From the Guidelines
A 37-year-old woman who has undergone a total hysterectomy for benign conditions does not need a vaginal Pap smear, as the risk of developing vaginal cancer is low and routine screening offers minimal benefit. This recommendation is based on the most recent and highest quality study available, which suggests that cervical cancer screening is not indicated for women who have undergone a total hysterectomy or removal of the cervix for benign gynecologic disease 1. The key points to consider in this scenario are:
- The type of hysterectomy performed: if it was a total hysterectomy with removal of the cervix, screening is not necessary, but if it was a supracervical hysterectomy where the cervix remains, regular Pap tests should continue following standard screening guidelines.
- The reason for the hysterectomy: if it was due to cervical cancer or precancerous changes, regular vaginal vault cytology screening should continue.
- The patient's history of abnormal Pap tests or high-risk HPV: if there is no history of abnormal Pap tests or high-risk HPV, routine screening is unnecessary. It is essential to note that even if Pap tests are not needed, regular gynecological exams are still necessary to monitor overall vaginal and pelvic health 1. In addition, women who have had a hysterectomy and have a history of cervical intraepithelial neoplasia (CIN) 2-3, or women for whom it is not possible to document the absence of CIN 2-3 before or as the indication for the hysterectomy, should continue to be screened until they have a 10-year history of no abnormal/positive cytology tests 1. However, the most recent study 1 takes precedence in guiding clinical decision-making, and its recommendations should be followed.
From the Research
Vaginal Pap Smear Necessity after Hysterectomy
- A 37-year-old woman who has undergone a hysterectomy may not require a vaginal Pap smear, as the risk of vaginal cancer is extremely low 2.
- The US Preventive Services Task Force recommends against routine cervical cancer screening for women who have undergone hysterectomy for benign disease, as they are not at risk of cervical cancer 3.
- However, women who have undergone hysterectomy for cervical precancer or cancer may benefit from vaginal Pap smear screening, particularly in the first 5 years after surgery 4.
- For women who have undergone hysterectomy for benign uterine non-HPV-induced conditions, there is no need for systematic follow-up cytology 4, 5.
- On the other hand, women with a history of HIV infection may benefit from vaginal Pap smear screening after hysterectomy, as they are at higher risk of abnormal vaginal cytology and vaginal intraepithelial neoplasia (VAIN) 6.
Risk Factors and Screening Recommendations
- Risk factors for vaginal cancer include a history of other lower genital tract neoplasia or cancer, smoking, immunosuppression, and exposure to diethylstilbestrol in utero 2.
- Women who have undergone hysterectomy for cervical precancer or cancer should undergo annual vaginal Pap smear screening for at least 5 years after surgery 4.
- HIV-infected women who have undergone hysterectomy may require more frequent vaginal Pap smear screening, as they are at higher risk of abnormal vaginal cytology and VAIN 6.