Mea colpo
August 4, 2023 12:05 PM   Subscribe

I have to get a colposcopy and cervix biopsy and I am quite terrified. Am I making the right choice?

My Pap smear has come back abnormal for HPV consistently now for the past 4 years. My NP said it should clear on its own since I had gardisil and the “other” high risk strain, but since it hasnt gone away, and I’m reporting pain and bleeding, I need to get a colposcopy and biopsy. I normally love my OBGYN, she’s been very considerate about pain and pushing myself in order to make sure things work (I.e., I’m considering getting an IUD after this and said I would wait it out for 3 months even if it felt uncomfortable—and she was like wtf why would you do that, let’s get it out after a week.) she was also the one to tell me that pain during intercourse is not normal and I should get a PV PT. She told me the colposcopy is more painful than IUD insertion, but then said that they don’t offer numbing because it can mess with the biopsy result, and that most people do not have pain with it. She even mentioned something about there being less nerve endings in a cervix.

However, from gathering one story from a family member, and a bunch other on social media, I’m starting to question if it’s not going to hurt and if I have a right to pain management. I’ve seen stories ranging from its fine to it is absolutely not fine and gyno care is so medieval in that it doesn’t provide pain management off the bat for invasive procedures. I am a little terrified of the pain but more terrified afterwards—that I will have more medical trauma and it will just add to the discomfort I experience in my body. Or that I will be too scared to get this done again if I need it.

So far, my NP gave me 600 Mg of ibuprofen for pain management. Upon telling her I was really scared (my paps hurt a LOT recently, so I can’t imagine that getting a punch biopsy is going to hurt less), she gave me 1mg of Ativan. I don’t think this going to manage pain, but make me loopy.

I’m afraid to push more about pain management (I’m both anxious about doctors and anxious how they’d perceive me—a Black woman—on asking for pain management.) my other option is to go to a friend’s OBGYN, who does offer numbing, but they have a significantly longer wait and I don’t have the history there like I do my OBGYN. I also wonder if my OBGYN will feel slighted if I go elsewhere, and I want to continue working with her.

There is also option C, which is to skip this altogether. It’s a tempting option given how nervous I am about it.

My questions are:
- Is Ativan enough for this kind of procedure if I’ve had pain at paps before? I’m guessing it won’t manage pain but will distract me from it?
- Does anyone have a script of what to say in asking my doctor for pain management further than what I’ve explained?
- I know you all are NMD, but perhaps anecdotally: Would it be ok to push off this procedure to see a different OBGYN who offers numbing? Are there consequences with my current OBGYN being upset?
posted by buttonedup to Health & Fitness (29 answers total) 4 users marked this as a favorite
I typically have discomfort bordering on pain with standard Paps and if anything my colposcopy was actually a little better (maybe they were just more ginger with me knowing it was a more invasive procedure). I honestly don't remember experiencing any pain at all - I remember saying, "That's it?" when it was over because I was expecting kind of a big to do and it was... no big deal.

Ibuprofen and Ativan sound like an extremely reasonable plan for this procedure. Don't delay, postpone, or, god forbid, skip it all together. Pretty much the whole point of getting routine Paps and HPV screening is so that if they are abnormal you can proceed with colposcopy. Just get it over with. This is one of the absolute best things you can do for your health.
posted by telegraph at 12:35 PM on August 4, 2023 [9 favorites]

I have not had this procedure, but had a cervical biopsy a few years ago in the office (I hadn't taken any pain meds as I didn't anticipate a procedure that day). While it was painful enough to make me sweat, it did not last and it was an important diagnostic test, so I have no regrets.

I would sure as hell take the ibuprofen and the ativan and go for it. I also don't think there's anything wrong with asking your OB/GYN or another OB/GYN whether additional medication is possible! But please, please, don't skip this altogether. You know something's up! You have 4 years of paps to go on at this point. Please don't wait too long on something this serious.

Is there someone you trust and can take with you to the next appointment/request for additional pain management? Sometimes it's a comfort to have a second person in the room who's there as your advocate or who can write things down to document stuff you might otherwise not recall afterwards.

I think that as far as consequences to your relationship with your current doctor, it's not on you to worry about her potential upset. First, you don't know that she would be upset! This is borrowing trouble. Second, your job is to look out for you and your feelings, not hers.

I am a white lady though, so while I've had my share of awkward OB/GYN encounters (by which I mean one experience that in retrospect I have reprocessed as an assault, as well as the ol'slut shaming nurse, and perhaps worst of all my own constant low level anxiety about whether my issues are valid or not) I don't have the additional layer of black womens' historical experience of medical neglect. I hope you get answers here and IRL from folks who can speak to that aspect.
posted by Lawn Beaver at 12:36 PM on August 4, 2023 [4 favorites]

Don't delay, postpone, or, god forbid, skip it all together. Pretty much the whole point of getting routine Paps and HPV screening is so that if they are abnormal you can proceed with colposcopy. Just get it over with. This is one of the absolute best things you can do for your health.

THIS. Cervical cancer is no joke and you deserve to have answers. I haven't had this procedure but I have had several where I was terrified of pain (i.e. LASIK - lasers in the eyes) and Valium helped a lot. If Ativan can even distract you from the worry, that could be enough to make it through.
posted by tafetta, darling! at 12:48 PM on August 4, 2023 [15 favorites]

something about there being less nerve endings in a cervix.

oh hell no no no no no. This is nothing but convenient patriarchal hogwash passed on from male doctor to male doctor. Along with the term hysterical. Cervixes are innervated just fine, thankyouverymuch.

I have .. discomfort ... from PAPs. IUD insertion was a horror show. I would brook absolutely no bullshit about ibuprofin being sufficient for a colposcopy (and as you noted ativan is not a pain med). Hells no.

Please don't skip it. But please don't let them up there without sufficient pain management that is not "let's just see how you do"
posted by Dashy at 12:49 PM on August 4, 2023 [10 favorites]

I've had a colposcopy and cervical biopsy and I found them very, very painful. If I had to undergo that procedure again I would absolutely demand pain management. Just so you hear this from multiple people: you have the right to request and receive adequate (by your standards) pain management for any invasive procedure. Full stop.

Here's what I would do, based on what you've laid out here. I'd talk to my current GYN and tell her that the pain management on offer is not enough. I'd say that I enjoy working with her but if she's not in the position to budge on pain management, I'm going to have the procedure done elsewhere but I want to come back to that practice. You could even couch it as a "I don't want to be the squeaky wheel in your practice so I'll take my fears to a different doc so you don't have to deal with it" even though we both know IT IS NOT AN UNREASONABLE FEAR. Anyway. She can either be totally okay with plan A, which is more pain management; plan B, which is having the procedure done elsewhere and then going back to her for everything else; or plan C, which is she cuts you loose as a patient. Any one of those is an acceptable outcome, I think. I know it's scary to advocate for yourself and I am SO SO SO sorry that the medical establishment treats black women so abysmally.

If it helps at all, you have this internet stranger's full support and every single best intention I can send your way.
posted by cooker girl at 12:50 PM on August 4, 2023 [11 favorites]

Oh, and I promise you, I'm going to tell you this not to scare you but to let you and everyone else know: I have birthed two children. My colposcopy/cervical biopsy felt very much like late labor. Everyone is different and experiences pain in different ways, yes. But there is absolutely no reason for you to white-knuckle this procedure and your GYN should be on your side.
posted by cooker girl at 12:52 PM on August 4, 2023 [1 favorite]

I agree don't skip it.

I needed a bone marrow biopsy and was told it was not possible to have sedation (this was in the ER). I said then I wasn't having one. They figured out how to give me sedation. I share this because "not possible" doesn't always mean not possible. (I am an old white lady and I know that makes a difference, but I think this still holds.)

It seems like you have a good relationship with your ob/gyn, who is generally sensitive to pain issues. I know it's hard to speak up, but I think you need to say that you will not have the procedure without some kind of numbing or sedation and that you will go to another ob/gyn if you need to. Sometimes it's hard for patients to remember that you are allowed to just refuse something you don't want. If your ob/gyn is upset, that is completely not your problem.

I hope you can get what you need and that your test results turn out ok.
posted by FencingGal at 12:56 PM on August 4, 2023 [4 favorites]

I am male so I have no idea about the procedures or the pain associated with them, but I do have long term experience with chronic pain. With respect to that I say that you (or someone you bring with you) are the only ones who are going to advocate for yourself in terms of pain management. Advocate that one or two pills is a rational reasonable plan of action and that it does not make you a drug seeker. Also, pain medication works best when it is taken before the pain becomes severe. In this case, 15-30 minutes beforehand.

I also do not think there is anything wrong with saying to your current OB/Gyn that you are considering going to a different doctor that uses numbing and ask if they will reconsider. If they still say no, you can still use them after the procedure or if you like the one who does the procedure stick around. One thing I would not do is skip it altogether.
posted by JohnnyGunn at 12:57 PM on August 4, 2023

Just as a data point to illustrate that experiences vary widely even in the same person, I've had three colpos. One hurt more than I expected, but was not unbearable. The other two I didn't have any pain. I didn't take any pain medication for any of them. Good luck!
posted by CheeseLouise at 1:01 PM on August 4, 2023

I don't recall my colposcopy being egregiously painful, but it was uncomfortable. Regardless, just because they can't numb the cervix itself doesn't seem to mean they can't give you more/better systemic pain meds. I'm not sure what that would be, maybe gabapentin or something, but I think it's worth it to keep gently pushing.
posted by misskaz at 1:08 PM on August 4, 2023 [2 favorites]

You've got a lot of good advice here so I'm just going to add my voice to those saying please, no matter what you do, don't skip the test.

a person whose best friend died of a gynecological cancer
posted by BlahLaLa at 1:18 PM on August 4, 2023 [4 favorites]

The colposcopy is essentially looking with different instruments (a scope). I had 3. The biopsy is the shitty part. And I’m going to be real, I had 2 biopsy sessions with anywhere from 3 to 4 biopsies taken. They hurt! However it was quick and the following cramping subsided after a couple hours.

Absolutely manage the anxiety. Absolutely inquire about sedatives or any pain relief. Absolutely go get it done!!! If not by this doctor than by someone, asap. There are so so so many things to do to prevent the spread of cervical cancer and it’s not something that you want spreading.

Sometimes things suck, even with all the available pain relief and sedative options, but we have to do them.

Again, it was quick but the cramping afterward can last a while. The first time wasn’t so bad. Then second time I had a deeper biopsy and the cramping came swift and hard but subsided suddenly a few hours later.

Take a friend or family member if you can. Take some juice or Gatorade for your blood sugar if you feel woozy. That helped me afterward.
posted by Crystalinne at 1:26 PM on August 4, 2023 [1 favorite]

For mine, they used a dental numbing spray. I felt some minor cramping but it was not a big deal.

Maybe approach it as, "If I experience pain I do not want to suffer through it; I will stop the procedure immediately. Will you be able to provide pain relief in that situation or should I go somewhere that offers numbing to ensure I'm able to complete the procedure?"
posted by metasarah at 1:37 PM on August 4, 2023 [8 favorites]

As a data point, I haven't had a cervical biopsy but I do have endometriosis and ptsd. I've had a colonoscopy under sedation and I've also had cervical care ( IUD placement) done under twilight . The IUD o was more of a bonus procedure to other things i needed done. I think with all of your concerns along you may be able to ask if you can get both done under sedation at the same time. By the time I woke up I felt fine and normal otc meds were more than enough.

Some of this is mostly because I react very poorly and everything involving that area was painful as all get out. My litteral hysterectomy was less painful and better managed than some of my outpatient gyncological care quite frankly. It's absolutely okay to have very specific needs and they should not be discounted.

Ativan will do a bunch to help you relax and care less about things including pain. It's won't manage pain but it will decrease the stress and concern you have about it. It could be enough, but personally I don't know if I'd chance it.

Do get the care though, you need to know what's going on. Best wishes.
posted by AlexiaSky at 1:40 PM on August 4, 2023 [2 favorites]

Response by poster: Hi everyone, thank you so much for your advice. Ok, I will not skip it. As much as I want to skip it…I will not skip it. I did just call the MA and ask if there was any way to get further pain management, and asked further about the procedure (because a colpo doesn’t sound bad, but I didn’t know about the rest.) She walked me through—colpo, 2-3 biopsies with one being endocervical, and endocervical cutterage. The MA reiterated that they won’t provide pain management further because it’s not necessary, “it’s just a pinch, I promise” and it can cause bleeding which will blur the results. There doesn’t seem to be budging there. I will message my MD but imagine it’s the same.

I did call my friend’s OB and their office without hesistation said yes, they will give local numbing for it, I just need to get the order from my doctor. I am hoping that this isn’t some kind of ruse, as my doctor won’t do numbing, but they are under the same medical system so I imagine it’s not. I’ll use some scripts from here to craft that message to my doctor asking for an order to be sent to them if possible. If not, I’ll have to establish care with the new OB.

I appreciate the variety of answers of the pain level here and general pain management. I hope it’s not wrong for me to want further pain management, even if it might not be bad. I don’t want to risk it. Reading some of these answers puts me at ease that I am not wrong for asking for this. Thank you all. Hopefully I’ll have good results!
posted by buttonedup at 1:46 PM on August 4, 2023 [18 favorites]

I had an extremely unlikeable male gyno do my colposcopy when I was 27 after a single HPV positive pap. I typically have a pretty high pain tolerance but I felt like I might pass out after the procedure (I was given the world's biggest ibuprofen pill, I think after the procedure, along with a tiny can of juice (?!?!?!)). I'm glad I had it done because it's very important to take care of these things, but if I ever had to have one done again I would want pain meds beforehand. And a better doc.
posted by jabes at 1:46 PM on August 4, 2023

I’m going to warn you that dependent on your anatomy, the pain level may vary. I have things that can be hard to reach and they had to use a tenaculum on me which was so painful I had a vasovagal reaction and fainted. So please take whatever pain medication is available and - more pertinently - have someone available who you can call to drive you home afterwards if necessary.
posted by bq at 2:49 PM on August 4, 2023 [2 favorites]

You deserve the pain management. And you also need this test. I’d do the process to get seen by the other doctor. Also, the Ativan is an excellent idea and should make the whole thing more tolerable for you.
posted by Miko at 5:23 PM on August 4, 2023 [2 favorites]

I had an IUD insertion done under anesthesia after a failed (for pain reasons) IUD replacement procedure. As far as I can tell, it’s usually not done under anesthesia because it’s more expensive, some people have adverse reactions to anesthesia, and you have to have someone to take you home after the procedure. If you, like me, have a history of unusual amounts of pain for cervical procedures, are okay with spending several hundred dollars more to have no memory of the procedure, tolerate anesthesia well, and have a partner who will happily wait for you and drive you home… by all means ask if it’s a possibility.

While I was under anesthesia, with consent they did a hystereoscopy to try to figure out if there was a reason for the pain and ended up biopsying a polyp; I was in enough pain for the first 10 min after I woke up that I was extremely glad I did not have that as a conscious procedure. That is a more invasive procedure than what you’re planning on, but I provide it as a data point.

Get the health care you need, but don’t feel bad for asking for unusual accommodations if your body has unusual reactions to procedures.
posted by A Blue Moon at 5:26 PM on August 4, 2023

I've had three colpos and reading about the procedure before the first had me so anxious that it triggered my vasovagal response when the doctor described very visually what she was about to do. I've since learned to not ask for descriptions!

The next two were with my most trusted obgyn and it felt quicker and easier than a Pap smear, as I am always at ease with him. Comparatively, I've had an HSG test for fertility tests, which was quite painful so you can be assured that I don't simply have a high pain threshold.

Memail me if you want further details about the experience and any differences between the two provider's procedures and im happy to share what had me nervous and what it was really like. Just didn't want to give you too many details if less is better!
posted by icaicaer at 6:07 PM on August 4, 2023

For context, when I had to have a cervical biopsy, the hospital did it under general anaesthetic as a matter of course.
posted by chariot pulled by cassowaries at 8:08 PM on August 4, 2023 [5 favorites]

Your update sounds promising. And your course of action sounds good, too. To ease your mind or normalize it a bit, it's really common; I had one abnormal pap, then the coloposcopy. I remember it being very very uncomfortable. And I had cramping afterwards and a tiny bit of blood. So I wore a pad after. They didn't numb it.

I had precancerous cells, so I was referred to an oncology gyno who did a LEEP procedure to take out the cells. That was done under anesthesia in the OR, but according to him and research online, that is rare and most procedures are done outpatient.

I was so nervous and a total wreck when asking the doctor about the procedure. So you're not alone in being nervous! But I'm so happy I did all the things and did the follow-up paps which were more frequent right after to make sure.

Please continue with the procedures and the next steps. Cervical cancer can be dealt with if caught early enough. Take good care. 🙏🏼❤️
posted by AnyUsernameWillDo at 12:25 AM on August 5, 2023

I like reading the Mayo Clinic explainers
posted by AnyUsernameWillDo at 12:26 AM on August 5, 2023 [1 favorite]

I get really really really angry when providers say that a cervical biopsy is "just a pinch." Sure, maybe for them, maybe for some people.

But for others, it's very painful and I'm so fucking sick of being dismissed and belittled for having pain. I'm not exaggerating, I'm not over-emotional; it fucking hurt.

I like your plan of going to the second provider. Good luck, and I hope the results are all clear in the end.
posted by cooker girl at 7:16 AM on August 5, 2023 [2 favorites]

My gyn prescribed me a single 5mg valium before my colonoscopy and it made all the difference. Turns off the give a fuck center of your brain, it's a miracle drug when used rarely.

Now I take a 5mg valium before all my regular gyn appointments, and the dentist, so basically 3 a year, and my life is so much better for it.

Being an ultra overnight pad with you for any bleeding on the way home. You'll be okay!
posted by phunniemee at 1:59 PM on August 5, 2023 [1 favorite]

If your pap smears have been hurting a lot, the colpo and biopsy will hurt more. Like a lot more.

Valium and the like may make it easier to go through each process, but it will do NOTHING for the pain that comes after. I fainted in the parking garage outside of my doctor's office after my 4th colpo because it caused such profound cramping and hot flashes.

Ask for pain management that you can take before the procedure, during the procedure, and AFTER.

Do not deny yourself further pain management, and do not be afraid to tell the doctor doing the procedure to stop completely if whatever they give you isn't working.
posted by The Adventure Begins at 9:48 AM on August 7, 2023 [1 favorite]

I searched for this question specifically because I went for the same thing today and wanted to be properly prepared. In case you want more data points:

I'm not sure what kind of biopsy you're scheduled for but i went in for colposcopy, cervical biopsy (ECC, endocervial curettage), and endometrial biopsy. Colposcopy and cervical biopsies (4) were for me very "slight pinch/discomfort." However the endometrial biopsy done at the end which I describe as "a special kind of hell." Ten seconds of the worst period cramps I've ever had, felt like the instrument was going to come back out through the skin of my lower abdomen, but you can't move of course since your feet are mounted in the straps and there's multiple people between your legs so... the normal "curl into a ball" period cramp reaction is not an option. -4/10, would not recommend but get it done anyway, it's important, just be prepared it's decidedly awful. I'm sorry.

I took 600mg ibuprofen and some CBD and it was not enough. It's been an hour and the after-shock nausea and cramping are finally gone.

Thank you for posting this question, the detailed experiences were also very helpful to me. I hope everything goes well for you.
posted by danapiper at 2:52 PM on August 9, 2023 [1 favorite]

You've already gotten great answers and have a great plan of action - I'm so glad you're going to get it done!

Some places have idiotic and archaic views on pain, even if their medicine is otherwise good.

It's reasonable and routine to make it clear that you like your provider but aren't willing to settle for the pain control she's offering in her clinic. It may not be her policy, but one set by her higher-ups. It may be helpful for her/clinic to hear 'I'm going elsewhere because you aren't meeting my needs for this procedure. My longstanding and trusting relationship with you isn't enough to make me put up with your ancient/archaic views on pain control'.

It doesn’t mean you dislike the provider or are a 'bad patient', but that this is an important issue with decisions often not focused on best care for the patient (ie insurance calling it "optional " and requiring payment, clinic policy based around liability, perceptions of the procedure, and perhaps additional staffing, monitoring equipment or something else that sedation would require them to maintain).

Fwiw, I wouldn't expect any grief from the provider about referring you elsewhere for the procedure and then returning to her for care if you want to keep seeing her. The provider may agree with you but be unable to change clinic policy. I hope she and her staff actively support you in whatever is needed to get the care you need and deserve.

I'm sorry we have such a shit medical system that makes any of this optional, and that puts additional burdens on you to 'prove' you should receive pain control for a procedure. While it's routine and 'fast', carpel tunnel surgery is also routine and fast (6 minutes!) but that doesn't mean it should be (or is) done without twilight sedation.

All that long blah blah blah is intended for is to support your decision, your perception of this situation (you're absolutely right!), and to add another voice to those advocating for the provider with better pain control options, and adding that this scenario is common and shouldn't (!) result in your provider 'firing' you or giving you grief.
posted by esoteric things at 1:16 AM on August 10, 2023

Response by poster: Hi! This is for future readers and anyone who wanted to come back and check. Thank you all for your advice and support, it's much appreciated <3

I did my colposcopy yesterday. The other doctor I called who would numb during a colposcopy told me that was a mistake, they do not offer that. I called around a few other places and they do not either. So it is not common for that to be offered. I decided to stick with my regular MD.

I took 400 mg of ibuprofen (because I forgot how much to take--was quite nervous) and then 1mg of Ativan. I didn't really feel any effects of it with my anxiety, so I took the 2nd one right before the procedure. It did not kick in until after the procedure -_- My doctor was very kind. She said she was glad I said something even though nothing can change. She said she doesn't deny that some people have excruciating pain, but she believes that's more due to incompetent doctors who don't care about being gentle. She even had the nurse hold my hand.

The whole thing was uncomfortable like a pap. The vinegar smear burned and made me start to cramp, but was bearable. Surprisingly, the biopsies itself were not bad. I felt something pinch but it was over quickly with a following cramp. The worst was like someone else mentioned, the ECC. I couldn't really concentrate then due to the cramping and pain - it looked like a long metal stick going in and then I just blanked from panic. I cramped badly after that and felt tears coming, and then the Ativan kicked in. It didn't help me with the pain but it sort of flattened my response. With 2mg, I became drowsy. Eventually, I passed out in the car and don't really remember much after. I woke up 6 hours later-- so I may have slept through the pain. I am bleeding coffee grounds but it is not too much. I don't feel very crampy today.

All in all, it was bad--out of the painful things I've experienced it's not at the top though. I think the medication for me helped with just not panicking after the ECC, and with knocking me out for the rest of the day.

I will echo it's important to do and it is bearable, but goodness, if it's not a standard practice to numb, at least ask for an Ativan or take some edibles afterwards. The biopsies are not bad but the ECC was the worst for me. I hope the results turn out to be good!

Thank you all again.
posted by buttonedup at 1:08 PM on August 30, 2023 [7 favorites]

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