Pap Tests After Hysterectomy

Ivor Benjamin, MD
Last Modified: November 1, 2001

You may think me terribly stupid, although I'm not. I am just not informed. I have had two surgeries for what they called chocolate cysts in my ovaries. When I was 35 years old I had a complete hysterectomy, after a tumor was found in my uterus.

My question is, do I still have a cervix? Is there a reason for a Pap smear? All things that I should have known, but no one to explain them to me at the time.  
Thank you for your time.

Ivor Benjamin, MD, Former co-Editor-in-Chief of OncoLink, responds:

Dear AK,
No question is "stupid"!

Unfortunately, many women do not know if they have had their cervix removed at the time of hysterectomy. Either way (i.e. if it was removed or not) it is advisable to continue to have annual Pap tests and pelvic examinations performed. If the cervix is removed at the time of hysterectomy, this does reduce or eliminate your risk for developing cervical cancer (assuming that the gynecologist removed the entire cervix).

However, even if your cervix was removed, it is possible to develop dysplasia (pre-cancer changes) in the vagina that may be detected by a Pap test. If found, these vaginal pre-cancer changes are called "vaginal intraepithelial neoplasia" or VaIN. If VaIN were to develop it is often detected on a Pap test. Following the abnormal Pap test of the vagina, colposcopy to examine and perform directed biopsies of any abnormalities is needed. If these colposcopic biopsies reveal pre-cancer (i.e. VaIN), then a common treatment for this is laser therapy. This is usually curative.

If your cervix remains, then you had a supracervical hysterectomy. Your risk for developing cervical cancer is similar to that of women who have not had a hysterectomy. Therefore, women who have had supracervical hysterectomies should have annual Pap and pelvic examinations and tell their current gynecologist that they have had a supracervical hysterectomy.

You also mentioned that you had a "tumor" in your uterus. Anytime that a tumor is removed surgically, it is important to know more details (i.e. was it benign or cancer) and what type of tumor it was. This information should be relayed to your current gynecologist.

Thank you for your great question and interest in OncoLink!