Pap smears after hysterectomy
Many women are unsure about whether a Pap smear is still required after having a hysterectomy (surgical removal of the uterus). This depends on a number of factors:
Was the cervix removed at the time of hysterectomy?
The majority of hysterectomies include the removal of the cervix (referred to as a total hysterectomy). In some cases the cervix is retained (referred to as a sub-total or partial hysterectomy). If the cervix has not been removed a woman is still at risk of cervical cancer and, therefore, needs to continue to have Pap smears.
Why was the hysterectomy performed?
There are many reasons why a hysterectomy is performed including heavy bleeding, genital prolapse, fibroids or cancer. If a hysterectomy is performed because of cancer of the uterus, cervix, ovaries or fallopian tubes then a woman may still require a smear to be taken from the upper part of the vagina (often referred to as a vaginal vault smear). Women who do not know why their hysterectomy was performed or women who had abnormal cells found at the time of surgery may also require a vaginal vault smear.
Were Pap smears normal before the hysterectomy?
If a woman has a history of high-grade Pap smear abnormalities she may require vaginal vault smears. If a woman does not know if she had abnormal Pap smears in the past or has not had a Pap smear she may require an initial vaginal vault smear to ensure no abnormalities exist.
In addition, women who are immunosuppressed (taking medication which suppresses the immune system, HIV) may also require vaginal vault smears. Having an impaired immune system increases the risk of cancer of the lower genital tract. Women who were exposed to the drug diethylstilboestrol (DES) in utero (referred to as DES daughters) also need to have smears after hysterectomy as exposure to this drug increases the risk of a rare form of vaginal cancer. DES daughters should undergo an annual DES exam which involves an internal pelvic examination, a visual inspection and palpitation of the vagina and vaginal smears.
Women in Queensland who have had a hysterectomy but are unsure as to whether they still need Pap smears can contact our Health Information Line for more information (07 3839 9988 or 1800 017 676).
Last updated: December 2008
© Women's Health Queensland Wide Inc. This article was written by Kirsten Braun and reviewed by the Women's Health Queensland Wide editorial committee. It was published in Health Journey Issue 4 2008.