Wednesday, August 22, 2007
This is a teeny bit graphic but it's my attempt to demystify the Abnormal Pap smear for other women. If you can't handle talkin' 'bout Vaginas then just don't read this post. Chicken.
So I had a Pap Smear come back abnormal.
This is WHY we have pap smears. We go to the doctor every year (and if you don’t, and are a woman under the age of 65, you should) because of the many conditions that might go overlooked unless a red flag goes up when you have your annual exam. About 5% to 7% of pap smears produce abnormal results. Primarily, pap smears are a method of early detection for Cervical Cancer. And conditions like HPV* that are associated with Cervical Cancer.
So I go. Every year I get my exam. I brave the chilly tools and undignified experience and the unpleasant sensation of someone poking around my insides. Putting my feet into cold metal stirrups and leaning back on that weird inclined medical bed thing always makes me feel like I’m getting into some bizarre ride or machine, except my vagina is front and center so apparently IT’s the one driving. It’s a FREAKY feeling. But I do it. Because I want to live a long life, I care about my family and I want to have children someday (and part of planning for that is making certain that my reproductive system is healthy and hasn’t been taken over by aliens or anything).
We learn in health class (hopefully) that girls should get annual exams and about some of the things a pap smear can detect. No one, however, talks to you about what happens when you get a call from the nurse saying your pap is “abnormal.” I did some research. An abnormal pap smear (love that phrase, by the way) can mean many things and can be handled a few different ways. It can mean you have an infection, that you have pre-cancerous cells in your uterus, that you have HPV... it could even be that your pap smear was inaccurate. Click here and here for more detailed information. When I called the nurse back in a panic, she theorized that the GYN would probably just do a second pap to make sure the first was accurate. She was trying to be reassuring. I wanted to be reassured so I chose to take her word for it.
My appointment was yesterday. It was then, after being weighed and peeing in a cup and filling out forms (you know the drill, I swear they do this to make you feel that you have no power and are therefore less likely to complain when they keep you waiting forever and poke you with frozen metal implements), that the nurse handed me a form to sign. A form that, essentially, served to acknowledge that I had had the Colposcopy and Biopsy procedure explained to me and knew the risks involved.
I hadn’t. I didn’t. And... I was scheduled for WHAT?!?!
Biopsy is a scary word. Biopsy means - to the uninitiated layperson with NO experience of it - You Might Have Cancer And The Doctor is Gonna Cut You. Mix into that the fact that the doctor wants to cut me IN MY UTERUS and - you know what? I got a little tense. Call me crazy but I wasn’t stoked on that combination.
The nurse breaks this news to me and then drops me off in an exam room. I sat there for 30 minutes on the fresh sheet of paper they pull across the table (I really don’t LIKE sitting bare assed on what to me appears to be something very similar to butcher paper. HELLO? If you can wrap dead meat in it, I don't want it NEAR my private bits.) Waiting. For half and hour. For the doctor to come in and explain why she needs to CUT ME IN MY UTERUS.
When she arrived it pretty much went like this:
She read my lab results to me. I have some atypical squamous cells of undetermined significance (ASCUS. Yes. It’s an official designation. Wacky, huh?). The short version is - there were some signs of wonky-ness in my uterus.
To determine the exact nature of these cells, the Doctor will perform a Colposcopy (read here and here about Colposcopies) and possibly a Biopsy.
First the Doctor has you position yourself in the stirrups (the same as the Pap Smear position. Superfun) for the Colposcopy. She puts in the speculum (evil cold duck-lip thing) and widens the Vaginal opening enough to see what’s going on in there. A vinegar-like solution is spread around and it turns abnormal cell growth white so it can be easily identified (this feels similar to but not nearly as scratchy as a Pap smear). She uses the Colposcope to get a better look at the cells. IF the Doc finds sufficient abnormal cell growth (read here: pretty much any at all), she cuts a small piece of that tissue off to be tested - that is the Biopsy. This feels like a very sharp pinch; less pronounced than I would expect it to hurt if someone cut a bit of tissue off of my hand or leg (but without the reassuring knowledge that you can kick the person who has injured you in the hand or leg.) It DOES hurt, but it isn't all that bad and it is fairly brief. I did NOT feel noticeable continued pain after the Biopsy - as you would if you were cut somewhere externally.
Women have these done ALL THE TIME. They just don’t talk about it (presumably because no one wants to talk about having HPV, which seems pretty stupid considering that three out of every four adults over the age of 18 have been infected with it) so it sounds really freakin’ scary. The Biopsy causes mild bleeding. It is not like menstrual bleeding, it’s more thin and bright red - like what you expect from a cut on your skin. It can also cause cramping. I experienced a tiny bit of this but the nurse gave me four Motrin prior to the procedure and really - they did the trick. It did hurt but wasn’t nearly as bad as I thought it would be. If I can handle it, most other women will be fine.
After the Doctor was done, she put something on the cut to help stop the bleeding. This stuff looks icky AND she tells me that in a few days this material will “drop out” on it’s own so I shouldn’t freak out. JOY. Love being told that my Vagina will be expelling stuff. Woo-hoo!
Oh, and my warm fuzzy Gyno tells me that you should not “Place anything in The Vagina for two weeks after this procedure.” I wanted to ask, “oh... THE Vagina? The one right here or the one I keep on my kitchen counter? WHICH Vagina exactly am I not supposed to put ‘anything’ in?” But she did at least clarify that she means, “Tampons or intercourse.” Which I guess is to reassure me that she didn’t assume I put like power tools or an extra pair of shoes up there.
The good news is, I’M FINE. There was very little abnormal cell growth. I will probably just have to have my PAP every 6 months for a while until we are sure nothing weird is developing. In two weeks I’ll get the results of the Biopsy which will be more specific. Statistically, it will probably turn out to be no big deal. But I would rather KNOW.
Mind you, for the last ten minutes of sitting on that stupid paper waiting for the doctor, I seriously considered just leaving. I was uncomfortable and scared and horrified that she might have to perform a Biopsy and I wanted to GO HOME. I stood up and paced. I seriously considered walking out the door (after changing from the big paper sheet back to my blue jeans and underwear, of course). I'm glad I didn't. Proper Gynecological care can catch early evidence of cancerous growth, saving your life and your family a great deal of grief. My visit yesterday was unpleasant, but nothing compared to how horrifying it would be to find out that I had a condition that had advanced to the point that it couldn't be treated.
I just wish that ANYONE I knew had EVER mentioned having this procedure before. I was terrified. Stone cold horrified and ready to beat feet. So now, if this happens to YOU - you know it also happened to ME. And we're gonna be ok. Even if the news is bad, I will be finding out early - while something can be done to help me. If you get an abnormal Pap smear you may have to have a Colposcopy (which I can barely pronounce) and/or a Biopsy. You will survive both of them just fine. They aren't as bad as they sound and maybe you will be luckier than me and have a Gyno who warms up the speculum.
Also, from personal experience I can say that chocolate cake helps. Taken orally, of course. When your Uterus feels bad, four Motrin with a chocolate cake chaser may not actually fix anything but it does help.
*There are like 40 types of HPV, roughly 74% of adults in the U.S. are carrying it. It is sexually transmitted but a lot of people who have it have no symptoms and never know they have it. Some forms manifest as genital warts (which, since it’s an obvious question, I will share with you that I DO NOT have. Yay for me.) Some forms are associated with Cervical Cancer. It’s like this: NOT everyone who has HPV gets Cervical Cancer but everyone who has Cervical Cancer has HPV. Basically if you have HPV, then they watch for Cervical cancer... ‘cause you are at risk. Read here about HPV truths and myths!
ANOTHER addendum: My doctor has told me now that I do NOT have HPV. I am a little unclear on whether this means the initial tests were inaccurate or if this means it can "go away" - which I did not think was the case. Whatever the case, I preferred to have this accurately recorded here. And I'm not asking again lest she suggest another biopsy. A scalpel doesn't need to be anywhere near my ladybits again, thankyouverymuch. It's been a few years and I am still getting very regular checkups to make sure I am healthy because, no matter what my doctor says I do or do not have - keeping track of our health is something we owe it to our loved ones to do.