Khashayar Shakiba, MD, FACOG, FPMRS
Abnormal Pap Smear and HPV 2017-10-16T17:56:57+00:00

 

When young women become sexually active or approach the age of a young adult, it is strongly recommended to receive a pap smear on a yearly basis. A pap smear is performed by your routine gynecologist where cells from the cervix are obtained using a swab and sent out to a lab where they are analyzed. It is a painless test that takes only a few minutes and can assist in early detection of any abnormal cells circulating the surface of the cervix.

Hearing results from your physician that your pap smear came back abnormal does not distinctively mean cervical cancer. In most cases, the results are suggestive of abnormal cells but not conclusive and a repeat pap smear is performed in 6 months to see if the cells have matured to a diseased or normal state. A pap smear can also reveal that a strain of HPV (human papilloma virus) is present. There are over 20 strains of HPV, with only 2 being “high risk”. If a pap smear’s results come back suggesting that the cells may be consistent with those of a strain of high risk HPV, then your physician may recommend that a colposcopy be performed. A colposcopy is a procedure that Dr. Shakiba performs in office where the cervix is visualized under high magnification and the area of the cervix that is harvesting the potentially diseased cells, is taken as a biopsy and sent out for pathological readings.

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WHY DO I NEED COLPOSCOPY? — Colposcopy is used to follow up abnormal cervical cancer screening tests (eg, Pap smear, human papilloma virus (HPV) testing) or abnormal areas seen on the cervix, vagina, or vulva. Your Pap smear may be abnormal if you have cervical pre-cancer or cancer, often caused by HPV infection of the cervix. HPV is explained in detailed separately.

The colposcope magnifies the appearance of the cervix (picture 1 and figure 1). Acetic acid or vinegar is placed on the cervix and vagina to stain the cells and to allow the clinician to better see where the abnormal cells are located and the size of any abnormal areas. The size, type and location of abnormal cells help to determine which area or areas may need to be biopsied. This information will further determine how severe the abnormality is and also help to determine what treatment, if any, is needed. When monitored and treated early, pre-cancerous areas usually do not develop into cervical cancer.

PREPARING FOR COLPOSCOPY — Before your colposcopy appointment, you should not put anything in the vagina (eg, creams).

Colposcopy can be done at any time during your menstrual cycle, but if you have heavy vaginal bleeding on the day of your appointment, call your healthcare provider to ask if you should reschedule.If you take any medication to prevent blood clots (aspirin, warfarin, heparin, clopidogrel), notify your healthcare provider in advance. These medications can increase bleeding if you have a biopsy during the colposcopy.If you know or think you could be pregnant, let us know. Colposcopy is safe during pregnancy, although we usually do not perform biopsies of the cervix when you are pregnant.

COLPOSCOPY PROCEDURE — Colposcopy can be performed by a physician, nurse practitioner, or physician assistant who has had specialized training. Colposcopy takes approximately 5 to 10 minutes, can be performed during an office visit, and causes minimal discomfort. Colposcopy is performed similar to a routine pelvic examination, while you lie on an exam table. Dr Shakiba will use an instrument called a speculum to open your vagina and look at your cervix . The colposcope is like a microscope on a stand, and it does not touch you. Dr Shakiba will apply a solution called acetic acid (vinegar) to your cervix. This solution helps to highlight any abnormal areas,making them easier to see with the colposcope.
When this solution is used, you may feel a cold or slight burning sensation, but it does not hurt During colposcopy, Dr Shakiba may remove a small piece of abnormal tissue (a biopsy) from the cervix or vagina. Having a biopsy does not mean that you have precancerous cells. Anesthesia (numbing medicine) is not usually used before the biopsy because the biopsy causes only mild discomfort or cramping. The tissue sample will be sent to a laboratory and examined with a microscope by pathologistsSome women also need to have a biopsy of the inner cervix during colposcopy; this is called endocervical curettage (ECC). Pregnant women should not have ECC because it may disturb the pregnancy. The ECC may cause crampy pain, although this resolves quickly in most women. If you have a biopsy, Dr Shakiba may apply a yellow-brown solution to your cervix. This acts as a liquid bandage.

AFTER COLPOSCOPY — If you have a biopsy of your cervix, you may have some vaginal bleeding after the colposcopy. If your provider used the liquid bandage solution, you may have brown or black vaginal discharge that looks like coffee grounds. This should resolve within a few days.Most women are able to return to work or school immediately after having a colposcopy. Some women have mild pain or cramping, but this usually goes away within one to two hours.Do not put anything in the vagina (creams, douches, tampons) and do not have sex for 48 hours after having a biopsy.If you have a biopsy, ask your healthcare provider when your results will be available (usually within 7 to 14 days). In most cases, further testing and treatment will depend on the results of the biopsy.Do not assume that the biopsy results are normal if you do not hear from our office — call and inquire about the results. Most women will need a follow up test (repeat cervical cancer screening (Pap smear) and/or colposcopy) within six months.

When to seek help after colposcopy — Call our office if you have any of the following after colposcopy:

●Heavy vaginal bleeding (soaking through a large menstrual pad in an hour for two hours)
●Vaginal bleeding for more than 7 days
●Foul smelling vaginal discharge; remember that the brown/black, coffee-ground discharge is normal for the first few days
●Pelvic pain or cramps that do not improve with ibuprofen (Advil, Motrin)
●Temperature greater than 100.4ºF or 38ºC