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Menopause

Cervix closed - need pap smear

05/29/2008

Question:

Im 4 yrs into menopause and went to the dr. for a pap smear. He wasn`t able to do it as my cervix is closed. As I am a DES baby, I need a pap every six mos. (have lots of atypical cells)l. What are the treatment options?

Answer:

Most physicians are no longer doing pap smears every 6 months for women exposed to DES.  An annual pap smear that includes swabbing the 4 quadrants of the vagina is usually sufficient.  The most common cancer associated with DES was clear cell carcinoma.  Most cases have been diagnosed in the late teens and twenties.

A closed cervix generally means the canal is closed.  The face of the cervix is usually always visible.  The pap smear can be done on the face of the cervix.  It just won't have cells from the canal if the canal is closed.  This is a problem if you have had atypical GLANDULAR cells.  Glandular cells come from the canal.  If you have had atypical GLANDULAR cells, you may have to have the canal slightly dilated in the office to sample the canal.  With a history of moderate to severe dysplasia or cancer of the cervix it would also be important to dilate the cervix.

Most pap smears that have atypical cells have atypical SQUAMOUS cells that come from the face of the cervix near the canal opening.  If you have had atypical squamous cells, you could request reflex testing on your next pap smear, meaning that if atypical cells are present on your pap smear, they will test for the High Risk Human Papilloma Viruses (HPV).  If those are present,  you may need colposcopy or pap smears every 6 months.  If High Risk HPV is not present, you can wait to repeat the pap in one year.

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Response by:

Margery   Gass, MD Margery Gass, MD
Formely, Professor, Clinical Obstetrics & Gynecology
College of Medicine
University of Cincinnati