Why we do those paps sometimes (Score 1)

While it may seem silly, the truth is that a woman can still develop dysplasia despite the lack of a cervix. The cervix is attached to the upper portion of the vagina, when a hysterectomy is performed it is possible that a portion of the cervix may be inadvertently left behind. Moreover, the transformation zone (the area on the cervix where most cancers develop) can extend onto the upper vagina in some women leaving them at risk despite a properly performed hysterectomy. Several times a year we will see a woman in our practice with dysplasia of her vaginal cuff picked up by one of these "silly-seeming" pap smears. If left untreated, these lesions could progress to cancer. The HPV virus which is responsible for cervical dysplasia and cancer is also highly implicated in vaginal and vulvar dysplasias and cancers. Now, admittedly, the development of a lesion in a woman who has had a hysterectomy is uncommon, but it does happen, and if you are the one it happens to..... If you are the doctor who decided that woman didn't need a pap - you are probably facing a lawsuit - despite all the evidence that in most situations the pap was not necessary. Evidence based medicine is great and I practice it whenever I can, but we all must realize that human physiology is highly variable and outcomes are based on likelihoods, odds ratios, and relative risk. Sometimes bad things happen to good people despite the evidence.