pregnant and abnormal pap smear

[nicolexisxdead.livejournal.com]

background: I am almost 20 weeks pregnant and I had a pap smear that came back abnormal about a week ago. I'm 22 years old. I originally posted this in the "pregnant" community and some nice person referred me over here.

X-posted from pregnant.

I had my colposcopy today. Unfortunately, it wasn't "nothing" like I had been hoping. My pap results came back positive for HPV and I guess I have "Low grade squamous intraepithelial lesions". The doctor said on a scale of 1-4, with 4 being cancer, my pap results were a 2. So he did the colposcopy and had to take about four biopsies. I won't get the results of the biopsy back for 10 days! I will have gone crazy by then.




Anyway, this is all really scary and shocking to me. The doctor asked if I had any questions, but my mind was kind of blank so I couldn't think of anything. But now I'm full of questions. Firstly, how bad is this diagnosis? And how likely is it that this could turn into cancer? Does HPV ever go away, or will I have it forever? Is it dangerous for the pregnancy at all? Will I die from this some day? Will I be able to have a normal sex life in the future? And lastly, could I have gotten this years ago and it's just now showing up on the pap? Or is it more likely I got it from my last sex partner?

I'm scared, and embarrassed because I've never had an STI before...blegh. And I know little to nothing about HPV.



Thanks in advance for any and all help!

Comments

[hairballsplat.livejournal.com]

somebody who knows more than me will probably come along, but...

i was diagnosed with HPV 12 years ago. Had the colposcopy done. Freaked me out and I couldn't think of anything to ask either. Didn't know that there are lots of different types of HPV, only some cause cancer. Didn't know that HPV can go away. You've got great questions, maybe can you call your doc's office and ask them these questions...i bet they'll be pretty understading and try to help you out.

My HPV went away, i was not pregnant at the time, but did successfully carry two pregnancies to term. Have no idea how i got it. Wish i could help more.

[nicolexisxdead.livejournal.com]

Thank you, it is very scary to hear.

[archangelbeth]

What HPV is, is the genital's version of the cold, and flu, viruses. Some 80% of all sexually active people have been exposed to HPV, and there's a 30% chance of being exposed on one's very first encounter with a non-virgin partner.

HPV isn't tested for in STI tests. There are few or no tests approved for men (though tests for women can be used on them, it's "off-label" and not all doctors will do it, even if asked). It's just too common! And yes, you may've been exposed some time ago, or it may've come from your most recent partner.

There are many strains of HPV. The ones that affect the genitals (and sometimes the mouth or anus, if there's contact there) are divided into two overall types: those which can cause warts, and those which can, if left long enough, cause cancer.

But, seriously, they're like the cold and the flu. Warts are perhaps less-than-attractive, and may be painful - much like my nose after I've been blowing it for a long time, with a cold. The strains that can progress to cancer are like the flu; sometimes the flu, untreated, turns into pneumonia. Untreated pneumonia can be fatal.

(Actually, a cold can be pretty horrible if it turns into sinusitis. I had a full-on case many years ago, which landed me in the ER on Christmas Day, and more recently I've been taking antibiotics to stave off a milder case...)

However, most people don't get sinusitis nor pneumonia. And most people who get HPV will "clear" it within two years, if they ever show symptoms at all. (It's debated as to the virus is totally gone, or if one is still a carrier. I don't recall what the research currently suggests.)

Now, for those whose immune systems aren't up to the task? That's where PAPs come in. And colposcopies and biopsies. PAPs detect the cell-changes that can lead to cancerous cells. Colposcopies and biopsies keep a close eye on what the cell-changes are, and, with subsequent paps and/or colposcopies, provide data on whether the cells are remaining the same over time, healing, or getting worse such that they need to be frozen off or otherwise removed.

It takes years to get cervical cancer. With routine medical care and follow-ups, there should be only the smallest of risks of that. It is true that taking chunks out of your cervix is something that, if done often enough, could cause it to be unable to hold itself shut properly; most likely, the doctor would want to monitor your cervix during the pregnancy, and do nothing to it till after delivery. Subsequent pregnancies could be evaluated for the risk of "incompetent cervix" (that's the medical term), and the cervix can have a small stitch or two put in it, to hold it shut till the baby's at term.

So, to answer your questions in order:

1: The diagnosis is such that the doctor will probably, at the least, want you to have paps every 6 months, and may recommend removal of the abnormal cells via scraping them off or freezing them or something. This is unlikely to be done while you're pregnant.

2: Not very likely.

3: Researchers aren't sure, but your body may well be able to clear even this in a couple years. You may want to use condoms with your partner to reduce the chance that he's supplying a fresh viral load, though, during penetration. (Assuming your partner is male here!) Less viral load = your immune system has less to fight. Try to keep your immune system in good shape, so it can help nuke that pesky HPV!

4: I don't believe it's likely to be very dangerous. It's so extremely common!

5: If you continue to have follow-ups to this, and regular paps in the future, the chances of dying from cervical cancer are virtually zip-all, nada, and zero.

6: I see no reason why you would be unable to have a normal sex life. 80% of everyone else with a sex-life has been exposed, too!

7&8: No way of knowing where it came from, alas.

Please don't be embarrassed for this, any more than you'd be embarrassed because you kissed someone and got strep throat from it, or because your kid brought home head-lice or something. (I have no idea how I got them when I was a kid! >_> ) Heck, be less embarrassed - strep and head lice have symptoms! HPV, especially in guys, has virtually none in most cases.

*offers hugs*

[fallconsmate.livejournal.com]

ack you had to say the l-word!! *scratches obscessively*

my son...i swear he got them once a month his third grade school year. i finally buzzed his hair short, treated his head, and applied hair gel every morning to his hair. no more buggies. but GAH!!

[archangelbeth]

Eep! Sorry! (I was very traumatized; they cut my long, long hair very short! *sob*)

[fallconsmate.livejournal.com]

eh, its ok....and my mama told me about coming home with lice, having her hair cut off short AND washed with kerosene.

non-pesticide treatment: heavy mayo application overnight and then combout with the little combs. oh and you can see what hair-do i'm sporting at the moment *points at icon*

(off-topic; sorry!)

[archangelbeth]

Kerosene? EEP!

I really, really hope my kid can somehow avoid that particular life-experience. She is very emotionally invested in her never-been-cut long hair.

Re: (off-topic; sorry!)

[fallconsmate.livejournal.com]

give her hair a very light hairspray before she goes to school. that's enough to keep the bugs away, seriously!

Re: (off-topic; sorry!)

[archangelbeth]

I'll keep that in mind -- but unless there's an outbreak reported, I don't think I can get her to agree. (In some ways, she can be very Asperger's stereotypical, and odor is one of them. She hates a lot of them.) Thanks, though!

[nicolexisxdead.livejournal.com]

Thank you so much, I feel 100 times better. My doctor was pretty tight-lipped about it so I assumed the worst.

[archangelbeth]

Feh, doctors! I'm glad that I was helpful, though. O:>

[in-pieces.livejournal.com]

when I was 22, I also had an abnormal pap. I was very scared, even enough that I didn't go back to my gyno right away when they called and said they wanted to do a colposcopy and biopsy. It took me a solid 4 months or so to go back.. I got my colposcopy and biopsy, and it came back that i had moderate-severe dysplasia (i think thats what it was... it wasn't warts, i had the abnormal cells) and i needed another procedure to scrape and burn all the cells off. I did that (it was called a LEEP). I was told to not have sex for a full month after that procedure.

ok, so that backstory is done - i'm now 26, and have had 2... hrm, maybe 3? completely normal pap smears. I did have to go back every 6 months until those were both negative, and then I could go back to having just a yearly pap. Its safe to say that my HPV has in whatever terms, cleared itself up.

soooo.... even though our HPV's were different (yours *sounds* like its the warts? kind, whereas mine was not...this is what I know.)

1. Its something like 80% of the population will have HPV at some point in their life (wow and if i'm totally pulling that figure out of my ass, someone please correct me!!)...it also sounds like they've caught it early, having it be low grade, and since you've gotten the colposcopy, once they have those results, they'll be better prepared to plan any further treatment. Its not *that* bad of a diagnosis.. I know its scary, but think positive, even if the results are not what you wished for.. Again, I don't know exactly what type of HPV you have, so I can't say if it could turn to cancer or not.. it could... or it may not be a cancer causing type. Your doctor would be best to answer that question for you.

2. HPV goes away... as far as I know. It's a virus, and if you think of something like a cold.. which is a virus, we don't have that cold our entire life after getting it the first time.

3. I dont know about how it affects pregnancy, best to talk to your doctor about that one.

4. You more than likely will not die from this someday. However, I'm not a fortune teller and don't know your future, or your specific diagnosis. Your doctor should be able to give you a very realistic picture though. (though in my mind, no, you are not going to die from HPV.. from what i've read, the people who often die from HPV, or HPV related cancer are ones that did not get checked out regularly, so did not find out about it until much much much later)

5. Your sex life will be just fine

6. From what my doctor told me when I was diagnosed with HPV - yes, you could have gotten it years ago and it was dormant, until something came along and shocked your body (in a sense..) My doctor told me that from the severity of *my* HPV, I had it for about 3-4 years before it was shown on a pap.. Now I only became sexually active when I was 18 - and I actually know who gave it to me.. but I had yearly paps since the age of 18 and it never showed up until that one.

also - since guys don't have a test for HPV - and they are usually asymptomatic, they almost always don't know they have it.. so you could have gotten it years ago, and possibly the shock on your body from the pregnancy is what brought it forth... similar to how if I haven't gotten enough sleep for instance, i'm much more akin to getting a cold, because my body isn't 100% on (now, I hope you don't take that as a "omg your pregnancy made your HPV!!!" or anything like that... I think that stress on my own body caused my HPV to come through, so its possible that all of the hormonal changes due to pregnancy did the same thing?? )

relax though.. you'll be fine.. and if you want you can call up your dr and read these questions you just asked all of us as well, and i'm sure they'll be just as reassuring because you're gonna be just fine.

[nicolexisxdead.livejournal.com]

Thanks for answering, I am very relieved. I don't think it's the warts kind because I haven't had any symptoms. Agh, guys are lucky.

[queensugar.livejournal.com]

LSIL is a very common result, and -- although I know it can seem scary, especially since there's such a lack of good public info out there -- is actually really not a big deal. This is a mild result and is not a "bad" diagnosis.

In the vast majority people who return an LSIL result, the body will fight off the infection and the abnormal cells will heal up on their own, without medical intervention, generally within two years. What your health care team will do is continue to monitor the abnormal cells to ensure that they do so.

If they do not, and if they for some reason progress to higher stages of abnormality, they can be removed from the cervix looong before they'd ever become cancerous or pose a risk to your health. For what it's worth, the average length of time for the earliest abnormalities to progress to cancer -- if they ever do, and most don't -- is about nine to 10 years.

The same rule, basically, goes for HPV in general. While the jury's a bit out on whether or not the virus is ever truly cleared from the body, or just goes dormant and controlled, what is agreed that the vast majority of immune systems eventually fight it off on their own, within a few years. After this point, the virus becomes undetectable within the body, and does not cause further problems.

It is not itself dangerous for the pregnancy, no. The majority of sexually active people have been exposed to a genital HPV infection -- one study found that after only two years of becoming sexually active, and an average of two partners, 30% of teen women had a genital HPV infection -- so this is something that, at this point, is fairly well understood.

There is almost zero chance you will die from this. Like seriously close to nil. The most effective weapon against cervical cancer is regular pap tests and appropriate follow-ups, because of their ability to detect mildly abnormal cells such as yours, long before they become cancerous. In the developed world, cervical cancer is statistically quite rare, deaths from it rarer, and the majority of these cases occur in women who have not had a pap within five years or more of their diagnosis, or who were not able to access appropriate follow-ups such as colposcopies. Keeping on top of your pap test schedule and any recommended follow-ups basically ensures that there is very, very little risk to your health.

Yes, you could have gotten it years ago, or more recently. There's really no way to know. A Pap test itself doesn't detect HPV (though it can be administered in conjunction with a HPV DNA test that can detect infections, though that is not recommended for routine use in females under 30 simply due to the extremely common nature of HPV infection) -- it only detects abnormal cells caused by HPV. If you are under 30 and your pap tests were previously normal, there's no way of knowing how long you have had this infection -- and for that matter, it may not be your first genital HPV infection. Most of them are undetectable.

Hope that helps! Let me know if you have any more questions. Just remember: almost everyone who has been sexually active with anyone who's been sexually active before them has been exposed to HPV. It's so common that many medical professionals simply assume people have had a genital HPV infection at some point. You are not at risk for cancer.

[queensugar.livejournal.com]

Oh, and I missed a question: yes, you will absolutely be able to have a normal sex life. :) Again, most of us have or have had a genital HPV infection; there is no reason that HPV alone would make a meaningful impact on your sex life. Most people never even have any idea they've been exposed, as they may not get abnormal cervical cells or the abnormal cervical cells they get heal up between or before they start getting paps.

In fact, one of the main reasons the recommended age to start pap testing was raised from 18 to 21 (in the United States) some years ago is that they were finding it was so common to get mildly abnormal cells due to HPV infection when first becoming sexually active, that young women (between 18 and 21) were getting too much medical treatment -- and that raising it to 21 allowed most of these cases to heal up on their own without leading to things like colposcopies, without increasing the risk of cervical cancer.

Hope that helps give you some perspective.

[nicolexisxdead.livejournal.com]

Thank you, I do feel much better after reading all the responses. I wish my doctor had been as thorough. I think sometimes doctors forget not everyone has been to medical school hehe.

[queensugar.livejournal.com]

I'm glad. :) Yeah, I find it frustrating how many doctors don't take the time to really explain HPV and abnormal results to their patients -- I know so many people that have endured so much stress and anxiety over what is more of an annoyance than a real worry -- but I'm glad you were able to find this space and get some answers.

[atalanta0jess.livejournal.com]

Honestly, I have a headache and haven't read the other replies. But a little repetition never hurt, especially in situations like this, right? :)

Firstly, I think your doc is a little nuts for explaining it that way. It's not like you're half way to having cancer or anything like that. Low grade changes are just that....low grade. They are not a big deal. In fact, they are SO not a big deal that it's not recommended to treat them! All you need to do is keep an eye on things and make sure they don't progress and get worse. If they do get worse, you'll still catch them before you have cancer, and you'll just need to get the cells removed. They probably won't want to do that while you're pregnant, but it's not a big deal to let things chill for awhile.

To answer your questions:

How bad is it? Not that bad. ;) I had low grade changes that eventually progressed to high grade changes and required a procedure to remove the cells. The procedure was a pain in the poon, but not that bad on the grand scheme. I had a few sore days, and a few more days of gross discharge. Pretty managable. Now I'm abnormality free (well, at least as far as my cervix is concerned. ;) )

Cancer? Not likely! Death? Even less likely. Like, I'd eat my hat.

I'm unclear on whether HPV ever goes away, as far as the virus living in your body...but most likely your body will fight off the infection, and whether or not it still dwells in you, it'll stop causing you problems, and that's the most important thing.

I don't believe this is dangerous to your pregnancy, no. I'm not totally positive whether they would treat it while you're pregnant, if you do end up needing treatment, but I don't think that'll be a big deal.

YES, you will DEFINITELY have a normal sex life in the future!

And yes, you could have gotten it years ago. I have HPV, and I've only ever had one partner. I didn't get my first abnormal pap until nearly 4 years after I started sleeping with him without condoms. So it's awfully hard (and honestly, pointless!) to try to figure out where you got it from.

Good luck. And deep breaths. This really is not going to be a big deal, promise. :)

[jennifer0246.livejournal.com]

So sorry your doctor wasn't able to explain the situation more clearly to you. I'm actually very surprised you had biopsies - typically, unless there is a significant risk of invasive cancer, the recommendation is to avoid biopsies in pregnancy (because unless there's an extreme risk to your health, there's really nothing to be done until you've delivered).

HPV is extremely common, and LGSIL is the lowest step on the line of abnormalities, and it is a very, very VERY long line. The overwhelming majority of abnormal paps are LGSIL, and they resolve themselves without any intervention, usually within a couple of years. During this couple of years, you can expect to have pap smears more frequently, to monitor the situation and ensure that the cells aren't progressing in a concerning manner. HPV doesn't go away, but over time it does stop affecting the cervix.

This should not affect the pregnancy at all, though having cervical procedures like biopsies is more risky than not having them, and I would encourage you to do your own research and consider whether to consent to more biopsies before you deliver, if your doctor recommends them.

You will not die from this. Cervical cancer does kill people, but that's really quite rare, and nearly always in those who haven't had regular health care / whose cervical abnormalities haven't been detected until the cells have progressed to a very serious level of anomaly.

You can expect to have a very normal sex life in the future. It's absolutely impossible to know when you contracted HPV or who you contracted it from, and from a medical standpoint - it doesn't matter at all. What's important is that you are aware of your cervical health, monitoring the situation, and being pro-active about remaining healthy.

[misspaigeb.livejournal.com]

I'm kind of surprised that your doctor even did a colpo while you're that pregnant. My understanding was that paps done during pregnancy can have skewed results anyway because pregnancy can change the cells, and usually treatment isn't done until AFTER the birth. If I were you, I wouldn't have anymore, and I would wait until after your baby is born to have another pap and then colpo if necessary. As others have said, this is not life threatening at all and it's very very very very very unlikely you will get cancer ever.

[marionravenwood.livejournal.com]

My understanding was that paps done during pregnancy can have skewed results anyway because pregnancy can change the cells, and usually treatment isn't done until AFTER the birth.

I completely agree. You shouldn't be getting pap tests--let alone biopsies--while your pregnant or for a while after delivery: the cells are more likely to be abnormal due to pregnancy. I feel so strongly about this that if I were you I would get away from the doctor who recommended it.

It's very likely that you'll clear the HPV on your own and that your pap tests will be normal after delivery, but it may take some time, like at least six months or more after the birth. I wouldn't do another pap test until then. LSIL may not be nothing, but it's not urgent or extremely dangerous either: the majority of LSILs become normal over time without treatment and those that don't take a very long time to get worse.

[paraxeni.livejournal.com]

Seconding this. I'm pretty appalled that a colpo was performed for apparent LGSIL detected during pregnancy.

[nicolexisxdead.livejournal.com]

Uhh so the colpo/biopsies were pretty much completely unnecessary? That was extremely unpleasant : /. I would switch doctors, but I'm not even sure who scheduled the procedure. And I think with the health insurance I have, this is a normal thing they do. But if I had known all of this information going into it, I probably would have just turned down the colposcopy.

[afilteredview.livejournal.com]

The link I posted said that doctors usually don't treat HPV in pregnant women because it could cause early labor. I'm not sure if the pap/colp is included in what they mean by treatment. Is it possible to call your doctor and ask some questions? Say "I was looking up some information online about HPV and paps/colposcopies during pregnant and I wanted to know if you could answer some questions for me"

You can also find out who ordered to have the procedure done. You have a right to that kind of information

[misspaigeb.livejournal.com]

Your health insurance might cover it, but it's not up to them what kind of treatment you receive - it's up to you and your doctor. It really bothers me that he/she didn't explain any of this to you, but it's (sadly) pretty common.

[paraxeni.livejournal.com]

I'm just really unhappy that they seem to have scared you quite badly, so big hugs to you. The level of abnormality you had is really common, and it seems like your doc basically terrified you by basically implying you were halfway to cancer. I mean you're fairly young, (young enough that in my country you would never have had a pap smear, we don't get them before 25) pregnant, and obviously at the mercy of a pretty bad doctor.

[atalanta0jess.livejournal.com]

Yeah, what is this, on the scale of 1 - 4, you're at a 2 business? Come ON doctor!!

[afilteredview.livejournal.com]

I looked up some info about abnormal paps/pregnancy and found this http://www.ashastd.org/hpv/hpv_learn_dysplasia.cfm#7

[spamanda77.livejournal.com]

You've gotten some great information here, but I wanted to add this:
http://www.thestranger.com/SavageLovePodcast/archives/2010/07/13/savage-love-episode-195
If you've never listened to or read Dan Savage before, he's a sex/relationship advice columnist who is pretty awesome. I find him to be so spot-on about STIs, sex, and all kinds of things. Maybe this will help you realize that yes, of COURSE you will be able to have a normal sex life.
*hugs*