Dear Dr. Samson,
I have two teenage daughters and wonder: At what age are vaginal exams indicated for Pap smears?
This is one of the most common questions I am asked by mothers of teenage daughters.
In the past, vaginal exams were instituted as part of a pre-marriage evaluation. Because of this timing, it was assumed that the examination was performed to assess the anatomy and to be sure it was normal for reproduction. Many years ago that was, in fact, the motive.
As time progressed, the Pap smear was developed, which allowed the evaluation of the cells at the cervical opening. This microscopic exam gave the physician the ability to discover cancer or "precancer" cells while they were still at a local level. This afforded local management and eradication of potentially devastating lesions.
The vaginal exam then took on new importance. Regular exams became mandatory for good health care and cancer control. For years the age-old axiom that such exams should be instituted with marriage persisted.
As social customs and moral practices changed, sexual activity started at younger ages and in no relation to marriage. We can argue about the wisdom of premarital sexual activity, but we cannot deny it is much more common.
Many clinical studies have documented the increased risk of cervical neoplasia (presence of cancer or "precancer" cells in the cervix) in the sexually active female. In addition, the use of birth control pills in the adolescent population has increased. Thus, the incidence of the vaginal exam in the teenage population has followed this trend.
With this in mind, the answer to your question seems apparent. Routine vaginal exams with Pap smears would seem warranted for all teenagers on birth control medication and adolescents who are sexually active.