Dear Dr. Roach: I am a widow in my early 70s and am not sexually active. I had my last Pap smear and complete gynecological and breast exam in 2014. My Pap smear was negative, and my gynecologist said she didn’t think I’d need Pap smears anymore since they had been negative for over 10 years. I was relieved to hear that, since I have vaginal atrophy and find the ovarian exam and Pap smears to be very painful.

In 2015 I returned for just the ovarian and breast exams. No problems were found.

Recently I received a letter from my gynecologist’s office saying I was due for a gynecological checkup and/or a Pap smear. I have scheduled an appointment for the gynecological checkup, but not the Pap smear. What is your opinion about a woman my age who is not sexually active needing Pap smears, especially if past Pap smears have been negative and the woman has vaginal atrophy?


Dear J.P.: The guidelines are clear that women over 65, who have no history of abnormalities with their regular Pap smears and especially no history of gynecologic cancer, do not need further Pap smears. Their risk for developing cervical cancer is very, very small. However, I still think regular gynecologic care is appropriate. In fact, your gynecologist may have appropriate treatments for the vaginal atrophy. Not only can it cause symptoms, but it predisposes women to urine infections.

Dear Dr. Roach: I am 84 years old. A recent MRI shows that I have spondylolisthesis of the cervical spine. My main problem is loss of balance, and I get very tired after walking at a normal pace for 10 to 15 minutes. I have no back pain, and I think this is due to my daily back exercises. My neurologist has suggested that back surgery could correct my balance. Would surgery be worthwhile? Does surgery have benefits that last a reasonable period of time?


Dear M.V.: If you think of a simplified model of vertebrae as bricks on top of one another, spondylolisthesis is when the bricks don’t line up: One sticks out further in front, while another sticks out behind. Surgery for spondylolisthesis is usually performed only when there is intractable pain, or when there are progressive symptoms, especially weakness. I am puzzled why your neurologist recommends that you consider surgery for balance. I certainly would recommend a trial of balance exercises (different from, and in addition to, your regular back exercises), supervised by a trained physical or occupational therapist. I am exceedingly cautious about recommending spine surgery, especially to someone in their 80s, where surgical complication rates tend to be higher.

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