Womens Health

Cervical Pain

From the Woman's Diagnostic Cyber - Frederick R. Jelovsek MD

Cervix and Pap Smear Problems



Chronic cervical pain

I have had cervical pain (aching and stabbing) for over five years. Originally, I thought it was bladder related, because often the "episodes" make me have urinary frequency and urgency, and there is some pain just after urination. The doctors I saw told me that I was fine, but that my cervix was red and irritated which they said was normal for women on the pill, such as myself. Finally, about 4 years ago, I began to have breakthrough bleeding and I realized that it was actually my cervix causing the pain.

I saw a number of gynecologists, all of whom told me that it was impossible for me to feel pain in my cervix due to the lack of nerve endings to the surface. My bleeding continued, my pills were changed several times, but the pain worsened. Though all of my paps have come back normal, and I have had a colposcopy and a cervical biopsy (which showed only that I have glands on the outside of the cervix), the doctors finally said that the cervix bleeds to the touch and that I have chronic cervicitis for which there is nothing I can do.

I am uninsured and at the end of my rope! I am in pain constantly, sometimes with itching too, and I worry about this "infection" becoming systemic and not being treatable. I haven't been able to have intercourse with my husband for months! Is there ANYTHING I can do to help myself??

Recently I have noticed that it is aggravated by certain foods, i.e., tomatoes and mustard greens.

The cervix can "evert" somewhat due to OCPs. That puts glandular skin on the outside. Usually the acidity of the vaginal secretions cause a healing over of that glandular epithelium. If there is infection there, it doesn't heal well.

There are nerve endings in the cervix. They are less dense than other areas but some women have a quite sensitive cervix.

I assume the doctors have given you some courses of antibiotics. If not, erythromycin is a good one to use. If you've tried that, and are not allergic to sulfa, some of the topical cervical creams may also be useful.

Make sure your doctor has done a herpes smear. Sometimes a herpes cervicitis can present this way.

As far as topical treatment that you yourself can use, I would guess that douching might help but I'm not sure what to tell you to use. Usually we don't recommend it, but sometimes Betadine® douche can help.

I just wanted to extend my appreciation for your time and advice. I have ordered all of my medical records and plan to take them to a gyn and pay out of pocket (if I can afford it) and will follow your advice to have a herpes test and/or request some antibiotics. Thanks again!


Is all dysplasia HPV related?

I got the results of my cervical biopsy, and my doctor said it was a low grade squamous intraepithelial lesion (LGSIL). He said we weren't going to worry about it, and every three months, he would repeat the pap until it was clear, and if it wasn't clear in 12 months, then he would "LEEP" it back to clear.

I asked him where this came from and he said probably HPV (human papilloma virus), but the lab doesn't check for that so he doesn't know for sure, but in his opinion, all dysplasia is sexually transmitted, i.e., if your pap comes back with LGSIL, then you have HPV, regardless of what the report says. I asked him if he would ask the lab to DNA type for HPV, but he said they don't feel that tells them anything.

My husband and I have only been with each other, ever, and I have always had clear paps. I have read up on this, and I can't seem to find any other reasons for this to have developed so suddenly, after so many clear paps. Are there other possibilities?

Yes. Not all LGSIL or dysplasia comes from HPV. For example we see some related to menopause when estrogens are low. The pathologist is only looking at the nucleus of the cell in relation to the entire cell size. When the nucleus enlarges, it can be due to any infection or repair work on cervical cells. Any irritation can cause this. That's why we usually wait for it to clear up on it's own. It usually does and you probably won't need a LEEP. HPV is associated with much of abnormal Paps but not all by any means.


What is chronic cystic cervicitis?

What is "chronic cystic cervicitis" (per the pathology report following a hysterectomy)?

This is a condition in which the openings to the cervical glands get blocked by skin cells growing over the openings due to repair (metaplasia). Then the mucous in the glands can't get out and they form pockets of cystic areas. It is usually a benign process although rarely it can get severe enough to block off the opening to the cervix.

Is it necessarily related to an STD?

Not at all related to sexually transmitted diseases (STDs).

Is it a condition that shows up in a pap smear?

No. It is noticeable visually on speculum exam as multiple nabothian (mucous filled) cysts of the cervix.

Could it lead to cancer? (No pain is involved.)

No.There is no relationship to cancer.


Recurrent dysplasia, 2nd LEEP recommended

It all started a year ago with excessive bleeding. Then a D&C was done. Three months later, an abnormal pap test. Biopsy of it showed HPV virus. LEEP was done next. Then several cryosurgeries followed. After approximately 6 months, and having paps every 3 months coming back abnormal, one comes back normal. 3 months later an abnormal one that is biopsied and is showing dysplasia, and cervicitis. Now doctor wants to discuss further treatment options?!? What is left to do? And what exactly is acute cervicitis with koilocytosis? I have a family history of cervical cancer. Is a hysterectomy in line next?

We need more information to answer this. What are the different grades of dysplasia you've had, when and what grade is the current biopsy? If the last biopsy is acute cervicitis with koilocytosis, this is a benign inflammatory process that doesn't need further therapy at this time.

If you are a smoker, these changes can persist for a long time.

The current biopsy showed mild dysplasia. That was all I was told. I'm going to the doctor today because he wants to discuss further treatment options. I can't imagine what more can be done at this point. I really appreciate your prompt response on this. As far as the cervicitis though, on reading the symptoms, I wasn't even aware I have a problem, as I have none of those symptoms. I am a smoker and am currently on a birth control pill.

If there is just mild dysplasia in biopsy now, I would leave it alone and just follow with Paps and repeat the biopsy if it didn't improve in 9 months.

Stopping smoking would help your body to heal this on it's own. Smoking suppresses the local tissue immune system (IgA) in the genital tract.

Funny that you should say that, because I was thinking that too for just mild dysplasia. Just got back from the doctors and he wants to do another LEEP in two weeks. Not sure why though because biopsies are showing just mild. I would love to quit smoking, which he did tell me was important, but it is SO hard. The last LEEP I had done was a year ago. Does that make a difference? I am going in for LEEP, biopsies and ECC. What is ECC? And what is the recovery time?

If you keep having a LEEP procedure done to cervix, it eventually affects fertility because it destroys cervical glands. You've had quite a bit done to the cervix already so I guess another LEEP wouldn't add to that much, but I don't think it's needed for mild dysplasia.

The ECC is an endocervical curettage. A sharp, small rectangular-shaped instrument is used to scrape the inside of the cervix where the doctor cannot see with a colposcope. That is important to do as part of the biopsy to make sure there is not a more severe lesion in the cervix.

Both LEEP and ECC are office procedures, should take less than 30 minutes. Recovery time is mostly abstaining from sexual relations or any tampons in vagina, etc. for about 3 weeks.


Is HPV always sexually transmitted?

Is it possible to "get" HPV in any way other than sexually? I have been in what I thought was such a relationship for 30 years and found HPV on my last pap. My doctor just kind of alludes it had to be sexual and yet it wasn't me and its hard for me to believe my husband has been un- : faithful. Am I just being naive?

If it was your Pap smear or a biopsy that was read as HPV changes, then it is only about 85% accurate. They look for what is called koilocytosis and if the cytologist or pathologist sees it, they call it HPV compatible. Viral cultures or smears for HPV fragments are the more certain way to diagnose HPV.

Secondly, HPV can exist forever. We've had 80 year old widows (for 30 years) come up with an "HPV" compatible Pap. Exposure can have been many, many years before.

Thirdly, there's no reason it can't be introduced into the GI tract and from there to the genital tract. We don't know much about how it's totally transmitted but I'm sure it's not all sexually.

Personally, I'd assume that you don't really have HPV ( I don't recommend you get the smears for it but you could ask your doctor to do that if you want) and on the remote chance you did have it, It's likely in your case to have been contracted nonsexually, or sometime before marriage (either you and husband. I wouldn't let that Pap cause problems in a 30 year marriage, It's not that certain!


What is a LEEP procedure?

I have seen a couple of terms used and would like to know more about them.

What is a LEEP procedure, I know that is is commonly used to treat abnormal paps.

A LEEP (loop electrical excision procedure) is usually done in office. The cervix is injected with xylocaine. Then a wire loop with electrical current is used to excise tissue from the cervix that has the abnormal cells. It's sort of like using a melon ball scooper to remove the tissue. Chemical cautery or electrical cautery is used to make sure that the bleeding is under control. Nothing in the vagina for 3 weeks after that to let it heal then Paps in 3-4 months to make sure abnormal tissue is gone. It is about 80% effective.

What is HPV?

And what is HPV? I have never heard of a STD called this or a pap being returned with this kind of result.

HPV is human papilloma virus. It is ubiquitous in anyone having sexual relations. Most people's immune system controls the virus and it doesn't cause abnormal cells. Some people's immune system takes awhile to build antibodies to it and meanwhile it causes abnormal Paps. Smokers take the longest time to get over it but it persists for awhile in nonsmokers too.

Some people think HPV causes cervical cancer if one's immune system does not get on top of it. I suspect it is a promoter or initiator of cellular change that sets one up for possible cancer and something else (genetics, smoking, exposure to multiple partners etc.) carries it on.


Sexual activity after LEEP procedure

On Monday I had a LEEP procedure to remove some irregular cell development. My doctor said no sex for a month. Does this include all sexual activity or just actual intercourse? Please advise.

He/she means any activity that may disrupt or interfere with the cervix as it heals. The cervix is quite vascular and can bleed extensively if traumatized. Therefore, nothing in the vagina for about 3-4 weeks. Other sexual activity is ok.


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