Pap Testing and Sexual Activity Among Young Women in the United States

Abstract

Current guidelines of the American College of Obstetricians and Gynecologists/American Cancer Society recommend that a woman’s first Pap test be given approximately 3 years after first vaginal intercourse or at age 21, whichever comes first. This retrospective study assessed whether and how recently sexual activity occurred among young women and girls aged 15 to 24 years is associated with Pap testing rates. Data were obtained from the 2002 National Survey of Family Growth (NSFG), an in-person, population-based survey of reproductive age females in the United States. The NSFG database was analyzed for information on self-reported receipt of Pap testing and age at first sex among young women. In an interview conducted between 2002 and 2003, each female participant was asked if she had a Pap test in the previous 12 months, if she ever had sexual intercourse with a man, and, if so, at what age. The primary study outcome was initiation of sexual activity and its relationship to having a Pap test. The probability of having had a Pap test in the previous 12 months was calculated with use of a multivariable model with inclusion of the following factors that may increase the likelihood of a visit to the doctor and a Pap test: age, time since first sex, race and Hispanic origin, and mother’s education. Over 60% of women under age 25 had received a Pap test in the previous 12 months. Of the 33% of the women in this age group who had never had sex, 13.9% had a Pap test in the previous year. Of the women aged 15 to 20 years old who had first sex within the previous 3 years, 58.5% reported a Pap test in the previous year. Adjusting the data for the other factors in the model, time since first sex was strongly related in young women under age 25 to the likelihood of having had a Pap test in the previous year. These findings indicate that contrary to the current guidelines, nearly 14% of young women under 25 who had never had sex or who initiated sex within the previous 3 years had a Pap test. The investigators conclude that if the patterns found in this study persist, there will be an urgent need for further education and stronger interventions to obtain adherence to the current guidelines.