after the procedure 6.

Overuse of Pap Testing

• The overuse of Pap testing among women without a cervix and among older women is a concern, with studies estimating that almost 10 million women, or half of all women who have undergone hysterectomy, are being screened unnecessarily 3, 4.
• The continued screening of women who are not at risk of cervical cancer can lead to unnecessary procedures and costs, highlighting the need for adherence to evidence-based recommendations 2, 3, 4.