Abnormal Pap Smears
Many abnormal Pap smears are the result of a sexually transmitted disease called Human Papilloma Virus (HPV), which is the same virus that causes genital warts. While it is difficult to fully eradicate the virus, it is important to evaluate and treat all abnormal Pap smears for prevention and early detection of cervical cancer.
If you have an abnormal Pap result, our Johns Creek OB/GYN may recommend a colposcopy to take a closer look at the cervix. Biopsies may or may not be taken. Depending on these results, we may recommend treatment such as cryotherapy (freezing), laser vaporization, or LEEP (loop excision).
What is a colposcopy?
A colposcopy is a test in which the doctor uses an instrument called a colposcope to look at the vagina and cervix and possibly take a sample of tissue. A colposcope has a series of lenses that magnify the tissue in the vagina and cervix so that the doctor can directly examine the organs.
Tell your doctor if you think you may be pregnant. Your doctor will want to perform the procedure in a different way if you are pregnant.
What are the benefits of the procedure?
The doctor should be able to make a better diagnosis of the problem in your cervix and vagina and suggest further treatment if necessary.
There are also alternatives to this procedure so ask your doctor if alternatives are right for you and your particular circumstance.
What happens during the procedure?
The doctor will use a colposcope to look into your vagina. You will lie on the examining table just as for a regular pelvic exam. The doctor will use an instrument to spread the vaginal walls apart, and then place the colposcope at the vaginal opening.
When your doctor looks into the vagina, he or she will see your cervix. If the doctor finds some problem tissue, he or she may use an instrument to pinch or cut off a small tissue sample. You may feel a pinch or slight cramp. Then the doctor will remove the instruments. The tissue will be sent to the lab.
What happens after the procedure?
You may feel a little lightheaded right after the procedure. You may have to lie down for a few minutes after the test is over. The doctor will tell you what he or she saw. The test results should be ready in a few days or weeks, depending on the lab. Ask the doctor what other steps you should take and when you should come back for a checkup.
What are the risks associated with this procedure?
Risks are minimal. Complications rarely occur. Minor bleeding from the biopsy site may occur. Other risks include:
- Heavy bleeding (more than one pad per hour or more bleeding than your menstrual flow)
- Infection
Call the doctor immediately if you have:
- heavy bleeding
- fever
- pelvic pain
Call the doctor during office hours if:
- You have questions about the test or its result.
- You want to make another appointment.
Treatment Options
Primarily there are three treatment options for abnormal pap smears where the doctor feels certain cells are tissues need to be removed. Each of these procedures are conducted on an outpatient basis and have high success rates of solving the problem. The treatment options are:
- Laser ablation
- LEEP
- Cryosurgery
Laser Ablation of the Cervix
The abnormal skin on the cervix can also be removed using a laser. The laser has the advantage of removing the abnormal skin very precisely. Healing is more rapid than with cryosurgery and there is not a bad discharge afterward. The most common problem is bleeding that can occur even several days afterward. These procedures are done as an outpatient at the hospital. Local anesthesia, similar to the LEEP procedure is used for these procedures. Laser treatment of dysplasia is very effective, however about 10% of women may have a recurrence in the future as with the other methods. Certain types of dysplasia can not be treated with this technique.
How is a LEEP procedure performed?
A speculum is placed in the vagina just like for a PAP smear. The doctor will then place a numbing medicine in the cervix (similar to what the dentists use to numb your teeth before filling.) After the cervix is numb, a special wire loop is used to remove the abnormal area. The wire loop is hooked up to a special electrical machine and a sticky pad is placed on your leg in order to complete the electrical circuit. The procedure itself is usually painless, although some mild cramping may occur afterward. The whole procedure typically takes about 5 minutes to perform.
What happens to the tissue that is removed?
The tissue that is removed is sent to the pathologist to make sure that all of the dysplasia was removed.
What kind of follow-up do I need?
Typically you will be seen back in 2-4 weeks to make sure the cervix has healed. You then should have a follow-up PAP smear every 3 months for 2 years to make sure that there is no recurrence of the dysplasia.
What are the risks?
Most women do not have any problems afterward. The most common problem is abnormal bleeding from the cervix, which can occur even several days after the procedure. Infections are very rare. There is also some theoretical risks of damage to or weakening of the cervix, which can result either in fertility problems in the future, or complicate pregnancy. These risks increase with the amount of tissue that needs to be removed in order to cure the dysplasia.
Will I be cured afterward?
Most women will be "cured" afterward, however a small percentage may have a recurrence or persistence of the dysplasia following the procedure. It is, therefore, important to have regular follow-up visits for PAP smears afterward.