It’s not that I don’t want you to have a Pap…

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Hello, 18-year-old patient,

It is so fabulous that you’re as motivated about your health as you are, scheduling a Pap as soon as you arrived at college! You. Are. Awesome. And I can’t wait to talk about all the ways you can continue to be empowered about your gynecologic and sexual health. Before we get started, though, I have good news (I hope you’ll agree!). You don’t need a Pap test today! In fact, you don’t need a Pap at all until age 21!

See, the thing is, the guidelines changed awhile back, and it’s now no longer recommended for women to have Pap tests at all before the age of 21. I’m not really sure why your provider at home has been asking you to come in for Pap tests every year since you were 16. Weird. Maybe you can ask them?

The thing is, your immune system is in such tip-top shape at your age, and (sorry to say) HPV is so very, very (VERY) prevalent, that even if you have been exposed to HPV, and you develop a few abnormal cervical cells because of it, it’s all but guaranteed that your body will take care of the problem completely without us needing to do anything at all. Yay immunity! And if we did a Pap anyhow, and found a few of these funky-looking cells, and then did a whole bunch of procedures on your cervix you didn’t need…believe me, this guideline change is a good thing.

Plus, you’ve had the HPV vaccine, right? That’s loads of protection against the highest-risk strains of HPV right there. You’re already doing everything you need to do right now to defend yourself against cervical cancer.

Keep in mind that when we talk about the Pap test, we’re talking about one very specific thing – a screening test for cervical cancer – and there’s tons of other stuff for us to cover today.

Now, let’s talk about contraception. And chlamydia screening. And smoking. And sleep. And…

*****

Hi there, 22-year-old patient,

It’s great to see you again! It seems like just yesterday you were here for your first Pap last year. Did you change majors again? How was your semester abroad in Barcelona? Have I mentioned how fun it is to live vicariously through your adventures?

I’m delighted that you’re so on top of things, coming back for your Pap test exactly one year after the last one. But I have good news (I hope you’ll agree!). You don’t need a Pap today! In fact, you don’t need another Pap for two more years!

See, the thing is, the guidelines changed awhile back to recommend that Pap tests be performed every 3 years for young women. I know, it’s hard to wrap your head around a change like this when you’ve been hearing about getting your “yearly Pap” since you were a little girl tagging along with your mom to her doctors’ appointments. But I’m not really sure why your provider at home still wants you to have a Pap every year. Weird. Maybe you can ask them?

The thing about HPV-associated cervical abnormalities is that they usually move really. slowly. Seriously slowly. And, most of them resolve on their own, without us doing a thing about them. So when we used to perform Pap tests every year, often we’d find abnormalities that your immune system would have cleared up completely if they’d had a little more time. Exceedingly frequent Paps => increased likelihood of discovering otherwise self-resolving abnormalities that we then feel like we have to do something about because we have a hard time leaving well enough alone as medical providers => possible unnecessary procedures with associated discomfort and risk of future pregnancy complications and whatnot for you.

Seriously, this is a change for the better.

But just because you don’t need a Pap, that doesn’t mean I don’t want to see you! I’d like to check in about loads of other things. Like birth control. And STI testing. And drinking. And SLEEP. And…

*****

Welcome back, patient of any age whatsoever,

It’s so good to see you! It’s always great to catch up.

I’m so, so sorry you ran out of birth control because you thought you needed a Pap to get a refill. First you had midterms, and then you had to cover a bunch of extra shifts at work, and then there was some sort of friend drama you really don’t want to get into, and before you knew it a month or two had passed before you were able to get back to the clinic for a Pap test.

So, first of all, I’m delighted give you a refill today, whether it’s time for you to have a Pap or not. Especially because it sounds like your backup method of condoms and withdrawal haven’t really been working so well, since you took Plan B twice in the last month. Let’s get you back to Plan A ASAP.

Second of all, please, PLEASE don’t let yourself run out of birth control pills again because you think you’ll need to have a Pap test first. I will never, and I mean never ever, refuse to refill your birth control just because you’re overdue for a Pap.

I might ask you about it, and recommend it, and counsel you about why cervical cancer screening is important, and try to brainstorm with you some ways around the possible obstacles you’re facing when it comes to getting one scheduled (fear? timing? money?), but I most definitely won’t refuse to refill your pill just because you haven’t had a Pap. It feels a little like letting someone run out of their cholesterol meds because they haven’t had their colonoscopy yet. Why should one predicate the other? Seriously. No.

I’m not really sure why your last provider told you they wouldn’t refill your pill prescription until you had a Pap. Weird. Maybe you should ask them?

This doesn’t mean I don’t want to see you at all! If you’re on the pill, I’d still like you to come in periodically so we can measure your blood pressure, and touch base about side effects and any possible new risk factors, and so on and so forth. But seriously, if you’re running out, and haven’t been able to see me in awhile, just give me a call.

Please.

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