Cervical dysplasia?
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If you have a LEEP, you will experience cramping and some bleeding afterwards, but it should not be heavy. You will have an unusual discharge that looks like coffee grounds. This is nothing to be concerned about, just old blood. The procedure is not painful as they completely numb the area where they will be cauterizing you cervix. The only thing that is terribly unpleasant about it is the horrible odor. It smells like decay, and is caused by the burnt tissue sloughing off. It will take a few days before this wonderful odor appears, but do not be alarmed, and DO NOT DOUCHE! You could cause a severe infection.
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THE CERVIX IS the opening to the womb. It’s the part of your uterus that extends into your vagina, and it’s also vulnerable to cancer. In fact, many of our grandmothers and great-grandmothers died from cervical cancer, and until the 1940s cervical and uterine cancer killed more women than any other gynecological cancer, including breast cancer. But thanks to an accidental discovery by Greek physician George Papanicolaou, millions of women worldwide are spared from cervical and uterine cancer.
While doing research on the menstrual cycle of guinea pigs for a genetics experiment in 1917, Dr. Papanicolaou noticed that he could see cellular changes in vaginal tissue and fluid obtained from the guinea pig. This gave him the idea to obtain vaginal fluid samples from a woman who had uterine cancer. If his theory was correct, then one could actually see cancer cells in the vaginal fluid. And if that proved true, one could routinely check the vaginal fluid for the presence of abnormal cells before they had a chance to develop into cancer. Well, he was right. He could indeed see the woman’s cancer cells in her vaginal fluid. Though it was too late to save her, it was not too late to save her daughters and many other women from this sort of cancer. At last, a painless way to screen for cervical cancer (which advances into uterine cancer) was discovered. In 1943 a paper that Papanicolaou coauthored, “Diagnosis of Uterine Cancer by the Vaginal Smear,” received international attention, and by 1948 the Pap smear, as it was dubbed, became a widespread cervical cancer screening method. Unfortunately, women still develop cervical cancer (currently, 160,000 women worldwide die each year from cervical cancer), though not nearly as many as in the pre-Pap days.
Cervical Cancer: An STD
Women’s sexual attitudes and behaviors have changed since 1943. Studies are finding that cervical cancer rates in North America are starting to rise again, particularly in younger women. One reason may be that many women are simply not going for Pap smears as often as they should be. Women who have unprotected sex are at risk for a sexually transmitted disease called human papillomavirus (HPV), which causes not only genital warts but cervical cancer. Monogamous women can also be vulnerable to HPV if their partners are promiscuous. Based on research led by the Johns Hopkins University School of Medicine, men may bring home HPV, which is now found in 97 percent of all cervical cancers. Studies show that certain HPV strains predispose you to invasive and noninvasive cervical cancer. Some studies also show that genital herpes is associated with an increased risk of cervical cancer. HPV has also been found to be linked to prostate cancer in men. Women at the greatest risk for cervical cancer are those who are immune suppressed, discussed further on in this chapter.
HPV is the most common STD in North America; 10 to 46 percent of all sexually active women are infected at any given point in time, depending on the population evaluated. HPV infection is what is widely accepted as the cause of cervical cancer. In 2001, 12,900 women in the United States had cervical cancer diagnosed, and 4,800 died of the disease. Roughly 700,000 cases of cervical dysplasia (precancer) are detected every year in the United States.
As of this writing, a successful vaccine against HPV-16—one of the most notorious strains of HPV—has been developed. HPV-16 is most commonly associated with cervical cancer. In a fall 2002 study, published in the New England Journal of Medicine, women who had not been exposed to HPV-16 were vaccinated against it. They were observed for a long period of time to see whether they would develop cervical precancer or even signs of HPV infection. The results were astounding: 100 percent of the women who were vaccinated against HPV-16 remained infection-free.
It’s important to note that the HPV vaccine is still in testing stages only and is not being widely dispensed. Roughly five years of testing is estimated before we see this vaccine make a dent in cervical cancer occurrence. Logically, young women and teens would be the first group to be vaccinated against HPV since women who were sexually active prior to this vaccine breakthrough may have already been exposed. The development of this vaccine does not mean that women would stop having Pap smears. Indeed, the only way to know whether the vaccine is being successful is to continue to screen women for cervical abnormalities. Also, before the vaccine can be deemed truly “successful,” we need to see Pap smear results over a considerable amount of time on the first generation of vaccinated women. We still don’t know how long the protection would last nor how frequently women would need to be vaccinated for sufficient protection over their lifetime. For example, if a fifteen-year-old girl received a vaccine this year, researchers would want to follow her for at least ten to fifteen years to see if she ever developed signs of HPV infection. At the time of this writing, HPV vaccine trials on young women are beginning all over the world at major universities. I’ll keep you posted in future editions!
Symptoms of HPV
HPV is asymptomatic. A healthy immune system will usually eradicate the virus on its own within six to eighteen months, but you can be reinfected again and again with various strains of HPV. A doctor will often be able to detect genital warts, which HPV causes. HPV can also trigger the cells on your cervix to behave abnormally, often referred to as dysplasia. Fortunately, though, a Pap smear will detect HPV.
Who’s at Risk for Cervical Cancer?
The Pap Smear
The purpose of a Pap smear, in lay terms, is to get some cells from both the outside of your cervix (exocervix, or portio) and the inside of your cervix (endocervix). The junction that joins both the endocervix and exocervix is called the transformation zone; it is also crucial to get cells from the transformation zone because this is the area where cell abnormalities are most often found. The test is done during a pelvic exam after a speculum is inserted into your vagina to widen the opening. For most women, the Pap smear is quick and painless.
When all the scrapings are obtained, your doctor will literally smear them onto a small glass slide and spritz a fixative (a sort of hair spray) onto the slides to hold the samples in place.
Those cells are then sent off to a cytologist (a doctor who specializes in reading cells), who will screen them for abnormalities such as abnormal cell growth, infection, and inflammation. A Pap smear can also detect cell changes on the vaginal wall, which are signs of vaginal cancer. And finally, a Pap smear can pick up yeast and HPV, which, as already mentioned, causes genital warts. In fact, certain people can have HPV without ever developing warts. Certain strains of HPV are more likely to cause cells lining the cervix to change. If an abnormality is found, then the idea is to treat you before anything more serious, such as cervical cancer, has a chance to develop. Other health practitioners besides doctors can also perform Pap smears. Physician assistants, nurse midwives, and nurse practitioners (often referred to as clinicians) often do Pap smears as well.
A Pap test is only used for determining cancer and should not be confused with a “wet prep,” in which a long Q-tip is inserted and used to soak up discharge for yeast, trichomoniasis, bacterial vaginosis, or other vaginal infections. A separate swab is used to obtain cultures for chlamydia and gonorrhea. There’s a newer test for chlamydia that requires a swabbing inside the cervical canal. When you see your doctor for any kind of irritation, infection, or discharge, this is when you’ll be swabbed. A Pap test is not done when there’s an infection.
It’s All in the Technique
While some doctors “give great Pap,” others do not. In fact, Pap smear technique is one of the most commonly covered stories in general practice magazines. That’s because an accurate interpretation of your Pap smear is directly related to the purity of the sample to begin with. Poorly obtained samples can lead to false negatives. As a result, cervical cancers could be missed. Although recent media reports suggest having separate labs analyze your Pap tests, no professional, medical, or federal organization agrees with this approach.
The best way to ensure an accurate sample is to make sure your doctor knows what he or she is doing. Much of the problem has to do with the instrument doctors use to do Pap smears. Currently, no Pap smears should be done without a tool called a cytobrush (which looks like a mascara brush) as well as a small wooden spatula; any other tools, such as cotton swabs, are simply not appropriate. Other ways doctors can taint your sample is by waiting too long to smear the samples onto the slide. Your doctor must transfer your samples (from both the exocervix and endocervix) to one slide, quickly spraying a fixative onto the slide to avoid the common problem of air drying, which is associated with poor interpretation.
The Right Steps to a Good Sample
The following steps are considered the shortest route to a good sample—and the shortest route to an accurate reading:
Do not douche or use tampons or vaginal medication for at least twenty-four hours prior to your Pap test. Any of these can interfere with the sample.
Your doctor should do your Pap smear before screening you for any STDs, such as gonorrhea or chlamydia. A long Q-tip is used to obtain cultures when screening for STDs.
Your doctor should remove excessive amounts of vaginal discharge prior to doing the Pap.
Under no circumstances should your doctor be using a lubricant before the Pap smear. This will interfere with the sample and render it useless.
Under no circumstances should your doctor perform a Pap smear during your period. This will interfere with the sample.
Repeat Pap smears must be at least two to four weeks apart.
Your doctor should be using a cytobrush and wooden spatula to obtain samples from both the exocervix and endocervix, as well as from your vaginal walls. Recent studies show that by doing it this way, the yield of the sample (high-quality cells you can accurately read) improves sevenfold.
Your doctor should not be performing a Pap smear if you have a lot of pus discharge, a sign of infection. Ask your doctor during the exam if any unusual discharge is present, and question your doctor if he or she continues to perform the Pap smear in the presence of unusual discharge.
In general, avoid Pap smears during pregnancy. If for some reason you’re having a Pap smear done while you’re pregnant, you may experience some slight spotting, but this should not jeopardize your pregnancy.
To transfer your sample onto a slide from the wooden spatula, your doctor should smear the sample with a single stroke using moderate pressure to thin out clumps of cells and mucus. Too much force or manipulation will damage cells and interfere with appropriate interpretation. To transfer material from the cytobrush, your doctor should roll the bristles across the slide by twirling the brush handle.
If you think you’re at risk for genital warts, caused by HPV, or you are a “DES daughter,” you need to have your doctor take additional smears from suspicious areas. (Note: DES stands for diethylstilbestrol, an estrogen-containing drug prescribed to some women between 1941 and 1971 to prevent miscarriage. Any daughter born to a mother who took DES runs a higher than normal risk for reproductive organ abnormalities, cervical and vaginal cell changes, and cancer. For more information visit desaction.org, the website of DES Action.)
Most Pap test errors have to do with a poorly collected or preserved sample. Detection error occurs when abnormal cells on the Pap slide are missed or misinterpreted. Again, using a fixative solution to preserve the sample is now the gold standard for preparing Pap slides for interpretation.
Special software now approved by the FDA, such as AutoPap Primary Screening System or TriPath Imaging, uses computerized images that help to interpret Pap slides more accurately.
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