Patient is fearful of having another Pap smear

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 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 booked an appointment for the gynecological checkup, but not the smear. What is your opinion about a woman my age who is not sexually active needing Pap smears, especially if past smears have been negative and the woman has vaginal atrophy?

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 small. However, I still think regular gynecological 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: My husband just received a diagnosis of multiple sclerosis. We are not thrilled, but it could have been much worse. He is older than me, in his 70s. A few people have said that if you are going to get MS, it is not as bad when you are older. Is that true? What is his prognosis?

N.W. I am sorry to hear about your husband. There is no good age to get this diagnosis. MS is the most common demyelinating disease of the nervous system. The myelin is a covering around the nerves, which protects them and speeds impulses. Without myelin, nerves cannot properly perform their function of communication. The myelin is destroyed by the body’s own systems, by an immune system that mistakes myelin for an invader.

It used to be thought that people who got MS at a younger age had a slower rate of disease progression. However, more recent studies have shown that age is not a strong predictor of the course of the disease. Similarly, being male was thought to predict worse outcomes, but that no longer seems to be the case.

It is very hard to predict how MS will progress in any given individual, as the disease can range dramatically. Some people have only a single episode in life (sometimes called benign MS, about 15 per cent of cases).

However, the most common is relapsing-remitting, with times of normal function interspersed with acute attacks. Finally, there is progressive disease, which can start right away (primary progressive MS) or after a period of time of relapsing-remitting (secondary progressive). About 12 per cent of people have malignant MS, which leads to a need for assistance walking within five years.

MS is a complex disease and I can barely scratch the surface of it here. There are many types of symptoms, but most people have at least one of the following: eye symptoms, numbness or weakness in a specific area and fatigue.