Floss regularly, eat five servings of fruits and vegetables daily, know your cholesterol numbers, if you're a woman have an annual Pap test . . .

Yikes! When it comes to health care recommendations, you may feel overwhelmed or you may even be indifferent to it all, especially when the experts keep changing their recommendations. This is especially true for college students. It's difficult for healthy 20-year-olds to think in terms of worst-case scenarios. Things like annual check ups and concerns about cholesterol seem more suited to your parents and grandparents.

But as young adults, especially if you are sexually active, now is the time for you to start taking a proactive step for your own well-being. This applies to men and women, but women are the focus of this week's article, because some of the guidelines for young women's "annual exams" have changed.

Bottom line: Young women are still urged to have annual exams. That part has not changed, but what happens at that annual exam is what's new. The annual examination visit includes a review of the woman's medical history, evaluation of health care needs, a complete physical, including breast and pelvic exam, and when appropriate, screening for sexually transmitted infections.

The pelvic exam is done to allow the health care provider to determine the health of the woman's reproductive organs, including the vagina, cervix, uterus and ovaries.

The "annual exam" guidelines used to include a Pap test, but that is no longer true for every female student. Now the experts say that Pap tests don't need to be done as early or as often for some college-aged women. A group of 29 organizations recently developed the Consensus Guidelines, which revised the recommended timing of Pap testing, based on a better understanding of how cervical cancer develops.

What is a Pap test? The Pap test is a sample of cells from the cervix that are sent for specialized analysis in a laboratory to detect abnormal cells that could lead to cancer.

According to the new guidelines, screening can begin later than previously recommended, and some women will no longer need Pap tests every year. Previously, women were advised to have their first Pap test by the time they turned 18 or when they become sexually active, whichever occurred first.

The new guidelines now say that the first Pap test should be done by age 21, or within three years after starting sexual activity, whichever comes first.

In addition, it is also now recommended that:

Women should have a Pap test every year between ages 21 and 30.

After age 30, if a woman has had three consecutive normal Pap tests, she can go to a testing schedule of every two to three years.

Confusing? Yes. ... And another source of confusion is that people often equate a Pap test with the entire physical examination. A pelvic exam may still be needed even when a Pap test is not, as in the following examples:

A woman is less than 21, only recently became sexually active and is using a prescription method of birth control.

A woman has symptoms of a vaginal or pelvic infection.

A woman has a gynecological problem, such as irregular periods or ovarian cysts.

Does this mean the Pap test isn't as important as it used to be? Not at all. Cervical cancer is the second leading cause of cancer-related death in women, with 13,000 new cases in the U.S. each year. Finding it early is still critical for effective treatment.

Almost all cervical cancers are caused by specific strains of the sexually transmitted human papillomavirus (HPV). Research is showing, however, that only a small proportion of women infected with these HPV types will develop cervical cancer. Other factors such as smoking and genetics may play a part in determining a woman's individual risk.

If you have any questions about how this information applies to you or about any other women's health issues, please call the Women's Health Department at University Health Services at 863-2633.