These days, many people can skip the dreaded Pap smear in favor of a far less invasive and more private way to screen for cervical cancer: disposable, DIY swabs that can be used to test for high-risk variants of HPV, the virus responsible for most cases of cervical cancer. In January, the U.S. Health Resources and Services Administration (HRSA) said many people can opt for self-testing, either at home or in a health care setting, rather than undergoing uncomfortable exams with a clinician.
Home testing for HPV, short for human papillomavirus, is a big step forward, but don’t lose your gynecologist’s number yet. There are reasons to make an ob-gyn appointment that have nothing to do with cervical cancer, says Jeanne Conry, an ob-gyn who previously chaired the Women’s Preventive Services Initiative, an HRSA-supported coalition that makes recommendations about women’s health care. “If we see ourselves only as the Pap smear specialists,” she says of ob-gyns, “we have failed [patients].”
Cervical cancer screening is vital. Research has long suggested that most people diagnosed with the disease are un- or under-screened, which is common. As of 2021, about a quarter of U.S. women weren’t up-to-date, according to the American Cancer Society. That’s where at-home HPV tests come in. This style of discreet testing has the potential to boost screening rates for some groups of women, including those who were previously behind on testing.
Someone who gets an abnormal result on an at-home test will still likely need a follow-up exam. And people at high risk for developing cervical cancer, including those who have compromised immune systems or have been diagnosed with a precancerous condition, should still get regular screenings from a doctor. So should people in their 20s — a decade when sexually transmitted HPV infections are common and usually harmless, explains Amanda Bruegl, a gynecologic oncologist at the Oregon Health and Science University School of Medicine in Portland. Though some research suggests self-collection works about as well as clinician-led HPV testing, the American Cancer Society still votes for letting your doctor do it, if possible.
Conry agrees with that stance — in large part because “a woman coming into the office to see a clinician is going to get everything taken care of, plus the cervical cancer screen.”
The average well-woman visit involves much more than a Pap smear —which, even before the HRSA’s latest guideline, most patients don’t need annually. During one of these appointments, an ob-gyn might also perform a breast exam, provide consultation about birth control and family planning, screen for other STIs, talk about menstruation or menopause and more, says Colleen Denny, a New York–based ob-gyn and a fellow of the American College of Obstetricians and Gynecologists.
“We have 20 minutes to talk about all the things that have happened to you in your reproductive life all year,” Denny says. “It’s great that we don’t have to wedge a Pap smear into there also.”
In the United States, where almost a third of the population has limited access to primary care, an ob-gyn may also be the doctor some people see most regularly —or the only one they routinely see. In a 2022 study of reproductive-age U.S. women, researchers found that more preventive health care visits took place with ob-gyns than generalist physicians from 2011 to 2016.
Ob-gyns sometimes deliver far more than reproductive health care. “I’m doing things like refilling people’s asthma inhalers and screening them for depression,” Denny says. Blood pressure checks, vaccinations and general upkeep can all take place during ob-gyn visits, Bruegl says.
The bottom line: Skipping annual appointments means missing out on important care. HPV testing can now happen at home. But “someone should be talking about all the [other] basic health screenings, all the basic wellness things, every single year,” Bruegl says.
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