Abnormal PAP: I'm scared!

mandana · Dec 22, 2005

My OBGYN goes straight to colposcopy with an abnormal pap. He doesn't feel that a follow-up pap is as beneficial as being able to see things clearly.

I know this because I asked about it at my recent pap when I found out that approximately 1 in 3 people have been or will be infected with HPV at some point in life!

CseMgr1, ASN, RN · Dec 22, 2005

I think I had maybe one "normal" pap smear during my 36 childbearing years. One of my gynecologists told me years ago that I was born with an abnormal cervix: the glands which help to protect it are supposed to be on the inside and mine wound up somehow on the outside, resulting in chronic cervicitis and abnormal PAP's. I had cryosurgery, but the condition returned after my son was born. Back in 1990, I came back with a Class IV pap, and my gynecolgist went so far as to tell me that I had Carcinoma in Situ and scheduled me for a D&C. Fortunately he was wrong, for the biopsy came back with the same old, same old dysplasia. After I went through menopause, the condition cleared up completely.

AgentR · Dec 22, 2005

I had an abormal pap. Repeated pap, came back abnormal too. So I went in for the colposcopy and biopsy. The biopsy just felt like a little pinch, I don't think it hurt. I remember thinking after it was over "that was it?!?"

I just had low level changes, and they had me repeat paps every 3 months, until I had two normal ones in a row. It cleared itself up! :)

hypnotic_nurse · Dec 22, 2005

I've had two colpos, and the pain level depends a lot on the skill of the MD and the sharpness of the instrument (btw, the snips they take for a colpo are teeny, and most docs will only do one or two -- the resident who did my first one took 7). But even the one done by the inexperienced resident I'd only put at a 5 (of 10). And afterwards you can do whatever; I went back to work.

Oh, and both mine turned out to be no big deal.

Bipley · Dec 23, 2005

the only part that hurt with the leep is the numbing process...a needle in the cervix does not feel good.

i'm a pain weenie, if i get a papercut i'm jumping up and down on one foot whining. childbirth would likely kill me or the staff delivering the baby, not sure which.

point being, i had an endometrial bx a few years ago. she numbed my cervix and i didn't feel a thing. i was worried about that part, i thought it was going to hurt and she told me as she was doing it and i didn't feel a thing. maybe it is technique?

scraping the inside of my uterus hurt like crazy and that was awful, but the lido injection i'm thinking must be technique?

zambezi, BSN, RN · Dec 23, 2005

Another chat site that I go to has a good motto: Don't waste a good panic...at this point, try not worry too much...my story won't reassure you so I won't share it right now but I will say this:

The colposcopy is not horrible...kind of like a pap but a little different...there is definately a pinching sensation when the biopsies are taken but it is quick...the sound that the biospy device makes was worse sounding than the actual discomfort associated with it...You will probabaly have some funky discharge for a couple of days that is brownish in color (from the acetic acid they put on the cervix), so have some pads or old undies available...I think I had a lift restriction for about 7 days or so, as well as nothing inside the lady parts...

If you have to have a cone biopsy it is not bad either, but hopefully your colpo won't show anything to be worried about...

Many women have dysplasia and not many end up with cervical cancer...The majority of cervical dysplasia is caused by the HPV virus...sometimes the virus expresses itself and then can go away...so you may have dysplasia on one exam and then not on the next....If there are abnormal cells, a LEEP or Cone biopsy is usually a "cure"...of course, follow-up is important...

Please please continue to go for your follow-ups, even though you don't have many risk factors...the fact is is that HPV is easily spread- a huge amount of the population has it...most of the time it is not an issue, but it can be, so take care of yourself with the follow-up appointments.

Again, chances are that things will be okay- don't freak out too much yet (I know that waiting is the harderst part!). Ask your doc about taking some ibuprohpen or something before the colpo- I have heard that it helps (though again, I didn't think that it was particularly painful).

Michelle. · Dec 23, 2005

I had dysplasia after my son was born, the biopsy hurt just a tad.. but more like a pinch.. its over in a matter of seconds.. very well able to go back to work afterwards-- but i'd take the day off anyways just for some "me" time lol..

I had laser surgery done to get rid of the abnormal cells. I decided i was going to be tough and not have any anesthisia-- you can opt to be put to sleep- but its only a 5 min procedure.. so i felt it was unnecessary- um, it was very painful. They told me most women compare it to be like bad menstrual cramps- but i've never in my life had cramps that bad- even the labor and birthing of my son wasn't that bad! lol.

They showed me videos of it so i would be prepared.

No sex for 2 weeks was all they advised. some spotting.

i ended up having sex when my 2 weeks was almost over... and i ended up getting a major infection. ouch!

alyca · Dec 23, 2005

Dysplasia is actually pretty common and is usually nothing. As far as HPV, I was involved in the huge study through the UW here in Seattle that was published earlier this year. The study was the creation of a vaccine to prevent HPV, which is usually what leads to cervical cancer. Studies all vary, but as many as 80% of the population becomes infected with HPV. There is no cure for it, it does not generally even get noticed by those who have it, but it increases the risk for developing cervical cancer. Basically, if they can prevent you from getting HPV, they can greatly decrease your risk of developing cervical cancer. Now, the big debate is when to give the vaccine (must be before any sexual activity, since the virus is so prevalant), and how to market it. It will NOT be a required vaccine, but it would be really nice if everyone would get it.

Having HPV is not noticeable. THe most common forms have no actual warts anywhere, just the virus in your system. THey can tell you have it buy testing your blood. There are other forms of HPV where there are actual warts, but those are not the same forms of virus that have the cervical cancer link.

Sorry so rambling. In this study, I got what ended up being a placebo, and had PAPs every 3 months (I was a starving college student, and was paid and got my checkups free and birth control, etc) Anyway, a PAP came back showing ASCUS, which is abnormal small cells of unknown specification, then I had a repeat which showed mild dysplasia, then had a colposcopy and biopsy. Fairly painless, just ended up with some cramping and had to wear a lumpy bumpy bad for a couple hours. Honestly, THAT was the worst part of the whole thing. Those suck!!

TennNurse · Dec 23, 2005

It's been a little while since I worked in gyn, but here's what I remember about helping with colpos.

For the most part, it is a lot like a Pap. Stirrups and speculum, then the gyns I worked with would swab the cervix with plain old vinegar. They said it made the abnormal cells show up really well in the green light of the colposcope. They just used those big Q-tips that we called Texas swabs.

Next they'd focus the colposcope (which looks a little like that thing that the optometrist has you look through when he says, "Which is better, 1 or 2?") and look at the outside of the cervix. If they saw anything that looked abnormal, they'd snip it off with a long-handled pair of alligator forceps that had a very small snipper at the end. Usually, only 2 biopsies were taken. They would also get some samples from the endocervix, which is also done in a Pap, and all this stuff got sent off to the lab. Some women hardly noticed a thing and went shopping afterward, some c/o cramps and got some big doses of ibuprofen. (We didn't keep anything stronger in the office)

I did learn that HPV, present in roughly 1 out of 3 people, was involved in a lot of abnormal Pap smears. Like many viruses, HPV has a lot of different strains that behave in different ways. Some of them cause cervical changes that if left untreated could lead to cervical cancer. Cervical cells are among the slowest-growing ones in the body, and the Pap smear is, at best, about 80% accurate in detecting changes in cervical cellular structure and behavior. Since the changes do occur so slowly, this success rate has been deemed acceptable. (I've long thought that if men needed a less-than-pleasant yearly screening test for cancer, improved accuracy would be pursued vigorously, but that is fodder for another thread). Depending on the technique used by your lab, (Thin Prep vs the old way) this percentage can vary. I once had a lab employee tell me that reading Paps was most like staring at very busy wallpaper to see if there were any pattern variations that didn't look right. Considering that lady partsl and cervical cells can look very different depending on where we are in our cycle, whether we are pregnant or on birth control, or are post-menopausal, this is not a job I think I'd like. Both gyns I worked for made the comment often that women who get yearly Paps are not the ones who end up dx'd with advanced cervical cancer. Since these changes occur so slowly, very often the biopsies taken during the colpo stop the changes in their tracks. When this was not the case, a LEEP was the next step, but let's get you through the colpo before we start freaking out about that.

I can understand your being afraid. It is an unfortunate anatomical fact that significant changes can occur in our reproductive organs, and without a 2nd party armed with magnifiers and vinegar, women are clueless. Many women with HPV never see a wart or any other type of growth. The next time you talk to your gyn, I'd recommend asking if HPV was detected on the Pap, and if not, if she can test you when you go in for your colpo. Some gyns do this as a matter of course during the colpo, but not everyone does. You can also ask to have the virus typed if the test is positive, and this will tell you if you have a strain known to be linked with cervical cancer. If you have gotten Paps on a regular yearly schedule, I feel safe in saying that this is likely not going to prove to be serious.

I hope this helped alleviate some of your fears. Good luck, and I hope everything turns out to be OK. :icon_hug:

debzster · Dec 23, 2005

Hi I had Abnormal Pap and was told the same thing. I called my OB and went back for my 2nd one and I was fine. I don't know how it could of been bad at first when I had a full Hyst. Anyway, my obgyn said that HPV virus is a precursor to cancer and it is a very unstable virus and it is not uncommon if we have had an intamte realationship. He made it sould like 95% of the population has it. Micro professor said the same think. I believe they now have a vaccine for it. Vaccine for the young ones who have never been exposed. Just keep an eye on it.

Dr also told me with the unstability of it it can be transmitted from an person with a wart on their hand. Interesting, I never knew that. But there are many strains of it.

Nurse-o-Matic · Dec 23, 2005

Thanks so much everyone! I can't tell you how much better I feel after reading these posts. I suddenly don't feel so alone in this experience. Knowing what to expect during the colposcopy and afterward is so helpful. I'm also going to call the gyn tomorrow and find out what grade my pap came back as. I'll keep everyone posted on my journey through abnormal pap he**. What a good thread this is for women to read and educate themselves. Thanks again!

Nella · Dec 23, 2005

If this helps: I ad an abnormal pap with dysplasia about 20 years ago. I had the colp done. That part didn't hurt. But bxs were taken and that part did hurt. But it only hurt during the bx part and subsided shortly thereafter.

But truthfully, I think I had one vicodin left over from a previous back injury and took that before the procedure. A friend drove me there and home. I remember being more mortified by the fact that I worked in that health care system for 10 years and knew all the doctors, including the one who did my procedure.

And the good news is I've never had an abnl pap since.