Colp or Followup PAP?
February 9, 2018 11:07 PM Subscribe
So it's pretty simple: I am 38. I had an abnormal PAP and my doctor wants to do a colposcopy. I think I would prefer to do a followup PAP in six (now four) months. Am I being stupid?
Short story long: My initial appointment was on 12/6. Because of insurance shenanigans, I was not able to go for a colp within 30 days (which they initially said was important, but later said because of the kind of results, they weren't too fussed about the test happening within 30 days).
I've had a colp before and it was Unpleasant and ultimately showed a big old pile of nothing. At this point, my appointment for this thing that I do not want to do is on 2/19 which is 2.5 months post the weird PAP. The longer this wait goes on, the more I just want to call them and tell them that I would prefer to do a followup PAP smear in May to see if there is still any abnormality.
Is this stupid? I feel like my friends who've had abnormal PAPs have not had automatic colps after the test, but have sometimes had follow up PAP smears. Am I wrong here? Should I just do it? I'm trying to guage whether I should just suck it up or if my preferred path is just as valid. TYIA.
Short story long: My initial appointment was on 12/6. Because of insurance shenanigans, I was not able to go for a colp within 30 days (which they initially said was important, but later said because of the kind of results, they weren't too fussed about the test happening within 30 days).
I've had a colp before and it was Unpleasant and ultimately showed a big old pile of nothing. At this point, my appointment for this thing that I do not want to do is on 2/19 which is 2.5 months post the weird PAP. The longer this wait goes on, the more I just want to call them and tell them that I would prefer to do a followup PAP smear in May to see if there is still any abnormality.
Is this stupid? I feel like my friends who've had abnormal PAPs have not had automatic colps after the test, but have sometimes had follow up PAP smears. Am I wrong here? Should I just do it? I'm trying to guage whether I should just suck it up or if my preferred path is just as valid. TYIA.
Yeah, without knowing your specific PAP results, I'd do the colposcopy. It would be a little stupid to recommend otherwise without knowing the specific kind of bad result and there is probably a reason your doctor feels it's important to do it. There's nothing inherently Unpleasant about a colposcopy, and you can talk to your doc ahead of time about whether, given your results, they really need to biopsy if they don't actually see anything funny and have him/her explain their reasoning to you. My kind of bad results meant that when they didn't see anything funny they did an endocervical curettage which was Not Fun but also found my cancer, so I am definitely on team Be Careful.
Other thoughts: you can also call now and ask about prefunking some pain management if that's what is wigging you out- my doctor has sometimes okayed a large dose of ibuprofen taken about an hour ahead of time, which can help some.
If part of avoiding this is that you have some degree of anxiety about it or about medical stuff in general, it can really help to communicate that to your doctor. Even better is if you have an idea about what might mitigate the anxiety for you so you can ask for that. I have had multiple, multiple rounds of this and what really helps me is having my doctor tell me *exactly* what he is doing as he goes along and warn me when something is going to happen and give me an idea of how long something uncomfortable might last or the kind of weird something might feel. You might want the exact opposite, but regardless it is okay to ask for what you need to feel more comfortable.
posted by My Top Secret Sock Puppet Account at 12:02 AM on February 10, 2018 [2 favorites]
Other thoughts: you can also call now and ask about prefunking some pain management if that's what is wigging you out- my doctor has sometimes okayed a large dose of ibuprofen taken about an hour ahead of time, which can help some.
If part of avoiding this is that you have some degree of anxiety about it or about medical stuff in general, it can really help to communicate that to your doctor. Even better is if you have an idea about what might mitigate the anxiety for you so you can ask for that. I have had multiple, multiple rounds of this and what really helps me is having my doctor tell me *exactly* what he is doing as he goes along and warn me when something is going to happen and give me an idea of how long something uncomfortable might last or the kind of weird something might feel. You might want the exact opposite, but regardless it is okay to ask for what you need to feel more comfortable.
posted by My Top Secret Sock Puppet Account at 12:02 AM on February 10, 2018 [2 favorites]
Midwife/NP here (TINMA/IANYCNM-NP/etc.): Another vote for do the colpo. Not sure where you are, but most providers in the US follow pretty standard (evidence-based, well-researched) guidelines for abnormal pap management. Generally, a six month repeat pap interval means that there were suspicious-enough looking cells that they want to get in with the colpo to check for anything more worrisome, so that further cancer-preventing action can be taken if necessary. We of course also don't know your past pap results, but having an abnormal result in the past (depending on what the result was, when it was, etc.) may also guide management. If you *really* want to avoid the colpo, call your provider's office and ask for their opinion, as they will have your full history available and can give their advice on your particular case, better than any of us can. Given that you had an uncomfortable colpo in the past, I would let the provider performing the next one know what happened so they can be aware and try to support you better. And of course, if it ever hurts or you feel uncomfortable, you have every right to say so and ask them to stop.
As a bit of broad overview (apologies if you know this already, but just to be clear on why these tests are ordered, and for the reference of any future readers): a pap is a sample of cells from the surface and inside of the cervix, and it's looking for pre-cancerous cells. Depending on your age, an HPV test may also be done to check whether you have a high-risk type of HPV that is more likely to cause cancer. (Most cervical cancers are caused by changes to the cells from high-risk HPV viruses. Many people will be exposed to HPV at some point, but many people will also clear the virus on their own). Depending on what we find (anything from inconclusive to normal to abnormal cells), different treatments may be recommended. The procedure for a colpo is like a pap, but takes a bit longer, as we put a speculum in and then a camera to look more closely at the cervix and vagina. We will add vinegar and iodine to see what the tissues look like and whether they hold the dyes. If the tissue "holds" the vinegar, it's more suspicious for cancerous changes, and a biopsy will likely be taken (which can be uncomfortable, but is generally extremely quick). Taken together, the results of the colpo and biopsy may indicate it's okay to wait for the next pap, or that other treatment is needed to prevent cancerous cells from growing. On the whole, most women who have abnormal smears will not have cancer, but women with high-grade (more serious) changes are those most likely to develop cervical cancer.
TL, DR: an abnormal pap finding suggests some changes in your cervical cells that, in most cases, won't lead to cancer, but in some cases, might. A colposcopy is a procedure to look closer at those cells and make better decisions about cancer prevention/treatment. Delaying that investigation may allow cancer cells to grow, making later treatment more difficult. A previous normal colposcopy result is a good thing (no cancer found!) but not a frivolous investigation just because nothing was found. (A good analogue might be a breast exam: if your provider finds a lump on the manual exam and sends you for an ultrasound that turns out to be "nothing," you'd generally be thrilled!) A pap shouldn't hurt, and a colpo might be uncomfortable, but in either procedure you have the right to ask your provider to slow down, explain what they're doing, and/or to stop if that is what you want.
(Hope that makes sense, I've got night shift brain!)
posted by stillmoving at 1:46 AM on February 10, 2018 [6 favorites]
As a bit of broad overview (apologies if you know this already, but just to be clear on why these tests are ordered, and for the reference of any future readers): a pap is a sample of cells from the surface and inside of the cervix, and it's looking for pre-cancerous cells. Depending on your age, an HPV test may also be done to check whether you have a high-risk type of HPV that is more likely to cause cancer. (Most cervical cancers are caused by changes to the cells from high-risk HPV viruses. Many people will be exposed to HPV at some point, but many people will also clear the virus on their own). Depending on what we find (anything from inconclusive to normal to abnormal cells), different treatments may be recommended. The procedure for a colpo is like a pap, but takes a bit longer, as we put a speculum in and then a camera to look more closely at the cervix and vagina. We will add vinegar and iodine to see what the tissues look like and whether they hold the dyes. If the tissue "holds" the vinegar, it's more suspicious for cancerous changes, and a biopsy will likely be taken (which can be uncomfortable, but is generally extremely quick). Taken together, the results of the colpo and biopsy may indicate it's okay to wait for the next pap, or that other treatment is needed to prevent cancerous cells from growing. On the whole, most women who have abnormal smears will not have cancer, but women with high-grade (more serious) changes are those most likely to develop cervical cancer.
TL, DR: an abnormal pap finding suggests some changes in your cervical cells that, in most cases, won't lead to cancer, but in some cases, might. A colposcopy is a procedure to look closer at those cells and make better decisions about cancer prevention/treatment. Delaying that investigation may allow cancer cells to grow, making later treatment more difficult. A previous normal colposcopy result is a good thing (no cancer found!) but not a frivolous investigation just because nothing was found. (A good analogue might be a breast exam: if your provider finds a lump on the manual exam and sends you for an ultrasound that turns out to be "nothing," you'd generally be thrilled!) A pap shouldn't hurt, and a colpo might be uncomfortable, but in either procedure you have the right to ask your provider to slow down, explain what they're doing, and/or to stop if that is what you want.
(Hope that makes sense, I've got night shift brain!)
posted by stillmoving at 1:46 AM on February 10, 2018 [6 favorites]
[NB: I didn't intend any of the above to sound patronizing, and hope it doesn't come off as so. In my experience as a provider and recipient of pap smears, it does feel there is a lot of misunderstanding about the purpose, importance, and implication of cervical cancer screening tests--much more so than, say, breast cancer screening or colon cancer screening. Some of this has to do with misinformation and poor medical practice, for which I blame medicine. Some has to do with societal stigma placed on women and the shame, fear, and embarrassment many women feel when having pelvic exams (for which I blame society, but is another topic for another day) and this is often the reason women delay paps and follow-up, but also the reason they unfortunately sometimes have poor outcomes. I hope that you are able to find the information you need and desire to make a well-informed decision and a good provider to support you through that!]
posted by stillmoving at 2:03 AM on February 10, 2018 [8 favorites]
posted by stillmoving at 2:03 AM on February 10, 2018 [8 favorites]
Do the colposcopy. It's some relatively minor discomfort in the long run to make sure you can be cancer free. I had a run of scary-level abnormal paps, two colp with lots biopsies. The day or two of cramping was worth it to make sure I didn't develop cancer. Talk to your doctor to see if you can take some Motrin for cramps before the procedure and possibly an anxiety medication if you need it.
Look, with medical stuff, we don't always get our preferred path. I would prefer to not have had 2 surgeries and be disabled. It doesn't work like that. I had to do them anyway.
Do the colp and hopefully it WILL be a pile of nothing. But then you'll know for sure.
posted by Crystalinne at 3:12 AM on February 10, 2018
Look, with medical stuff, we don't always get our preferred path. I would prefer to not have had 2 surgeries and be disabled. It doesn't work like that. I had to do them anyway.
Do the colp and hopefully it WILL be a pile of nothing. But then you'll know for sure.
posted by Crystalinne at 3:12 AM on February 10, 2018
Your medical provider will consider just having a repeat PAP a sub-optimal route, because otherwise they'd have recommended that instead. But they are in a better place than us to consider how sub-optimal it is compared to their recommendation. If you would really prefer to wait, why not ask them how much more of a risk it is for you to get a repeat PAP later and then wait. Then you can make a more informed decision about what to do.
Other factors you may wish to take into account is how much worse the colposcopy really is for you than the PAP as a procedure, and how much worse prolonging the wait will be than just getting it over with. And if you wait for a PAP you may get the same result and be advised to have a colposcopy anyway.
In the NHS less than 1 in 1000 women referred for colposcopy are found to have cancer at the time of the colposcopy, so the odds are very, very good that you don't have an immediate 'get cancer treatment now' problem. But do make a choice to do something about this.
posted by plonkee at 6:47 AM on February 10, 2018
Other factors you may wish to take into account is how much worse the colposcopy really is for you than the PAP as a procedure, and how much worse prolonging the wait will be than just getting it over with. And if you wait for a PAP you may get the same result and be advised to have a colposcopy anyway.
In the NHS less than 1 in 1000 women referred for colposcopy are found to have cancer at the time of the colposcopy, so the odds are very, very good that you don't have an immediate 'get cancer treatment now' problem. But do make a choice to do something about this.
posted by plonkee at 6:47 AM on February 10, 2018
Another way to look at things: if you decide to wait and do a second follow-up pap and you still end up having to do a colpo after that one, you've endured an extra office visit and the discomfort of a second pap, all for naught. At least this way you can skip the inconvenience and discomfort of a second pap -- while I know they're not as uncomfortable as a colpo, for me at least they're still pretty uncomfortable, sometimes.
posted by halation at 7:09 AM on February 10, 2018
posted by halation at 7:09 AM on February 10, 2018
When was your last bad pap/colpo? Because if it's been years and you cleared in the meantime? I'd wait and ask for the followup pap. But I've also never had a uncomfortable pap smear but the one colpo I did have was excruciating and traumatic, so I'm speaking from a bad experience here. I also cleared the bad cells by the time I had a followup pap six months later but I also haven't had a bad once since. If I had to have another colpo I'd demand a metric fuckton of benzos. And I'd probably wait six months to have another pap first.
posted by elsietheeel at 7:52 AM on February 10, 2018 [1 favorite]
posted by elsietheeel at 7:52 AM on February 10, 2018 [1 favorite]
Ugh, yeah, culpos are the worst, but I would also get one to be safe. See if you can get a rx for a light painkiller beforehand. And bring your own pad--you'll bleed a little after, and the ones they give you there are horribly diaper-like.
posted by radioamy at 10:16 PM on February 10, 2018
posted by radioamy at 10:16 PM on February 10, 2018
Please do it. I had carcinoma in situ at age 20, a cone biopsy, then 10 years later another cone biopsy (removed a donut shaped piece of cervical tissue, intended to remove the carcinoma). Colposcopies in between showed the return of severe displasia, leading to the second cone biopsy.
After these procedures I was cancer free, and was able to become pregnant and have 2 children. If I and my physician hadn't been aggressive, I would likely be dead. Although HPV often "burns out", sometimes it doesn't.
posted by citygirl at 5:53 PM on February 11, 2018
After these procedures I was cancer free, and was able to become pregnant and have 2 children. If I and my physician hadn't been aggressive, I would likely be dead. Although HPV often "burns out", sometimes it doesn't.
posted by citygirl at 5:53 PM on February 11, 2018
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As I understand it, there is substantially more nuance in the dispo of the Pap than just:Abnormal yes/no, but rather there are specific follow ups indicated for the various specific cell morphologies and abundance and the genetic screening for the particular HPV strains. That’s based on being a patient, not a healthcare provider.
posted by janell at 11:17 PM on February 9, 2018 [1 favorite]