I've had some good discussions since I first wrote about the American College of Obstetrics and Gynecology's (ACOG) decision to change the age that first Pap smears are needed in women to 21 years old regardless of sexual activity. That advice and recommendation stand.

I have had very healthy talks with my partners in the office, gynecologist friends and readers about the message that is being sent by this new recommendation. Many feel that although Pap smears may not be needed, pelvic exams, yearly screening for sexually transmitted infections and ongoing discussions between teens and their doctors about sexual and menstrual health are essential for those young women who are sexually active.

Seeing your primary care doctor yearly - whether that be a pediatrician, nurse practitioner, family doctor, or gynecologist - is important when young women are sexually active. Discussions about birth control, infection prevention, menstrual issues, sexuality, emotional well being and healthy relationships are parts of that yearly visit, even if a Pap smear isn't on the list. Screening for STDs can be done using urine so for many women who are otherwise having normal periods the pelvic exam may or may not need to be done for all women every year.

Pap smears only screen for cervical cancer and its precursors and I agree with the recommendation that Pap smears are not needed until around age 21. Still, any sexually active person or teen with menstrual issues should be seeing their provider yearly for other discussions and screening.