Do I need a Pap (Papanicolau) smear if I'm not sexually active?

Pap Smear Screening for Women Who Are Not Sexually Active

Women who are not sexually active do not need routine Pap smear screening for cervical cancer. 1

Rationale for Recommendation

The primary purpose of cervical cancer screening is to detect human papillomavirus (HPV) infection and related cellular changes that could progress to cervical cancer. HPV is a sexually transmitted infection that is the causative agent in nearly all cases of cervical cancer.

Risk Assessment

• HPV is transmitted through sexual contact, including genital-to-genital contact
• Women who have never been sexually active have an extremely low risk of HPV infection
• Without HPV infection, the risk of developing cervical cancer is negligible

Current Guideline Recommendations

The 2021 CDC Sexually Transmitted Infections Treatment Guidelines specifically address cervical cancer screening and note the following important points:

• Cytology (Pap tests) and HPV tests are not considered screening tests for sexually transmitted infections 1
• Cervical cancer screening is recommended for all persons with a cervix, regardless of sexual orientation or gender identity 1
• However, the guidelines do not specifically recommend screening for those who have never been sexually active

Special Populations

For adolescents (under age 21):

• Cervical cancer screening is not recommended in immunocompetent adolescents 1
• This is because HPV infections and squamous intraepithelial lesions in adolescents are more likely to regress than those in older persons 1
• The only exception is for adolescents with HIV infection, who should be screened 1 year after onset of sexual activity, regardless of age 1

When to Begin Screening

The timing for initiating cervical cancer screening should be based on:

1. Sexual activity status (current or past)
2. Age
3. Immune status

For women who have never been sexually active:

• No screening is necessary
• Screening should begin when/if sexual activity begins, following age-appropriate guidelines

Potential Harms of Unnecessary Screening

Performing Pap smears in women who have never been sexually active may lead to:

• Unnecessary discomfort and psychological distress
• False-positive results leading to additional unnecessary procedures
• Resource utilization without clinical benefit

Important Counseling Points

When discussing this recommendation with patients:

• Explain that HPV is sexually transmitted and is the causative agent for cervical cancer
• Clarify that "sexual activity" includes any genital-to-genital contact, not just penetrative intercourse
• Emphasize that screening recommendations will change if sexual activity begins
• Document the discussion about screening decisions in the medical record

When to Reconsider Screening

Screening should be initiated:

• When sexual activity begins (following age-appropriate guidelines)
• If there is a history of sexual abuse or assault that the patient may not have previously disclosed
• For patients with HIV infection, regardless of sexual activity status

By following these evidence-based recommendations, unnecessary procedures can be avoided while still ensuring appropriate cervical cancer prevention for women based on their actual risk factors.