To have health and balance in our lives, we have to be able to give ourselves permission to have pleasure and fun, but at the same time be aware of and take responsibility for our actions. Because of this, when we have knowledge, we are in a position of power to make the best decisions for ourselves. This is true for every aspect of life including our sex lives and decisions related to it. And I would briefly like to comment on how this relates to new recommendations announced today from the American College of Obstetrics and Gynecology for PAP smears (unfortunately timed just after the new recommendations for mammograms).
The ACOG is “simplifying” PAP guidelines by stating that women do not need to get their first PAP until age 21 years old. Furthermore, they are recommending that now women only need to have a PAP smear every 2 years (instead of yearly) if their test results have been normal. There used to be additional recommendations related to the age that a woman becomes sexually active, but these are now being touted as ‘confusing.’ The new recommendations have been established after years of studies and data collection and there is validity to the points being made by the ACOG. But what I see missing here is the element of patient education and information.
We know that girls are becoming sexually active at an earlier age than a decade ago. We also have studies that show increasing incidence of Chlamydia and even Syphilis (up 36% in women in the US!). Also, a recent study from the Univ. of Waterloo in Canada found that an increasing number of seniors are contracting HIV from unprotected sex – possibly because they don’t believe that they are at risk for such STDs.
Women need to know the facts about sexual activity and how it related to cervical cancer risk, as well as risk for all STDs and complications that accompany them. They need to be told (repeatedly) that the more sexual partners they have, the increased risk for developing cervical cancer. Education is the key for them to understand their risk so that they can make smart decisions both about their sexual activity and their medical care related to it. If teenage girls are starting to have sex at an earlier age (sometimes 7 years before they hit the age of 21), they need to know that they should be going to the ObGyn for a pelvic exam and a PAP smear. And girls who have received the HPV vaccine should not consider themselves ‘protected’ since the injection does not protect against all strains of HPV known to cause cancer. I do not think that we can teach abstinence with the hope that it will work. So instead, we need to have an over-abundance of education about risks and responsibilities that come with being sexually active. Knowing when your need for PAP is increased because of your sexual activity is one of those responsibilities and leaving it up to statistics is dicey.