Your annual gynecologic exam ... While no number of mobiles or creative artwork on the ceiling can change the uncomfortable nature of an exam that begins with putting your feet into the stirrups, it's definitely worth it. As noted previously, cervical cancer rates are down 70 percent since the introduction of the Pap test in the 1950s. Not just death rates, but the actual diagnosis of cervical cancer. That's because cervical cancer screenings can eliminate abnormal cells before they become cancerous, preventing the cancer in the first place.

Today we know that nearly all cases of cervical cancer are caused by strains of the human papillomavirus (HPV), which can also cause abnormal cervical cells called dysplasia.²⁸ While nearly all sexually active women have been infected with an HVP virus at one time or another, most of us manage to shake off the virus thanks to strong immune systems.

A long-term HPV infection, the type that is most likely to cause cancer, is more likely in women who have multiple sexual partners and so become infected over and over again. In fact, persistent infections of HPV increase the risk of the cervical cancer precursor high-grade squamous intraepithelial lesion (SIL) more than 10 times.²⁹

Until recently, preventing HPV infection was difficult if not impossible. Today, however, the vaccine Gardasil is designed to prevent infection with the two HPV strains that cause about 70 percent of all cervical cancers.²⁸

"It's tremendously exciting," says Diane Solomon, MD, senior investigator at the National Cancer Institute's Division of Cancer Prevention in Bethesda, MD, of the vaccine. "In the course of my career, we've come full circle, from where we didn't understand what caused cervical cancer before the 1980s; to firmly establishing that the HPV virus was the cause; to now using the virus to develop a vaccine to prevent the infection and the cancer. It's just remarkable how far we've come in 20 years."

The U.S. Centers for Disease Control and Prevention (CDC) recommends that all 11- and 12- year-old girls receive the vaccine, although it can be given to those as young as nine. The vaccine is also recommended for women ages 13 to 26. It costs about $360 for the three-shot series, and most insurance covers the cost. However, since Gardasil doesn't protect against viruses that cause about 30 percent of cervical cancers, you still need regular cervical cancer screenings even if you've been vaccinated. There is also no evidence of its effectiveness in older women, Dr. Solomon notes. "It's not that it doesn't work," she said. "It's that we just don't have any data on its use in older women."

Thus, most women reading this will still need a Pap. If you're one of them, know that the Pap isn't the only test you should ask for. The American Cancer Society notes that women over 30 have the option of dual screening—a Pap and an HPV DNA test. Both tests are so sensitive, says Dr. Solomon, that if they are both negative, you have such a low risk of any significant abnormality that you can go three years before being retested.

As far as the type of Pap test done, Dr. Solomon says the most important thing is that the sample is sent to a high-quality laboratory, something your health care professional should be aware of.

Cervical cancer screenings aren't the only gynecologic screening you need. All sexually active women 25 and younger, pregnant women and older women with multiple sexual partners or those who have begun a new sexual relationship should be screened for the sexually transmitted disease chlamydia at least annually. Left untreated, the bacterium that causes it can spread into the uterus or fallopian tubes and cause pelvic inflammatory disease (PID), a serious infection that can cause infertility, chronic pelvic pain or ectopic pregnancy. X

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