Here in Holland this woman start from here 30 years old start with cervix creeningsprogram by the goverment, they invite every 5 years for a sreening

The USA does not have “the highest cancer rates”, they are similar to other counties in comparable socio-economic groups. There is no doubt whatsoever that more effective screening – and proper treatment – massively reduces the incidence of cervical cancer but that it is a sexually-transmitted disease and so it has a higher incidence in regions and countries where there is more widespread sexual activity with less use of condoms.

The virus is not “dormant”. It is acquired – through sexual contact which on the cervix means penetrative intercourse – an infection occurs, the body’s immune system attempts to clear it and in most cases succeeds over a period of many months. If it fails to clear the virus, it becomes indolent and can then progress to cancer, but again not in all cases. There are other “promoters” for cancer of which the single most dramatic is smoking and acquiring more than one serotype of the virus is likely another; but there has never been any suggestion at all that Pap smears might do so.

What you are referring to is your “introitus” – the opening of your vagina itself. Two things keep this properly stretched, oestrogen and regular use – by having sexual intercourse (or “fingering” for that matter).

I presume that you have had intercourse at least some time in the past, otherwise you would have no need for Pap smears at all.

If you have no other menopausal symptoms requiring HRT, then patch or oral HRT would not be recommended, but an oestrogen cream (initially used daily for a couple of weeks, thereafter twice a week) applied specifically to the area of tightness would be an excellent idea, prescribed by your GP. {I have just last week prescribed this to a lady with a related problem – a urethral prolapse.}

You will also want to gently and progressively dilate it to facilitate Pap smears and anticipated intercourse. Whilst dilators for the purpose might be obtained through medical supply companies, we have found it much more practical to visit one of the ubiquitous “sex shops” and select one or more inexpensive, unadorned, plain dildos that you judge to be appropriate, to be used with some lubricant (generally cheap at the supermarket).

It does not however speak against my comments above, for reasons which may be a little subtle.

Firstly, in reference to the guidelines, there is necessarily an exception where sexual relations have started at a very early age and with many partners, which combination does carry such a greatly increased risk of cervical disease as to warrant Pap smears – beginning two years after initial sexual activity – even before the nominal “starting” age.

Secondly, it remains that cervical cancer is sexually acquired and there is absolutely no need for Pap smears prior to sexual experience. {Exception – maternal DES exposure.}

Finally, any woman presenting with symptoms such as bleeding that is evidently not menstrual, must be fully investigated by a gynaecologist and whilst such investigation may include a Pap smear, that does not by any means represent the totality of the investigation, in fact it is probably the least relevant part of such investigation. Cramping (pain with bleeding) would only occur in extremely advanced or aberrant cervical cancer and is more characteristic of other forms of uterine cancer which should not be confused with the type of cervical cancer which can actually be detected with a Pap smear. Adenocarcinoma of the cervix is generally not detected by a Pap smear but is probably the more likely type in a 20 year old.