In which condition is a pap smear indicated?

A Pap smear is primarily indicated for routine screening of cervical cancer and precancerous lesions, especially in women aged 21 and over. It is recommended to start Pap testing at age 21, regardless of sexual history, and typically occurs every three years until age 29. For women aged 30 to 65, a Pap smear can be done in conjunction with HPV testing every five years or every three years with just the Pap smear. This routine screening is crucial for early detection and has significantly reduced cervical cancer incidence and mortality.

In contrast, postmenopausal bleeding, while it warrants further investigation for potential causes, is not an indication for a Pap smear. Instead, it typically requires additional imaging or endometrial evaluation. Asymptomatic STIs may need screening but do not directly link to a Pap smear unless there's an indication of cervical changes or symptoms. Similarly, hormonal imbalances may require other forms of evaluation and do not directly call for a Pap smear as part of their diagnosis or management. Thus, routine screening remains the primary and appropriate context for conducting a Pap smear.