Pap smear after hysterectomy…when and how often do you need one?

Will I still need a regular pap smear after hysterectomy?

Does removing the uterus and cervix mean the HPV is gone, or does the HPV still continue to live in your body?

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I am sure many women share this fear with me, especially those who had a hysterectomy for a cancerous or pre-cancerous condition (like I did). Waiting for your pap smear test results is nerve-racking, especially if you were diagnosed with dysplasia or early stages of cervical cancer before the hysterectomy operation. After the surgery, you just hope to leave this all behind you.

Will women still need pap smears after hysterectomy?

• Women will still need a pap smear after a hysterectomy when abnormal pap smears with CIN were the reason for the operation. When they remove the cervix, you can no longer get cervical cancer, but there is still the possibility that the high-risk HPV continues to exist and causes changes to the cells of the vagina wall. When there is no cervix, they will take a swab to collect cells from the vaginal cuff, also named a vaginal vault smear.
• After a partial or supracervical hysterectomy, the cervix remains intact, and the possibility of developing cervical cancer remains. Those women need to continue having regular pap smears. As the risk of cervical cancer increases as you grow older, screening remains important.
• On the other hand, if you have never had any abnormal pap smears in the past and they do a hysterectomy for a benign condition like endometriosis or prolapse, screening is not necessary anymore.

Post hysterectomy abnormal pap smear

There are many possible reasons for an abnormal pap smear after hysterectomy. Those usually are no cause for alarm. Many changes in a woman’s body after the operation can give abnormal test results, such as:

• Lack of estrogen can cause atrophic changes, like thinning and drying of the vaginal walls.
• Regeneration of the tissue after the surgery.
• Infections
• After radiation therapy to treat cervical cancer

Reasons for hysterectomy and abnormal Pap smears can also be:

• HPV infection
• Cell changes in the vagina wall, also called vaginal intraepithelial neoplasia (VAIN)
• Vaginal or vulvar cancer

How often do women need a pap smear after hysterectomy?

Women that had a hysterectomy for pre-cancerous changes of the cervix need their first pap (vaginal) smear 6 months after the hysterectomy. Usually, the next screenings are at 1 year and 2 years after the surgery. They can continue with a normal pap screening schedule if these return normal. If the test results return abnormal, the doctor may decide to do more frequent tests.

After a partial hysterectomy, women should follow routine pap smear screening recommendations that apply to all women from 21 to 65 years of age.

Until what age should a woman have a pap smear after hysterectomy?

Painful pap smears after menopause can make many women reluctant to go for their regular checkups. Vaginal dryness at that age can make pap smears an unpleasant experience.

If you are really hesitant to go for your next pap smear, consider asking your doctor for Vagifem or another topical estrogen. These vaginal tablets are a low-risk form of HRT that will provide short-term relief from vaginal dryness.

Recommendations on the age at which women can stop having pap smears may vary from country to country.

According to the US Preventive Services Task Force, women can stop their pap tests at 65, have three negative results in a row, and are not at risk of cervical cancer.

The Australian Government’s Department of Health sets the recommended age to stop screening at 70, but only if you had no abnormal Pap results in the last five years.

Technologies evolve, and recommendations for pap smears and HPV DNA TESTING keep changing. Stay informed by checking the latest recommendations for cervical screening from the US Preventive Services Task Force.

Reviewed by: Kimberly Langdon M.D. (OB/GYN)
Date reviewed: 18/3/2019

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