Abnormal pap smear and colonoscopy

December 6, 2004 9:08 PM

HPV has been discussed a couple times here before, but I have a new question. A few months ago my pap smear came back abnormal, and soon I'm going in for a colposcopy. I tried doing some research on this, but internet resources weren't very detailed, and I don't know if I have a good doctor (I'm a student on an HMO). I'm wondering: how painful is the biopsy/LEEP they sometimes do after a colposcopy? How likely is it they'll even do a biopsy or LEEP if the test came back with a mild dysplasia? And how common is it for a woman to have to go back for colposcopies later in her life, if her first abnormal pap was at 22? Does the virus just usually go away, or does it get worse? Any OB-GYNs out there?
posted by anonymous to health (9 comments total)

The colposcopy hurts more than the LEEP, because they use a local during the LEEP and not the colposcopy. It feels like nasty cramps. I had mine when I was 21, and four years later, all paps normal. As far as I understand, the virus tends to disappear, but someone else will have to do that research.
posted by dame at 9:54 PM on December 6, 2004

(Posting this on behalf of a friend - Unsure if LEEP and Lletz Loop are the same thing, think they may be)

Firstly, try not to worry too much about the abnormal result on the smear test, at least the changes have been picked up early - which is always a positive. The colposcopy is just a way for your GYN to see exactly what is happening down there (a bit of a closer look than just getting a normal pap smear) and the biospy will be taken of any section of the cervix which has the abnormal cells appearing on it.

The biopsy itself is not really painful - more uncomfortable. To explain what it feels like, it is just like a "pinch" and only takes a few seconds. If the test comes back with mild displaysia, your GYN will just monitor it closely and may mean that you end up going back to see him/her every 6 to 12 months, rather than every two years. This is quite common amongst females. You are not alone!

The HPV virus can stay around for a while (GYN's are not 100% sure what causes it), but as a precaution your GYN will want to just monitor it (via colposcopy) to track how much or how little the cell changes occur.

If you end up having abnormal smears for a long period of time, your GYN may recommend a Lletz Loop procedure - where you go into hospital so they can remove the abnormal cells. This is done under general anaesthetic and you will only feel minor cramping (just like a regular period) afterwards.

You should get a good GYN - one you feel comfortable with to discuss these options and results etc... Try a Family Planning Clinic.
posted by Bdave at 10:19 PM on December 6, 2004

Specialist #1 explained to me that she looks into people with the colposcope [silver lining: this word is really fun to say!] first, then decides whether to biopsy them on the basis of what she sees. She said it wasn't uncommon for her to see very little and send people home - the immune system can sometimes clear it up right away.

The colposcopy doesn't hurt at all. The biopsies...hmm. I could barely feel the first one, but the second one hurt - a sudden sharp pain followed by mild crampy feelings. It wasn't too bad, but was made worse by the fact that the biopsy device sorta snaps together on itself to hack off a piece of flesh, making a blunt thunking sound, which freaked me out a little (for comparison, PAP smears don't bother me at all).

Specialist #1 told me to get a LEEP; I scheduled an appointment for one with Specialist #2. When I arrived, she gave me another colposcopy, said "oh, this isn't too bad!" and sent me home with only a PAP smear and an HPV test. (Both Planned Parenthood and the first specialist had told me that they couldn't test for HPV and had treated it as a near-given that I had it). She told me that there was no solid answer to the "should I get a biopsy/LEEP?" question, except in severe cases - it was a total judgment call.

Several months later, I got a letter saying my PAP was normal and I didn't have HPV. I've had 3 normal PAPs since then, although I'm only 21 and it's only been a year and a half or so.

Yikes, this got kinda long. I hope it's helpful. Honestly, try not to worry about all this too much. I was really nervous at first and it ended up being waaay less of a big deal than I'd anticipated. This is really common, and the vast majority of people turn out fine. Just make sure you keep getting PAPs regularly.
posted by introcosm at 10:29 PM on December 6, 2004

Yeah, the biopsy hurts. Especially if they're doing a few different sites on the cervix, and especially if your cervix is at all inflamed. Mine also turned out to be nothing - I'd had an abnormal pap or two, had the colposcopy/biopsy, they found nothing, and I've just gone for paps every six months instead of every year since, but they've never found any abnormal cells again. As introcosm said, it's pretty common (most of my female friends have been through it at some point, with no further investigation necessary for any of us) and it's ultimately not a huge deal, even if it hurts a bit while you're going through it. You can ask your doctor for pain medication preemptively if you think it might help.
posted by judith at 10:37 PM on December 6, 2004

Everyone else has gone into the details but I'll just tell you the best thing I can, which is Try Not To Freak Out Too Much. As Judith said, most people are okay in the end, and it's only moderately awful during the procedure.
posted by Medieval Maven at 5:55 AM on December 7, 2004

Yup, I agree with introcosm and judith. Uncomfortable, but not horrible. And it is ridiculous how many women have it.

As a side note, when I lived in the UK I found that doctors only recommend doing a pap smear every 3 years (compared to yearly in the US). I personally decided to compromise and now I only go every 2 years. I really think the annual check-up in the US is for doctors to make some easy money. But IANAD, so YMMV, do your own thing etc.
posted by widdershins at 6:23 AM on December 7, 2004

I will recommend a hearty dose of Advil before a biopsy (and if there's cryosurgery later, then too), if your doctor is not of the "here's some valium" variety. It's pinch-y more than painful, and the ache lasts all day, but it's not something you couldn't go to work with if you took ibuprofen regularly. (Don't, though. Lay on the couch and watch movies.)

I had cryosurgery several weeks after my biopsy. Again, more uncomfortable than painful, but I was massively stressed again (I was driving home 4 hours from college to see my regual GYN, so it was kind of an ordeal) and they didn't warn me they were going to do it twice with a 15 minute break "to thaw out" in the middle. The aftermath of the cryo lasted about six weeks, but that wasn't at all uncomfortable, just inconvenient and annoying.
posted by Lyn Never at 6:54 AM on December 7, 2004

Pretty much what everyone else said: it hurts a little and is scary, but it's not awful, lots and lots and LOTS of women go through it and it turns out to be nothing. So try not to stress yourself out, and do take the rest of the day off, nap, eat and let people pamper you as much as possible. I did that and it was a big help. FWIW I had my colposcopy done, umm, seven? years ago, after it I had to have paps every three months for a year, then every six months - now it's all back to normal and once a year.
posted by mygothlaundry at 11:09 AM on December 7, 2004

When I had a colposcopy, I didn't find it painful, but it was extremely uncomfortable. But then again, I have always found vaginal exams to be highly uncomfortable as well, so YMMV. The biopsy was quite painful, but very brief, at least. I don't remember being given a local, either, but hopefully that's SOP now. The doctor who did it made House seem like a cuddly fuzzball, so I would think your procedure would have to be less awful than mine. (Fortunately he was just someone I was referred to for that procedure only, not my regular GYN.) But, in the end, like a lot of other women, it turned out to be nothing and eventually went away.
posted by Shoeburyness at 11:55 AM on December 7, 2004