I am 19 years old and have been having pap smears for about 2 years now. My first two were normal, then within the past year, I started getting abnormal results. I had 3 consecutive ASC-US pap smears, then I had a 4th pap done and the results came back ASC-H. I am, however, negative for HPV and have had my gardisil shots. My OB/GYN ordered a colposcopy immediately following the ASC-H results and I am having it done on Friday.
I go to college about 4 hours away from home so it's very hard for me to see my gynecologist or speak with her about my questions. Has anyone been in a similar situation or does anyone have any insight on this situation? I'm just wondering how concerned I should be about the possible outcome of my colposcopy based on my pap smear results? Is this normal in females so young?
04-30-2008, 07:36 PM
Hi there....so sorry you're going through this. 19 seems like yesterday to me and now I"m 37...yikes ;) I've also been having repeat ASCUS neg HPV results since June 07. So if I understand correctly, this will be your first colpo...correct? If so, then all of your ASCUS results were from paps?? A pap is a screening tool...it's not diagnostic. A colpo will be more sensitive and it will be diagnostic. A pap can miss something that a colpo can pick up. So this may be simplistic (remember I'm no healthcare expert). If you draw a circle (cervix) on a piece of paper then on the inside of that circle start from the top and draw a continuous circle (q tip used during a pap)until you reach the middle. All the places within the circle that are blank (no ink) are places where cells could have been missed. Now, in my opinion with 3 paps behind you, this situation is probably less likely that they missed something over 3 paps. Also, your negative HPV status is more good news. There are women that were neg HPV that ended up with CIN III but I would venture that this situation is probably less common. So you've got some good things going for you that tend to point toward a good outcome.:)
The colpo on the other hand will wash the entire cervix with a vinegar solution and any abnormal cells will turn white. THe dr will then biopsy the specific areas that turn white. The lab will then look at those specific cells more closely. So the colpo will be more specific. When you have the colpo...ask that they take an ECC(endocervical curretage)sample as well (thats the part inside the hole of the cervix). Also, ask the Dr's opinion of what he/she saw. The Dr. should have some idea of what it looked like. Some will not say anything until results are back but they should have some idea. They may not share it unless you ask.
No matter what...KEEP THAT APPOINTMENT....STAY WITH YOUR FOLLOW UPS
Hope this helps.
04-30-2008, 08:17 PM
Tulip, Mommyandwifey has given you some good information. I strongly suggest you ask your doctor to do an ECC when he/she does the colposcopy. The ECC is endocervical curettage. The pap and colposcopy only look at the outer part of the cervix. The ECC scrapes the cervical canal (think the hole in a donut). It can get samples that the pap and/or colposcopy can't even reach.
I say this because my paps have always come back fine, and my colposcopy looked great (doctor's words), but the ECC found things neither sampling found.
Read about colposcopies, biopsies during colpos, and ECCs before your appointment. I also strongly suggest you get copies of your pathology reports (from the paps).
I wish you luck with your appointment! Let us know how it goes.
05-02-2008, 05:46 PM
Thank you for all the insight! I had my colposcopy today and made sure to ask my doctor to do the ECC. She was actually impressed that I asked her about it, haha! I was surprised that the procedure didn't hurt as much as I thought it would! It was much faster than i expected too. My results come in a week and I will be on edge until then.
I just have such mixed emotions about the whole situation. Today, my doctor told me that she is much less concerned with my case because I am HPV negative and she assured me that the gardisil vaccine might actually help to slow the progression if I do have any pre-cancerous changes. She reminded me, however, that something is clearly wrong here and my pap results are showing it so I can't be too unrealistic. I am just trying to stay positive! Nobody in my family has ever had any cervical problems before though and my parents, especially my mom, are being very supportive through such a scary time. I'm just so glad I have found a place where other women understand what I'm facing! Thanks again for all the insight =)
05-08-2008, 10:08 AM
I got my results from my colposcopy today and my doctor said that my biopsy showed that I have moderate dysplasia. She told me that she's not very concerned about it and since I am so young, it will most likely regress on it's own. I just have so many questions! My last pap smear result was "Atypical squamous cells; cannout exclude high grade intraepithelial lesion" so does having moderate dysplasia mean i DO have a high grade lesion?! Should I really not be concerned about this? It seems like I should be. It seems unlikely to me that the problem will just go away on it's own, but I am definitely not a doctor.
I haven't been able to speak with my doctor yet about the results because she left the information in a voicemail, but I have called the office and am waiting to hear back from her. In the voicemail, she suggested that the best way to manage the moderate dysplasia is for me to have a pap smear every 3 months until one comes back normal. She also said something about having more colposcopies as well. Are these the normal steps for this diagnosis?
I'm confused about what questions I should even ask my doctor when I speak with her. Any insight would be greatly appreciated!!
05-08-2008, 07:34 PM
Well, my guess is she wants to wait because of your age. She's the Dr, she knows more than I so I wouldn't dare want to suggest otherwise. From reading on this board and other places, I will say that for women my age (30 and over), who are HPV positive w/ moderate dysplasia the recommendation has been treatment either via leep, cryotherapy etc. w/follow up paps every 3-6 mos. Again, I presume your Dr's rec to "wait and watch" is due to your age. Usually younger women have a stronger immune system capable of fighting off the HPV thus allowing the dysplasia to regress. Women in their 30's and over are thought to have a more persistent strain and so treatment is indicated many times.
I would ask the dr. why he/she is choosing to wait vs. treatment. Don't suggest the reason...allow the Dr to explain why. The other question is if he is recommending follow up every 3 mos, that can be an emotional roller coaster (testing, waiting, testing, waiting)...if he were to remove the dysplasia via treatment, what kind of management plan would you be on. It might be that your appointments would be only twice per year. The other question is one for yourself and please don't take misunderstand me. At 19, we can become preoccupied with school, friends, summer fun etc. After a few "as is" tests, many young patients (and older for that matter) can view this constant testing as unnecessary and stop the follow up. You know yourself best so know that you absolutely MUST keep your appts EVERY 3 mos. If you are sure you can commit to that, then wait and watch may very well work. If not, you may want to pursue treatment. After discussing this with your Dr...if you are not satisfied...seek a 2nd opinion.