From the Guidelines
It is recommended to perform a Pap smear on a 23-year-old nulliparous and sexually abstinent patient every 3 years, as current guidelines suggest beginning cervical cancer screening at age 21 regardless of sexual history. According to the American Cancer Society guidelines 1, cervical cancer screening should begin at age 21 years, and women aged 21 to 29 years should receive cytology screening every 3 years. HPV testing should not be used for women in this age group. The guidelines also state that women aged younger than 21 years should not be screened, regardless of their age of sexual initiation.
The decision to perform a Pap smear on a 23-year-old nulliparous and sexually abstinent patient should be based on the current guidelines and the patient's individual health history and concerns. Some key points to consider include:
- The patient's age and the recommended screening schedule
- The patient's sexual history and the risk of HPV exposure
- The patient's overall health and any specific gynecological concerns or symptoms
- The importance of shared decision-making between the patient and healthcare provider
It's worth noting that the guidelines are based on a systematic evidence review and a collaborative process that included 25 organizations 1. The American Cancer Society estimates that cervical cancer incidence and mortality rates have declined since the introduction of the Pap test in the mid-20th century, and rates continue to decline to this day 1. However, the guidelines prioritize the patient's individual health history and concerns, and the decision to perform a Pap smear should be made on a case-by-case basis.
In terms of the patient's specific situation, being nulliparous and sexually abstinent does not necessarily exempt them from cervical cancer screening. The guidelines recommend screening based on age, and the patient's individual risk factors should be taken into consideration. If the patient has specific gynecological concerns or symptoms, a pelvic exam might be warranted, but this would be separate from cervical cancer screening. Ultimately, the decision should be made through shared decision-making between the patient and healthcare provider, considering the patient's individual health history and concerns.
From the Research
Cervical Cancer Screening Guidelines
The American guidelines recommend cervical cancer screening for individuals with a cervix aged 21 through 65 years 2.
Screening Recommendations for Young Adults
For people aged 21-29, screening with a Pap test every 3 years is recommended if the results are normal 2.
Considerations for Nulliparous and Sexually Abstinent Patients
There is no specific guidance on screening for nulliparous and sexually abstinent patients. However, the general recommendation is to start screening at age 21, regardless of sexual activity 2, 3.
Pap Smear Screening
Pap smear screening is recommended for any adolescent who has ever been sexually active or exposed to human papillomavirus or is 18 years of age 3.
HPV Testing
HPV testing is also an option for cervical cancer screening, and it can be used in combination with Pap testing to assess the risk of cervical precancer and determine the need for colposcopy or treatment 2, 4, 5.
Screening Strategies
Offering self-sampling kits for HPV testing can increase participation in cervical cancer screening, especially among women who are currently not screened 6.
- Key points to consider:
- Cervical cancer screening is recommended for individuals with a cervix aged 21 through 65 years.
- Pap test every 3 years is recommended for people aged 21-29 with normal results.
- HPV testing can be used in combination with Pap testing to assess the risk of cervical precancer.
- Self-sampling kits for HPV testing can increase participation in cervical cancer screening.