From the Guidelines
After a total hysterectomy for benign conditions, a 37-year-old woman does not need routine vaginal Pap tests, as there is no cervix remaining to develop cervical cancer. This recommendation is based on the most recent and highest quality study available, which prioritizes morbidity, mortality, and quality of life as the outcome 1. The risk of developing vaginal cancer is very low, occurring in only about 1 in 1,100 women.
Key Considerations
- If the hysterectomy was due to cervical cancer or precancerous changes, regular vaginal vault Pap tests are recommended.
- Women who have had a supracervical hysterectomy, where the cervix remains, should continue regular Pap testing according to standard guidelines.
- Regular gynecological exams are still important, regardless of whether Pap tests are needed, to check for other gynecological issues.
- A history of HPV, abnormal Pap tests, or other risk factors may lead to continued surveillance even after hysterectomy.
Evidence-Based Recommendations
- The American College of Obstetricians and Gynecologists (ACOG) and other guidelines support discontinuing cervical cancer screening after total hysterectomy for benign disease, if the cervix was completely removed 1.
- Women with a history of cervical intraepithelial neoplasia (CIN) 2-3, or those with a history of cervical carcinoma, should continue screening after hysterectomy for as long as they are in reasonably good health and would benefit from early detection and treatment 1.
From the Research
Vaginal Pap Smear Necessity after Hysterectomy
- A 37-year-old woman who has undergone a hysterectomy for benign disease may not require a vaginal Pap smear, as the risk of vaginal cancer is extremely low 2, 3, 4.
- The US Preventive Services Task Force has recommended that routine vaginal Pap smear screening is unnecessary for women who have undergone hysterectomy for benign disease 3, 4.
- Studies have shown that continued vaginal Pap smear screening in women after hysterectomy for benign disease does not appear to be useful, particularly in those aged 65 years or older 3.
- However, women who have undergone hysterectomy for cervical precancer or cancer may benefit from annual monitoring, including vaginal Pap smears, to detect vaginal recurrence of HPV-induced pathology 5, 6.
- The decision to perform a vaginal Pap smear after hysterectomy should be based on the indication for the hysterectomy, with those who had benign uterine non-HPV-induced lesions not requiring systematic follow-up cytology 5, 6.