Does a patient with a history of partial hysterectomy (surgical removal of part of the uterus) for endometriosis require regular Pap (Papanicolaou) smears?

Pap Smear After Partial Hysterectomy for Endometriosis

If the cervix was removed during the partial hysterectomy for benign endometriosis, no Pap smear screening is needed; if the cervix remains intact (supracervical hysterectomy), continue regular Pap smear screening as if no surgery occurred. 1, 2

Critical First Step: Determine What Was Removed

The term "partial hysterectomy" is ambiguous and requires immediate clarification through surgical records review. You must determine whether the cervix was removed or retained, as this completely changes the screening recommendation. 2, 3

• If cervix was removed (total hysterectomy): No Pap smears are indicated for benign endometriosis 1, 2
• If cervix remains (supracervical hysterectomy): Continue standard cervical cancer screening 1, 2

When Cervix Was Removed: No Screening Needed

Discontinue all Pap smear screening immediately if the hysterectomy was performed for benign endometriosis with complete cervix removal. 2, 1 This represents unnecessary healthcare utilization with no clinical benefit. 4

The evidence supporting this is unequivocal:

• Screening women after total hysterectomy for benign disease provides zero benefit and should be stopped 2, 1
• Vaginal cancer is extremely rare (1-2 per 100,000 women annually), and screening the vaginal cuff requires 663 Pap tests to detect one case of vaginal dysplasia with no improvement in patient outcomes 2
• An estimated 10.6-11.6 million women in the US receive unnecessary Pap smears after hysterectomy for benign conditions 4

Common Pitfall to Avoid

Many clinicians continue screening women after total hysterectomy for benign disease—this practice declined from 73.3% in 2000 to only 58.7% in 2010, meaning the majority are still being inappropriately screened. 5 Do not perpetuate this overuse of resources. 4

When Cervix Remains: Continue Standard Screening

If the patient had a supracervical (subtotal) hysterectomy with cervix retention, continue regular cervical cancer screening exactly as recommended for women who have not undergone hysterectomy. 1, 2

Specific screening intervals:

• Ages 21-29: Cytology alone every 3 years 2
• Ages 30-65: Either cytology every 3 years OR co-testing (cytology + HPV) every 5 years 2
• After age 65: May discontinue if adequate prior negative screening documented (3 consecutive negative cytology tests OR 2 consecutive negative HPV tests OR 2 consecutive negative co-tests within past 10 years) 6, 2

The cervix remains at risk for HPV-related cervical cancer regardless of uterine body removal. 1, 2

Special Circumstances That Would Change Recommendations

Even if the cervix was removed, screening would still be required if any of these apply:

• History of high-grade cervical lesions (CIN2/3): Continue screening for 20-25 years after treatment, even past age 65 6, 2
• History of cervical cancer: Continue screening indefinitely 6, 2
• Immunocompromised status: HIV, transplant recipients, chronic immunosuppression require continued screening 6, 2
• In utero DES exposure: Continue screening indefinitely 6, 2

However, endometriosis is a benign condition and does not fall into any of these high-risk categories. 7

Verification Through Medical Records

Never rely on patient self-report alone to determine hysterectomy type. 6, 2 Studies show only 67% of women correctly identify whether their cervix was removed during their own surgery. 3 Review operative notes and pathology reports to confirm:

• Exact procedure performed (total vs. supracervical hysterectomy)
• Whether cervix was removed
• Pathologic indication (confirm benign endometriosis, not high-grade cervical lesions)

This documentation review is essential before making any screening recommendation. 6, 2