A Little Protected Sex Never Hurt Anyone

So, we know that a pelvic exam is only necessary once every 2-3 years once a woman has had negative Pap tests three years running, but what happens when the Pap test comes back positive? Then what?
If a Pap smear reads positive (abnormal) it simply means that some different-looking cells appeared on the Pap smear slide. A positive Pap smear can be a scary and confusing experience, but rest assured that an abnormal Pap smear usually means there is fairly low probability of finding invasive cancer and a high probability of finding a curable precancer that can be treated without surgery. Statistics aren’t usually so trite; I apologize if that did nothing to assuage your concern. But information usually makes me feel better so let’s delve into some detail.

A Pap smear is used to detect changes in cells from the cervix (the cervix is the lower part of the uterus that connects to the vagina). When performing a Pap smear, a clinician takes a sample of cervical cells to test for any abnormalities. If the cells are in fact abnormal, this results in a positive Pap test. When a Pap smear comes back with abnormalities it is graded on a simple scale: ASCUS, LSIL, or HSIL. Physicians tend to use bulky, medical jargon to describe abnormal test results, so don’t be alarmed if you don’t understand their language; English translations are included.

ASCUS: atypical squamous cells of undetermined significance meaning unusual cells were seen, but the reason for their presence isn’t clear.

LSIL: low-grad squamous intraepithelial lesion meaning the unusual cells suggest the precancerous condition CIN1, or mild dysplasia.

HSIL: high-grade squamous intraepithelial lesion which suggests the precancerous condition CIN 2 or CIN3, mild or severe dysplasia.

A positive Pap smear can be caused by a variety of things. Many vaginal infections can lead to abnormal cells on the cervix, yielding the abnormal Pap result. Positive Pap smears can also indicate the presence of HPV (human papillomavirus). Yearly, one million women are diagnosed with HPV. Despite what the Gardasil “one less” commercials might lead us to believe, in most women with HPV, the virus clears and goes away on its own without treatment. In others, HPV can cause cervical dysplasia.

Cervical dysplasia is another way of describing abnormal cells on the cervix. These cells are often referred to as “precancerous,” which means they are not cancer, but if left untreated, could eventually develop into cancer. Low-grade dysplasia disappears without treatment in 84 percent of women under 34, and 40 percent of women over 34. In contrast, high-grade dysplasia must be treated by a physician. Finally, there is the low possibility that a positive Pap smear could indicate cervical cancer. Ideally, regular Pap smears will catch any abnormalities before they progress to high-grade dysplasia or cervical cancer.

After a Pap test comes back positive, a doctor will proceed differently depending on its cause. If the abnormal Pap is caused by a vaginal infection, a doctor will prescribe a medication to treat that infection. If the positive Pap is caused by abnormalities on the cervix, the doctor will likely perform a colposcopy to find out further information. During a colposcopy, a physician uses an instrument called a colposcope, which allows her or him to see the cervix up close. A colposcope is essentially a magnifying lens with a bright light. If the doctor sees obviously abnormal areas, s/he will take a sample, or biopsy, to gain more information on the reason for the abnormalities. Often, low-grade dysplasia can simply be monitored to ensure that it does not progress to more severe dysplasia. However, high-grade dysplasia must be treated.

There are many treatments for dysplasia. All processes involve the doctor removing the abnormal cells from the cervix. In cryotherapy, the doctor destroys the abnormal cells by freezing them. Another option is a LEEP (Loop Electrosurgical Excision Procedure). In a LEEP, a loop of wire with an electrical current removes the abnormal cervical cells. Another common procedure is conization (also called cone biopsy). In this case, a doctor removes the abnormal tissue and some surrounding tissue in a cone-shaped sample from the cervix. After these procedures, it is normal to have slight cramping, bleeding, or discharge. The medical literature all says that this part of the cervix is not sensitive and that “most women” say that the biopsy feels like a pinch. The women I know who have undergone a biopsy and further treatment for dysplasia disagree; they used strong language to describe in detail the pain of their individual procedures. So naturally, I try to avoid this outcome.

I have ranted about yearly cervical exams and the waste of lab and personnel costs in the past, but signs of abnormalities on the cervix should be monitored. If the Pap test comes back positive a follow-up visit simply should not be avoided. In the interim a little protected sex never hurt anyone.

HPV can be passed via skin-to-skin contact and although some claim that a condom is useless in protecting against the sexual transmission of HPV, certain studies suggest otherwise. A condom may not cover every point of HPV transmission, but it is definitely a good start. It has been said before, but bears repeating: a little protected sex never hurt anyone.

—Ms. Skeptical

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