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What does my abnormal pap smear mean?

There are several findings that can lead to an abnormal Pap smear result.   The first is the presence of atypical cells.  The second is the presence of the HPV virus.  Both will be discussed in detail below.

Atypical cell results include:

1. LGSIL: LGSIL stands for Low-Grade Squamous Intraepithelial Lesion. Low-grade means there are early changes in the size and shape of the cells often due to HPV.  A colposcopy is recommended to further evaluate the cervix.  Most of the time, low- grade squamous lesions resolve on their own in about a year.

2. ASCUS-H: ASCUS with possible high-grade squamous intraepithelial lesion (HgSIL). Some of your cells are not normal and there is a small possibility that they may be precancerous.  When we see a pap smear with this finding, a colposcopy is the next step.

3. ASCUS:  ASCUS is an abbreviation for:  Atypical Squamous Cells of Uncertain Significance.   Squamous cells are the cell type on the surface of your cervix. These changes may be caused by a vaginal infection or infection with a virus called HPV (human papillomavirus), or even in some circumstances be caused by a more serious lesion on the cervix.  When we see this finding, a colposcopy is the next step.

4. AGUS: AGUS stands for Atypical Glandular cells of Uncertain Significance.   Glandular cells are the cells that are located higher up in the cervical canal or uterus.  An AGUS diagnosis occurs relatively infrequently compared with other pap smear abnormalities. In this rare situation, a colposcopy is performed and occasionally other studies.  For example, in patients over 40, a biopsy of the lining of the uterus is performed.

5. HGSIL: HGSIL stands for High-Grade Squamous Intraepithelial Lesion. High-grade means the cells are very different from normal cells. These cells are more likely to lead to cervical cancer. A colposcopy is recommend to further evaluate the cervix.  Most of the time, HGSIL lesions are eventually removed with an office procedure called a LEEP as these lesions can progress into cancer (but usually this occurs over a period of 5-10 years).

6. Normal cervical cell results (often reported as NIL or negative intraepithelial lesion); however, positive for HPV. This result indicates HPV infection of the cervix, but no cell abnormalities were detected at the time of the testing.  Women who are infected with HPV have a higher likelihood of developing cell changes, which can progress to cervical cancer over time.  If this result is detected on your Pap smear, the next step is colposcopy.

What is HPV?

HPV stands for Human Papilloma Virus.  HPV is the most common sexually transmitted infection, impacting over 70% of sexually active men and women at some time in their lives.   Most HPV infections are asymptomatic and resolve spontaneously, but some infections cause warts and cancers of the genitals and oropharynx (throat).  There are over 100 strains of the HPV virus, 30 to 40 of which are sexually transmitted.  Our laboratory is able to identify if you are infected with the highest risk strains 16 and 18, or “other strains” of HPV, many of which have now been linked to cancer.

How did I get HPV?

HPV is transmitted by genital (skin to skin) contact, most often during vaginal or anal sex. HPV may also be passed during oral sex and affect the mouth or throat.   Most people never even know they have HPV, which is why it is so easily passed to others and an extremely common infection among sexually active individuals.  It may be impossible to know exactly how you contracted the HPV virus.

What can HPV do to my body?

HPV can cause genital warts and changes on a woman’s cervix that can lead to abnormal pap smears or even cervical cancer.  Some types of the HPV virus (low risk subtypes) are cleared from your body via your immune system.  Other types of the HPV virus (high risk subtypes) may persist or progress to more severe lesions.  It takes many years for an HPV virus to lead to cervical cancer.

What can I do if I am infected with HPV?

  • First, and foremost, be sure to follow our recommendations regarding need for colposcopy, repeat pap smears, or other recommendations.
  • No smoking! A woman who smokes doubles her risk for cervical cancer.
  • Limit number of new partners/exposure to HPV. Condom use may decrease transmission of HPV, as well as other sexually transmitted infections
  • There is no direct treatment for the HPV virus. In theory, anything that improves your immune system may help your body clear the virus. EstroDIM may be an option for you.  EstroDIM is a targeted supplement that supports proper estrogen metabolism.  Current data supports the combination of Indole-3-Carbinol and DIM have strong potential for improving cervical health, even regression and disappearance of cervical dysplasia.   http://www.ncbi.nlm.nih.gov/pubmed/10926790.
  • Optimizing your Vitamin A, carotenoids such as lycopene, vitamin C, vitamin E, folate, selenium, and Vitamin D may also help.  http://www.ncbi.nlm.nih.gov/pubmed/26853484 http://www.ncbi.nlm.nih.gov/pubmed/26439877  http://www.ncbi.nlm.nih.gov/pubmed/24605180

Will I pass HPV to my current partner?

If you have been with your partner for a while, your partner probably already has HPV. Your partner likely has no signs or symptoms of HPV.  There is no way to know if your partner gave you HPV, or if you gave HPV to your partner.  You can’t “pass it back and forth” to each other.

Can I prevent passing HPV to a new partner?

Condoms may lower your chances of passing HPV to your new partner, if used with every sex act, from start to finish. But HPV can infect areas that are not covered by a condom—so condoms may not fully protect against HPV.

Can my male partner get tested for HPV?

Right now, there is no HPV test for men.

I heard about an HPV vaccine. Can it help me?

Vaccines are available to prevent the HPV types that cause most cervical cancers as well as some cancers of the anus, vulva (area around the opening of the vagina), vagina, and oropharynx (back of throat including base of tongue and tonsils). They do not treat existing HPV, cervical cell changes, or genital warts. The vaccines are recommended at age 11 or 12 because they are most effective when given before a person’s first sexual contact.

What is a colposcopy?

Colposcopy is a simple, 10- to 15-minute procedure performed in our  office. You are positioned on the examination table like you are for a Pap smear, and an acetic acid solution (such as common table vinegar) is placed on the cervix.  Our doctors will use a colposcope — a large, magnifying lens, to view your cervix. A bright light on the end of the colposcope lets the doctor clearly see the cervix.  Abnormal cervical changes are seen as white areas — the whiter the area, the more severe the lesion. A biopsy is performed on any abnormal areas and sent to the pathologist for evaluation.  Based on the results of this biopsy, further treatment such as a LEEP may be needed or simply repeat pap smears every 4-6 months until the abnormal cells are cleared from your body.

What else can I do to prevent cervical cancer?

  • Get regular Pap tests (for most patients, an annual exam is covered without any out of pocket expense).  In our office, this means a Pap smear every year!
  • Do not smoke.  Nicotine is secreted into the cervical mucous and further damages the cells of the cervix.  If you smoke and have HPV, you have higher chances of getting cervical cancer. If you smoke, we can help you quit – ask us for help.
  • If you are age 26 or younger, you can get vaccinated against HPV. HPV vaccines do not cure existing HPV or related problems (like abnormal cervical cells), but they can protect you from getting new HPV infections in the future.

What is a LEEP procedure?

LEEP is an abbreviation for loop electrosurgical excision procedure.   LEEP is a 10 minute, simple treatment for abnormal cells on the cervix where the abnormal cells are cut away using a thin wire loop that carries an electrical current.

What happens during a LEEP procedure? 

During the procedure, you lie down on an exam table in the same position used to have a Pap test.  A speculum is inserted into your vagina. A numbing medication (lidocaine with epinephrine) is injected into your cervix. This usually causes your heart to beat faster or cause you to have a feeling like you drank a lot of caffeine.   A vinegar-like solution is applied to make the abnormal cells more visible.  The doctor then uses an electrical wire loop to remove the abnormal tissue. The tissue is sent to the pathologist to be tested.

Blood vessels on the area are sealed to prevent bleeding. The doctor may also apply a special paste — Monsel’s Solution — to prevent bleeding.  After the procedure you may have some spotting, brown discharge that has been described as “coffee grounds” from the Monsel’s solution.

Since our office is accredited by AAAASF, we can offer IV sedation for LEEP procedures if a patient is anxious about having this procedure done under local anesthesia.

Educate yourself. The following Web sites offer additional information:

American Board of Obstetrics and Gynecology
http://www.acog.org/Patients/FAQs/Cervical-Cancer

American Cancer Society
http://www.cancer.org/

American Social Health Association – HPV Resource Center
http://www.ashastd.org/std-sti/hpv.html

Eyes on the Prize: Support and Information for Gynecologic Cancers
http://www.eyesontheprize.org/

Foundation for Women’s Cancer
http://www.foundationforwomenscancer.org/

National Cervical Cancer Coalition
http://www.nccc-online.org/

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