Do Women 65 and Older Need Pap Smears?

Pap smears are a normal, if a bit uncomfortable, part of annual well-women visits. But can you stop getting them once you hit 65?

Recent news articles suggest you should. Pap smears test for cancer of the cervix, and that organ is essentially inactive once you’re well past menopause. Yet 20 percent of people diagnosed with cervical cancer have entered their silver years. In that case, why wouldn’t everyone continue being tested?

This seems like a contradiction, yet the answer is actually crystal clear: Your history determines if you should still get pap smears or not.

What Is a Pap Smear?

A pap smear is a minor procedure used to look for cervical cancer. It’s also called a Pap test and a Papanicolaou test. Your doctor, nurse practitioner or midwife will widen your vagina with a gadget called a speculum. Then, that medical professional will insert a special instrument inside your vagina, brush away some cells and send those cells to be tested. It’s common for women 25 and up to receive this test as part of a well-woman exam.

Pap smears might be done alone, or as part of a “co-test” that involves looking for signs of the HPV (human papillomavirus) at the same time. You won’t know the difference if you have both tests done at once. (An HPV test alone will test for the HPV virus, which could lead to cervical cancer. It is performed the same way.)

Is there a downside to having a pap smear? Not really, assuming your insurance or budget covers the expense. You’ll experience discomfort, and you may be emotionally uneasy having a procedure done to such an intimate part of your body. This is especially true of women who’ve experienced sexual trauma. As you age, your vaginal tissues get thinner and dryer, so the physical discomfort might be magnified a bit.

Who Does Not Need a Pap Smear at 65+?

The guidelines issued by medical organizations are just that: guidelines, or recommendations. No rule is set in stone. The decision about whether or not to continue pap smears is very patient-specific. Everyone has different risk factors.

In general, you likely no longer require pap smears starting in your mid-60s if you meet one of these requirements:

• You’ve had two consecutive negative HPV (human papillomavirus) tests within the past 10 years; one of those must have been within five years.
• You’ve had three negative pap smears within 10 years.
• You’ve had two consecutive negative co-tests (pap smear plus HPV test) within the past 10 years.
• You’ve had the same, or no, sexual partners for many years.
• You have had a total hysterectomy, meaning your cervix and uterus have been removed — unless that procedure was due to cervical cancer or pre-cancer.

In other words, if you’ve been tested regularly over the past decade, with no questionable results, and you haven’t had cervical cancer, you might talk to your doctor about skipping pap smears in the future. If having the test will give you peace of mind, however, feel free to continue.

Who Still Needs a Pap Smear at 65+?

Plenty of women should continue receiving annual or bi-annual pap smears. The reasons vary and include:

• You haven’t met the requirements listed above. That means you haven’t been tested for cervical cancer or HPV regularly over the past decade, or haven’t had negative results from those tests.
• You’re immunocompromised. For example, those with HIV need to get pap smears for the rest of their lives.
• You’ve had cervical cancer.
• You’ve had precancerous lesions of the cervix.
• This one is rare but crucial: If your mother took a certain drug known as D.E.S., for diethylstilbestrol, while pregnant with you, you are at risk for a rare type of cervical cancer. Do not stop being tested as you grow older.
• You’ve had multiple sex partners in recent years and your life expectancy exceeds 10 years.
• You have any of these red flags after completing menopause: discharge, discomfort, vaginal dryness, bleeding or painful intercourse.

In addition, if you haven’t had a paper smear in awhile, or had an abnormal result from a pap smear or HPV test within a decade, you’ll probably want to continue being tested every year or maybe every other year.

Even if you’re cleared of needing pap smears, you should still see a gynecologist every two years, at a minimum. Issues can still happen in the vulva, vagina and cervix. You can still get sexually transmitted diseases. You still need regular mammograms. Pap smears are only a small part of an annual well-woman exam.