Is a Pap (Papanicolau) smear still necessary after a partial hysterectomy?

Pap Smear After Partial Hysterectomy

Yes, women who have had a partial (subtotal/supracervical) hysterectomy must continue regular cervical cancer screening exactly as if they had not undergone hysterectomy, because their cervix remains intact. 1

Screening Protocol for Partial Hysterectomy

Women with a subtotal hysterectomy should follow standard cervical cancer screening guidelines:

• Cytology every 3 years (ages 21-65) OR co-testing (cytology + HPV) every 5 years (ages 30-65) 1
• The presence of the cervix means the same cancer risk exists as in women without hysterectomy 2
• Screening should continue through age 65 if adequate prior negative screening is documented 1

Critical Distinction: Total vs. Partial Hysterectomy

The type of hysterectomy fundamentally determines screening needs:

Partial (Subtotal) Hysterectomy = Continue Screening

• Cervix remains in place, requiring ongoing surveillance 2, 1
• No change in cervical cancer risk 1

Total Hysterectomy = Generally Stop Screening

• Cervix removed for benign disease means screening provides no benefit 2, 1
• Vaginal cancer is extremely rare (1-2 per 100,000 women annually), and screening has essentially zero benefit 1
• An estimated 10 million US women are screened unnecessarily after total hysterectomy 3

High-Risk Exceptions Requiring Continued Screening After Total Hysterectomy

Even with cervix removal, certain women must continue screening:

• History of CIN2/3 (high-grade precancerous lesions): Screen for 20-25 years after treatment, even past age 65 1, 4

  • Initial screening every 4-6 months until three consecutive normal tests within 18-24 months 1, 4
  • Then annual screening for the full 20-25 year period 1

• History of cervical cancer: Continue screening indefinitely for as long as reasonably healthy 2, 1, 4

• In utero DES exposure: Continue indefinitely due to elevated clear cell adenocarcinoma risk 2, 1, 4

• Immunocompromised status (HIV, transplant, chronic immunosuppressants): Continue indefinitely 2, 1, 4

Common Pitfalls to Avoid

• Assuming all hysterectomies are the same: Always verify whether the cervix was removed through medical records review 1
• Stopping screening prematurely in high-risk women: The 20-25 year surveillance period after CIN2/3 treatment is absolute, regardless of age 1, 4
• Relying on patient recall: Patients often cannot accurately report hysterectomy type or indication—documentation is essential 4
• Unnecessary screening after benign total hysterectomy: Research shows 69% of women with total hysterectomy continue to receive Pap smears despite no benefit, representing approximately 10 million unnecessary tests 3

Evidence Quality Note

The distinction between partial and total hysterectomy screening is consistently supported across multiple authoritative guidelines including the American Cancer Society, CDC, and ACOG 2, 1. The recommendation for continued screening with partial hysterectomy has remained unchanged across guideline updates from 2004 through 2025 2, 1.