Mayo Clinic: At what age should a teenage girl have her first
Pap smear and gynecologic exam? Should this be done by a
pediatrician or another provider?
Pelvic exams and Pap smears are not necessary in healthy,
adolescent girls who are not sexually active and who do not
have gynecologic symptoms or other concerns. The recommended
age for young women who have not previously needed a Pap smear
to begin having the test is 21. Primary care providers, such
as those in family medicine or internal medicine, can perform
that exam, or a gynecologist can perform the exam.
past, many health care providers used to recommend that teens
have a Pap smear at 16 or 18. Now, however, the American
College of Physicians does not recommend any routine
gynecologic exams for teens at low risk of having the HPV or
other sexually transmitted infections.
purpose of a Pap smear ó a procedure that collects cells
from the cervix ó is to check for changes in those cells
that could be a sign of cancer and look for the presence of
high-risk types of HPV that are known to cause cervical
the most common sexually transmitted infection in the U.S.
Although most cases of HPV do not cause symptoms or lead to
problems, certain strains of the sexually transmitted HPV are
considered high risk, and can lead to cancer and potentially
be deadly if left untreated. Two strains of the virus cause 70
percent of all cervical cancer. You can greatly reduce your
risk of HPV infection and cervical cancer by getting the HPV
vaccine. This anti-cancer vaccine most effectively builds
immunity when itís given between ages 9 and 14.
are not sexually active as a teen, in most cases there is no
need for a Pap smear because your risk of cervical cancer is
low, and you have no risk of HPV or other sexually transmitted
infections. Once you begin having sex, a Pap smear may be
appropriate. But even in many of those situations, Pap testing
still may not need to begin until 21.
some health care providers required a pelvic exam ó an
evaluation of the vulva, vagina, cervix, ovaries, uterus,
rectum and pelvis for any abnormalities ó before they would
prescribe contraceptives. Again, that is no longer the case. A
pelvic exam is not needed to obtain birth control. For most
healthy women, the first pelvic exam also can wait until 21.
young women whose medical history puts them in a higher risk
category for infection or cancer, a Pap smear or pelvic exam
may be recommended at an earlier age. Those risk factors
include a weakened immune system due to chemotherapy, organ
transplant or long-term corticosteroid use; exposure to the
medication diethylstilbestrol, also known as DES, before
birth; and HIV infection.
symptoms also may trigger a pelvic exam, such as heavy,
painful periods; pelvic pain or pressure; abnormal bleeding or
discharge; and itching, pain or lesions in the vulva or
vagina. In those situations, a pelvic exam may be necessary,
but a Pap smear typically is not required.
is time to get a pelvic exam and Pap smear, itís best to
work with a health care provider you know and trust. Before
the exam, ask your health care provider about what will happen
during the exam and what you can expect. Some providers have
anatomical models they can use to describe the procedures
beforehand, so you can clearly see what will happen. These
procedures are important exams, but they need not be a source
of anxiety or fear. If you have questions or concerns, talk to
your health care provider.