Indications for continued annual cytologic screening:
(1) The presence of cervix (i.e, a supra-cervical hysterectomy was performed rather than a total hysterectomy)
(2) A history of a significant abnormality detected in a previous cytologic preparation
(3) The hysterectomy was done for management of a gynecologic cancer.
(4) The woman has risk factors for vaginal cancer.
Risk factors for vaginal cancer:
(1) older age (postmenopausal age range)
(2) exposure to diethylstilbesterol (DES) when the woman was a fetus
(3) history of cervical cancer
(4) history of cervical dysplasia
(5) HPV infection (condyloma and VIN)
(6) vaginal adenosis
(7) chronic vaginal irritation
(8) uterine prolapse (less of a concern after hysterectomy)
(9) smoking
where:
• I am not sure that being older alone would be reason to do an annual examination, although some schedule of continued screening seems reasonable.
If none of these factors are present, then screening may be performed every 3-5 years, or even less often.
