Although cervical cytology screening programs have dramatically decreased rates of invasive cancer in developed countries, most guidelines in the USA were overaggressive in their management of abnormal cytology in adolescents and young women. These management strategies resulted in costly over-treatment. The purpose of this article is to review the evidence for the new guidelines in cytology screening in youth. Natural history studies of human papillomavirus (the cause of abnormal cytology and cervical cancer) suggest there is little risk of a significant pre-cancerous lesion going undetected within the first 3-5 years after the onset of sexual activity. The American Cancer Society now recommends that screening be initiated within 3 years of the onset of vaginal intercourse but no later than 21 years of age. The American Society for Colposcopy and Cervical Pathology allows for follow-up of low-grade squamous intra-epithelial lesions with repeat cytology or human papillomavirus DNA testing rather than immediate referral to colposcopy. The new recommendations appear to be safe and will decrease the current over-referral and over-treatment of adolescents and young women with HPV infections.