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Old 08-11-2007, 09:31 PM   #1
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Pap Smear Tests after total Hysterectomy?

I had a hysterectomy 18 months ago now and recently I was admitted to hospital (for another problem). I was asked how long had it been since I'd had a pap smear and I could not remember. My GP told me that because I had had a total hysterectomy that I no longer required these. A nurse told me that I did. I thought pap smears were all about checking for cervical cancer? I of course still have a cervix? Anyone the wiser?

 
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Old 08-12-2007, 01:14 PM   #2
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Re: Pap Smear Tests after total Hysterectomy?

I had a hysterectomy quite a few years ago and my physician still requires the pap as a part of my yearly physical.

 
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Old 08-12-2007, 02:10 PM   #3
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Re: Pap Smear Tests after total Hysterectomy?

Hi,

Let me tell you about my experience and you can decide what the best choice is in regards to Paps.

My family doctor told me after my hysterectomy in 2002 that I didn't need to have Pap tests anymore since I had never had an abnormal one and since I no longer have a cervix. (This is the current recommendation of the American College of Obstetrics and Gynecology.) So I went three years without one.

In 2005, my new family doctor talked me into have a Pap. It came back ASC-US (Atypical Squamous Cells - Uknown Origin.) A retest three months later was also ASC-US. At the time of the retest, my doctor had the lab do an HPV (Human Papilloma Virus) test on the cells, and I tested positive for one or more of the strains of HPV which cause cancer. (Approximately 80% of all sexually active people have HPV at some time in their life and don't even know it.)

I was referred to an gyn who did a colposcopy and biopsy which showed moderate and severe dysplasia (VAIN II/III) on my vaginal cuff (the area where my cervix used to be.)

I didn't have any treatment at that time, as my mom had just died, and I was having some severe depression. My gyn agreed that my body might clear the dysplasia on it's own (though I later found out that with VAIN III, that rarely happens), so we just monitored the problem with Pap tests every three months.

I had a normal Pap and colposcopy June of 2006, but I think my doctor missed something because in December, my Pap came back LGSIL (Low Grade Squamous Intraepitheliel Lesion), a level worse than it had before.

A colposcopy and biopsy in February 2007 showed carcinoma in situ, cancer which hasn't yet spread beyond where it originated. When the CIS was found, my gyn sent me to an oncologist, and I had laser surgery in May. My first follow-up Pap and colposcopy were this past Thursday, and I'm getting very nervous waiting for the results. I know the chances are good that everything will be fine, but since I have HPV, there is always the possibility of the dysplasia or even cancer returning.

If I had listened to my first family doctor and never had another Pap test, the cancer may never have been discovered in time. I'm just grateful that my new family doctor suggested that I go ahead with the Pap.

I know a lot of women consider Pap tests to be uncomfortable and embarrassing. But it's a minor inconvenience which could save your life.

Hugs,

Lisa

 
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Old 08-13-2007, 02:05 AM   #4
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Re: Pap Smear Tests after total Hysterectomy?

Thanks guys for your replies and your stories. Sashee I wish you luck with your results, sounds as though you have been through the mill. There are doctors and then there are doctors. It amazes me at how many different opinions one can get about something you would think should be universal. I have an appointment with a new GP next week and will discuss a pap smear with him then. Much appreciated.

 
Old 08-13-2007, 07:03 AM   #5
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Re: Pap Smear Tests after total Hysterectomy?

If you had you a total hysterectomy, you should not have a cervix (or your Dr. forgot something). If you had a partial hysterectomy, they would have left the cervix in place.

 
Old 08-13-2007, 08:31 AM   #6
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Re: Pap Smear Tests after total Hysterectomy?

Piperpilot, when you've had a total hysterectomy, the swab for the Pap smear is done across the top of the vaginal cuff where the cervix used to be. My doctor explained to me that since there is no clear dividing line between the cervix and the vagina, there are always some cervical cells left.

Also, the cells lining the vagina are identical to the cells lining the cervix, so they can become cancerous too. During a Pap smear, the doctor not only performs the test, but also visually inspects the vagina to see if there are any abnormalities.

 
Old 08-13-2007, 05:13 PM   #7
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Re: Pap Smear Tests after total Hysterectomy?

My wife's doctor does Pap smears whether she does full or partial. Partial makes obvious sense so I asked her about why she does with full hysterectomies. She believes that there are still cervical cells in the vagina and these could become, though greatly reduced because of the lower number, cervical cancer. Her approach is a better safe than sorry. Since my wife had a partial it's not a matter of discussion for us and she gets her regular annual tests.

Oops....didn't see the previous post. Obviously Shashi's and my wife's doctor agree.

Last edited by randyk47; 08-13-2007 at 05:28 PM. Reason: Didn't read all the proceeding posts.

 
Old 08-14-2007, 10:15 AM   #8
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Re: Pap Smear Tests after total Hysterectomy?

Shashi,

I understand. I was mearly addressing what seemed to be Lonelymum's question as to whether or not she still had a cervix:

"My GP told me that because I had had a total hysterectomy that I no longer required these. A nurse told me that I did. I thought pap smears were all about checking for cervical cancer? I of course still have a cervix? Anyone the wiser?"

Her GP is obviously misinformed.

Last edited by piperpilot; 08-14-2007 at 10:19 AM.

 
Old 08-16-2007, 06:43 PM   #9
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Re: Pap Smear Tests after total Hysterectomy?

Thank you everyone for your input. I had a laparoscopic hysterectomy that removed my uterus, ovaries, fallopian tubes and an ovarian cyst 18 months ago. The census from reading your replies seems that pap smears should still be done and am definately going to address this with my "new" GP next week. This healthboard is a wealth of information. I do have another question though. I was told by many people that I would feel like a new woman after having the surgery but have been on a downhill slide ever since healthwise. Sure, no more ovarian pain but my whole immune system seems to be out of whack or something as I have had many health issues since and never felt 100%. Unfortunately I now have to go to another area on this forum as I have been just diagnosed with Dengue Fever. Just wondering how if anyone else has found other health issues afterward.

 
Old 08-29-2007, 06:51 AM   #10
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Re: Pap Smear Tests after total Hysterectomy?

Now I am really confused. I asked my new GP (whom was trained in the UK) about pap smears after a hysterectomy. He asked if my hysterectomy was done because of any chance of cancer and I said no. He said generally no need for pap smears thereafter then?

 
Old 08-29-2007, 07:57 AM   #11
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Re: Pap Smear Tests after total Hysterectomy?

Quote:
Originally Posted by lonelymum View Post
Now I am really confused. I asked my new GP (whom was trained in the UK) about pap smears after a hysterectomy. He asked if my hysterectomy was done because of any chance of cancer and I said no. He said generally no need for pap smears thereafter then?
Hi,

Doctors do follow the guideline that after a hysterectomy, if it was not performed for any type of gyn cancer, then a Pap test is unnecessary. However, with the rising incidence of HPV (almost 80% of all sexually active people have it), I feel that all women should continue to have a Pap test. HPV doesn't care if you no longer have a cervix. Since the cells of the vagina and the cells of the cervix are identical (squamous epithelia), HPV can cause cancer even without a cervix. That's just too big of a risk to take, if you ask me. As you read in my case, if I had listened to my first GP, I could have ended up with invasive cancer by now. I'm just lucky that they caught it before it spread.

Hugs,

Lisa

Last edited by Shshi; 08-29-2007 at 07:57 AM.

 
Old 09-02-2007, 08:29 PM   #12
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Re: Pap Smear Tests after total Hysterectomy?

Hi Shashi (Lisa) Many thanks for coming back to me. I will go over what you have told me with my GP re HPV. I have to go back for blood test results in 2 weeks. It still amazes me how doctors just can't get together on something so cruicial like this Many thanks again.

 
Old 09-03-2007, 04:54 AM   #13
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Re: Pap Smear Tests after total Hysterectomy?

I am scheduled for a TAH on 9/7 with partial vaginal cuff removal as well. My doctor told me I will still need to have a PAP, every 6 months for two years. If all of those are clear, then I will have them once a year. Just thought you'd like another opinion to share with your doctor.
Good luck......Stacey

 
Old 09-04-2007, 01:50 AM   #14
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Re: Pap Smear Tests after total Hysterectomy?

Hi Lisa and Stacey. Firstly good luck to both of you. I hope all goes well and results are good. I am from Australia and live in Queensland. The Queensland Medical system is shocking and very underfunded. I see you are from the States. I have been very mucked about for 2 years within this system and have had quite a number of health issues that I am still dealing with. I am definately going to ask about a pap smear and am even considering ringing the hospital where I have a contact to make further investigation into this. Thank you so much and good luck once again.

 
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