Pap Smear Screening After Supracervical Hysterectomy
Yes, you absolutely need to continue Pap smear screening after a supracervical (subtotal) hysterectomy because your cervix remains intact and at full risk for HPV infection and cervical cancer. 1, 2, 3
Why Screening is Required
Women who have undergone supracervical hysterectomy must be screened following the exact same recommendations as women who have not had any hysterectomy at all. 1, 3 The critical distinction is that supracervical hysterectomy removes only the uterine body while leaving the cervix in place, which means you retain the same cervical cancer risk as any woman with an intact cervix. 2, 3
The cervix remains at full risk for HPV infection and development of cervical dysplasia or cancer when retained during partial hysterectomy. 3 This is fundamentally different from total hysterectomy with cervical removal for benign disease, where screening provides zero benefit and should be discontinued. 2, 4
Your Specific Screening Protocol
For average-risk women aged 21-29 years with a retained cervix, screening should be performed every 3 years with cervical cytology alone. 4
For women aged 30-65 years with a retained cervix, you have three equally acceptable options: 4
- Cervical cytology (Pap smear) every 3 years alone
- High-risk HPV testing every 5 years alone
- HPV and cytology co-testing every 5 years
When to Stop Screening
Screening should continue until age 65-70 years, provided you have adequate prior negative screening history. 1, 3 After age 70, you may elect to stop screening only if: 1
- You have had no abnormal/positive cytology tests within the 10-year period prior to age 70
- There is documentation that the 3 most recent Pap tests were technically satisfactory and interpreted as normal
Critical Documentation Step
You must confirm through your operative notes or pathology reports whether your hysterectomy was truly supracervical/subtotal with cervical retention. 3 If the operative records document "supracervical hysterectomy" or "subtotal hysterectomy," the cervix is present and screening is necessary. 3 This verification step is essential because many women incorrectly assume they had total hysterectomy when cervical tissue actually remains. 2
Common Misconceptions to Avoid
Having multiple pregnancies does not eliminate cervical cancer risk, and screening remains necessary regardless of pregnancy history. 3 The presence of external genital warts does not warrant more frequent screening beyond standard intervals. 1
Do not confuse your situation with women who had total hysterectomy for benign disease—those women should never receive Pap screening as it provides no benefit. 2, 4 However, your retained cervix places you in an entirely different category requiring lifelong surveillance until the appropriate age cutoff. 1, 3
Special Circumstances Requiring Indefinite Screening
If you have any of the following high-risk conditions, you should continue screening indefinitely regardless of age: 1
- History of in utero DES exposure
- Immunocompromised status (HIV, organ transplant, chronic immunosuppressant therapy)
- History of cervical cancer or high-grade precancerous lesions (CIN2/3)