Based on several recent studies, new guidelines for initiation of cervical cancer screening have been developed. Evidence shows that screening before the age of 21 years does not change the rate of cervical cancer in that age group or in older women. Cervical cancer, in general, is extremely rare in those younger than 21 years. Consequently, cervical cancer screening should begin at age 21 years. If cytology is performed before age 21 years, it is important to recognize that the management of cervical cytologic abnormalities in adolescents differs from that of the adult population. The publication of the American Society of Colposcopy and Cervical Pathology 2006 consensus guidelines has led to major changes in the management of cervical disease in adolescents, which emphasize minimal to no intervention. These guidelines advise against human papillomavirus testing and recommend observation for the management of cervical intraepithelial neoplasia 1 in adolescents. In addition, observation is preferred for the management of cervical intraepithelial neoplasia 2. The guidelines were established to minimize the potential negative effect that screening can cause, unnecessary referrals for colposcopy, and the negative effect that treatment can have on future pregnancy outcomes.