Cervix and Pap Smear Problems
From
Woman's Diagnostic Cyber
Frederick R. Jelovsek MD
   
Can't get pregnant after
dysplasia treatment
Treatments to the cervix for cervical dysplasia, such as conization
by cold knife, LEEP (loop electrical excision procedure), laser or
cryosurgery (freezing), can negatively affect the ability to get
pregnant. The cervical mucous glands play a role in fertility and they
are often destroyed or impaired by these procedures. The dysplasia
itself, altho it sounds as if you are cured, shouldn't cause
infertility. After a year of trying to get pregnant unsuccessfully, it
is recommended that you see a physician for diagnosis of secondary
infertility.
Yes. If you have a cervical factor causing infertility such
as the glands destroyed by past cryotherapy, you may need artificial
insemination in which your husband's sperm is injected directly into
the uterus around the time of your ovulation.
We don't know for sure. Many doctors suspect that viruses play a
role and stimulate cervical cells to have more nuclear activity. If
left alone over many years, that nuclear activity may turn into
malignant invasive growth if it progresses.
No. The pill doesn't cause it. There is an increased incidence of
dysplasia in women on the pill, but most people think that since women
on the pill use less barrier contraception such as condoms, they are
more exposed to sexually transmitted viruses if having sexual
relations with different men over the years. It is this lack of using
barrier contraception that makes women on pills more likely to get
dysplasia, i.e., more exposure to agents that could cause dysplasia.
If they did a study of women who used both pills and condoms it would
probably show the same incidence of dysplasia as women using condoms
alone.
This can be fixed. At the current time you should see an infertility
specialist.
Is cryotherapy overkill
for cervical dysplasia?
I assume you had a cervical biopsy that showed dysplasia. The Pap is
only a screening test and what is actually on the cervix can be more
abnormal (more severe) than the PAP smear suggests or less abnormal or
the same. But all treatment is based on what the colposcopically
directed biopsy shows. Usually there are 3 grades of dysplasia: mild,
moderate and severe/cis.
To answer your question, as to whether cryotherapy is overkill, it
depends on the grade of the dysplasia. If the biopsy is a low grade
squamous intraepithelial lesion consistent with mild dysplasia, then
cryotherapy isn't really needed at this point. Most of those lesions
(over 2/3) will regress to normal on their own over time. It just
needs to be followed with every 3 months Paps, but if it progresses
(Pap worse and subsequent biopsy worse) then some treatment would be
indicated. I'm not sure that cryotherapy is the best treatment,
however, if you want to get pregnant in th near future. If you had a
good colposcopically directed biopsy in which the physician was
confident that the worst appearing area was biopsied and it returned
as moderate dysplasia, I would put off treatment with cryo until after
you get pregnant. Just follow-up each 3 months with the doctor to see
that it doesn't get worse.
If you have severe dysplasia on biopsy, I would recommend treatment
before trying to get pregnant. I don't think you should take the
chance that it could get worse during the time you are trying to get
pregnant and then waiting for delivery.
Squamous Metaplasia
Cells that are repairing-- new growth. This is the body's normal
method of healing irritation or inflamed cells.
No. Metaplasia in a normal healing function, HPV is an infectious
process that makes changes in cells.
Atypical squamous cells of undetermined significance (ASCUS)
No. It states that the cellular changes seen are thought to be
mostly a response to some cervical inflammation or irritation,
however, some of the inflammation may be due to the human
papilloma virus (HPV). HPV usually goes away on its own after a
year or two as your body develops immunity to the virus. There
are some strains of the virus that are thought to be more
aggressive and if left for a long time, may promote more severe
changes called dysplasia and even cancer. That is why the Pap
changes need to keep being checked, to make sure they don't get
worse over time.
Atypical squamous cells of undetermined significance (ASCUS) is
usually treated by just repeating the Pap smear in 3-6 months.
Colposcopy is usually not done unless there are 2 or 3 ASCUS
reports in a row. Colposcopy only allows the doctor to see which
area of the cervix is giving the abnormal cells so a biopsy can
be directed to the worst area. The biopsy is the "gold standard".
Most of the time it needs to be done although sometimes if you've
had previous biopsies that are consistent with colposcopic
visualization and that visualization has not worsened, a biopsy
can be avoided.
In our office, ASCUS smears are repeated every four months. Some
physicians repeat them at every 6 months. If the Pap worsens, or
persists too many times then a colposcopy is done. So yes, you
will have to be seen more often than just once per year.
ASCUS Paps over and under age 50
Yes. Most of the time (70-85%) ASCUS Pap smears
revert to normal on their own over time.
Women under age 50 have a higher progression of
ASCUS pap smears to dysplasia than do menopausal
women, but the rates vary considerably depending
upon the population studied and the accuracy of
the laboratory used.
One study has noted that ASCUS Paps
over the age of 50 had a lower incidence of
progressing to dysplasia - 13% vs 30%.
Most studies, however, will quote a lower rate of progression to dysplasia
for younger women than 30%.
The point is that it is quite rare for the lesion
to progress all the way to an invasive cancer as
long as repeat Pap smears are monitored. Pap
smears that show only ASCUS can be followed for a
long time. Since your Pap has not worsened in 5
years, that is a fairly good sign it is not going
to progress at all.
On the other hand, 5 years is a very long time to
worry about this and undergo the hassle of
frequently repeated Pap smears. It might be time
to ask your physician to treat the cervix with
some method to get it to produce normal cells and
a normal Pap smear. ASCUS changes and even
dysplasia are curable by destroying the cervical
surface cells by freezing, cautery, LEEP, laser
and any procedure that destroys the abnormal cells
and stimulates the body's normal cells to repair
the damaged ones.
Unsatisfactory Pap smear
There are a number of reasons why a PAP smear may be read as
unsatisfactory. These include a thick normal vaginal secretion,
but more commonly cervical or vaginal infection will give you
inflammation. Also some of the endocervical cells may not have
been collected on the slide. Rarely a menstrual period may result
in too many blood cells and not enough epithelial cells to
assess. Anything that obscures the cytologist being able to see
enough of the expected cells will result in a report of
unsatisfactory. This is not an abnormal report, just a pain in the
bottom because it should be repeated.
And yes, the doctor did scrape your cervix as that is what he/she
needs to do to obtain the sample. Keep in mind, however that the
"scraping" is just to pick up cells that have already been
sloughed off of the cervical surface. It is NOT a scraping that
removes a layer of growing cells on the cervix.
Support for Cervicovaginal Problems
Healthshare at wdxcyber (abnormal Paps)
Healthshare at wdxcyber (condyloma/HPV)
Differential Diagnosis of
Abnormal Paps, cervical and vaginal discharge
Related Educational Articles
HGSIL - High Grade Intraepithelial Lesions of the Cervix on Pap Smear
What is a Microscopic Cancer of the Uterus?
Abnomal Pap Smear with Atypical Squamous Cell Changes - ASCUS
Carcinoma In situ of the Cervix and What to Expect
HPV Type Associated with Cancer
Bacterial Vaginal Infections in Pregnancy
Do You Need a Pap After a Hysterectomy?
Signs and Symptoms of Vulvovaginal Candidiasis
Natural Progression of an Abnormal Pap
Irritant Vulvitis Often Misdiagnosed as Yeast
Atypical Glandular Cells of Unknown Significance (AGCUS)
Papillomavirus Testing of Abnormal Pap Smears
Painful Intercourse Due to Vulvar Vestibulitis
STDs in Adolescents
Yeast Vaginitis - Treat the Symptoms or Diagnose by Culture?
PAP Smear Diagnosis of Endometrial Cancer
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