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vaginapagina2006-08-08 10:53 pm
althea) wrote in vaginapagina2006-08-08 10:53 pm
Entry tags:
HPV, cervical cancer, biopsies, and what comes next
I've got a few questions about HPV and cancer detection that I'm hoping you ladies can help me with. I don't want this to be longer than it has to be, so I'll just give you the short version and not link to previous posts.
-May 5: Found a small bump on my cervix.
-May 11: Went to my regular doctor, who took a swab to send out for HPV, gonorrhea, and chlamydia, but said I should still see a gynecologist to find out what that bump is.
-May 18: Called and spoke to my doctor's assistant/secretary/whatever, who checked the test report and told me "there's nothing there, you're fine," but to still see a GYN.
-June 26: Called doctor's office to arrange to pick up a copy of the report to bring to GYN. Found out that, oops, she'd read me the wrong report--my last Pap from January, which was normal--and that the report from the 5/11 swab said something different. Picked it up and saw that it was positive for "both low-risk and high-risk strains of HPV," but that the sample wasn't good enough for gonorrhea and chlamydia tests. Assistant/whatever woman tells me that it's okay, the fact that I had a YI at the time of the swab probably caused a false negative (wrong!) and that it's impossible to have both low- and high-risk strains (wrong!).
-July 21: After much rescheduling on both ends, I finally saw the GYN. She told me that she didn't just want to do a new Pap, which was what I'd been expecting, she also wanted to do a colposcopy and take biopsies of my cervix. She *also* wanted to do an endometrial biopsy just to be on the safe side, because I've got PCOS and have on occasion gone without getting my period for a couple of months. My period was almost gone, just a tiny bit of old, brown blood, but she said that was okay. I had the colp, the biopsies (three pieces of my cervix and one very ouchy scoop of my endometrium). The doctor told me that she'd call me in two weeks with my results. I hobbled home, trying to act as normal as possible in front of my teenage summer guest, who was already freaked out because he'd had to wait two and a half hours in the waiting room, wondering what had happened to me. (Edit: When she examined me, she did tell me that the bump was in fact a Nabothian cyst. So, I went in for something that turned out to be no big deal and ended up finding out I may have a serious problem. Go figure.)
-August 2: Despite the fact that the doctor said I'd only bleed for three or four days, I didn't stop bleeding until this day. Granted, it was very light, brown blood for the last week week, but still, jeez.
-August 4: Called for my results and was told the doctor was gone for the day. The receptionist said the doctor had my chart "in her files," so the biopsy reports might be in it, but probably not because she didn't call me. They did have my Pap and STD reports at the front desk, and she said everything there was negative. I'm a little wary of believing anyone other than a doctor at this point, but I took what I could get. She told me the doctor would be back in the office on Wednesday. Sigh.
-August 6: Got my period again, dammit!
If you've read all of that, thank you! Now, here are my questions:
-In my experience, the bad/scary test results get sent back to the doctor as soon as possible. If she didn't get my results back yet, I'm assuming they were okay. Thoughts?
-Also, if the Pap was normal, then I'm guessing I probably don't have any cancerous cells...right?
-If I do, what comes next? Do I have choices, or is there only one treatment option? I felt kind of ambushed the day I had the biopsies done. She said I didn't have to have them done that day, but I wanted to get it over with.
-Has anyone ever heard of women with PCOS needing an endometrial biopsy? My doctor said she didn't think there was anything wrong but that she wouldn't feel comfortable telling me I was fine unless she checked. O...kay? I guess.
-I *think* she told me to wait two weeks to have sex, but I wasn't sure and I didn't get to ask on Friday. Now, I've got my period and I'm wondering if it's okay to use my DivaCup. Does anyone who's had cervical biopsies know if that would be okay?
-Finally, just a general concern. You know how you kind of like to make a good impression on a new doctor, try to come across as mature and calm and not an emotional, hysterical hypochondriac? How bad do you think it is that I started crying in her office before the exam? I was telling her that the big speculum she'd mentioned using for the colposcopy might be difficult because I tighten up when I haven't had sex in a while and I'd actually pushed the speculum out back in May, right after my doctor had taken the swab. She asked, "Well...you *are* sexually active, right? How often do you and your husband have sex?" And I had to explain that my grandmother had been ill and had just died and I'd been flying back and forth to Florida, not to mention having a teenage relative sleeping in our living room, a few feet from our bedroom door. I just started sobbing. I think I freaked her out a little, though she seemed to understand once I told her about my grandmother. She even told me that her elderly grandmother had been very ill recently and almost died. So I don't *think* she thinks I'm a lunatic, but I'm not sure. I'm just hoping this doesn't affect how she treats me in terms of respecting my concerns rather than dismissing them. She seems pretty good and she has a solid plan for managing my PCOS, so I want to keep her if I can.
-May 5: Found a small bump on my cervix.
-May 11: Went to my regular doctor, who took a swab to send out for HPV, gonorrhea, and chlamydia, but said I should still see a gynecologist to find out what that bump is.
-May 18: Called and spoke to my doctor's assistant/secretary/whatever, who checked the test report and told me "there's nothing there, you're fine," but to still see a GYN.
-June 26: Called doctor's office to arrange to pick up a copy of the report to bring to GYN. Found out that, oops, she'd read me the wrong report--my last Pap from January, which was normal--and that the report from the 5/11 swab said something different. Picked it up and saw that it was positive for "both low-risk and high-risk strains of HPV," but that the sample wasn't good enough for gonorrhea and chlamydia tests. Assistant/whatever woman tells me that it's okay, the fact that I had a YI at the time of the swab probably caused a false negative (wrong!) and that it's impossible to have both low- and high-risk strains (wrong!).
-July 21: After much rescheduling on both ends, I finally saw the GYN. She told me that she didn't just want to do a new Pap, which was what I'd been expecting, she also wanted to do a colposcopy and take biopsies of my cervix. She *also* wanted to do an endometrial biopsy just to be on the safe side, because I've got PCOS and have on occasion gone without getting my period for a couple of months. My period was almost gone, just a tiny bit of old, brown blood, but she said that was okay. I had the colp, the biopsies (three pieces of my cervix and one very ouchy scoop of my endometrium). The doctor told me that she'd call me in two weeks with my results. I hobbled home, trying to act as normal as possible in front of my teenage summer guest, who was already freaked out because he'd had to wait two and a half hours in the waiting room, wondering what had happened to me. (Edit: When she examined me, she did tell me that the bump was in fact a Nabothian cyst. So, I went in for something that turned out to be no big deal and ended up finding out I may have a serious problem. Go figure.)
-August 2: Despite the fact that the doctor said I'd only bleed for three or four days, I didn't stop bleeding until this day. Granted, it was very light, brown blood for the last week week, but still, jeez.
-August 4: Called for my results and was told the doctor was gone for the day. The receptionist said the doctor had my chart "in her files," so the biopsy reports might be in it, but probably not because she didn't call me. They did have my Pap and STD reports at the front desk, and she said everything there was negative. I'm a little wary of believing anyone other than a doctor at this point, but I took what I could get. She told me the doctor would be back in the office on Wednesday. Sigh.
-August 6: Got my period again, dammit!
If you've read all of that, thank you! Now, here are my questions:
-In my experience, the bad/scary test results get sent back to the doctor as soon as possible. If she didn't get my results back yet, I'm assuming they were okay. Thoughts?
-Also, if the Pap was normal, then I'm guessing I probably don't have any cancerous cells...right?
-If I do, what comes next? Do I have choices, or is there only one treatment option? I felt kind of ambushed the day I had the biopsies done. She said I didn't have to have them done that day, but I wanted to get it over with.
-Has anyone ever heard of women with PCOS needing an endometrial biopsy? My doctor said she didn't think there was anything wrong but that she wouldn't feel comfortable telling me I was fine unless she checked. O...kay? I guess.
-I *think* she told me to wait two weeks to have sex, but I wasn't sure and I didn't get to ask on Friday. Now, I've got my period and I'm wondering if it's okay to use my DivaCup. Does anyone who's had cervical biopsies know if that would be okay?
-Finally, just a general concern. You know how you kind of like to make a good impression on a new doctor, try to come across as mature and calm and not an emotional, hysterical hypochondriac? How bad do you think it is that I started crying in her office before the exam? I was telling her that the big speculum she'd mentioned using for the colposcopy might be difficult because I tighten up when I haven't had sex in a while and I'd actually pushed the speculum out back in May, right after my doctor had taken the swab. She asked, "Well...you *are* sexually active, right? How often do you and your husband have sex?" And I had to explain that my grandmother had been ill and had just died and I'd been flying back and forth to Florida, not to mention having a teenage relative sleeping in our living room, a few feet from our bedroom door. I just started sobbing. I think I freaked her out a little, though she seemed to understand once I told her about my grandmother. She even told me that her elderly grandmother had been very ill recently and almost died. So I don't *think* she thinks I'm a lunatic, but I'm not sure. I'm just hoping this doesn't affect how she treats me in terms of respecting my concerns rather than dismissing them. She seems pretty good and she has a solid plan for managing my PCOS, so I want to keep her if I can.
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Again, sorry I don't know more. I wish you lots of good luck!
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I have heard about endometrial biopsies being done in women with PCOS who aren't menstruating regularly, whether it's a natural or artificial cycle, because the lack of endometrial shedding can other cause problems.
It's possible that the pap and STI tests are negative, but if it would make you more comfortable, confirm it with the doctor when you speak to her.
And on the last part, she may have made some notes in your chart about what was going on in your life, and probably doesn't think you're off your rocker. If you like her, and think she'll do well at being a partner with you in your care and management of PCOS, then stick with her.
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I have heard about endometrial biopsies being done in women with PCOS who aren't menstruating regularly, whether it's a natural or artificial cycle, because the lack of endometrial shedding can other cause problems.
Oh, good, thanks, I was a little worried that maybe she's a bit over-cautious. She even referred me to a breast specialist because my breasts are lumpy. I get the feeling she's the "better safe than sued for malpractice" type.
And I think (hope!) that you're right about her not thinking I'm a basket case. Hell, I kind of was that day, but I think she might have understood because her own grandmother had recently been so ill.
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Seeing a new health care provider when you're already under stress, and concerned about something that could be very serious could make most anyone break down. If she's as good as you say, she probably won't judge you on it, but she might ask you about how you deal with stress, or at least, how you're coping.
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As for the stress, yeah, this summer was the most stressful time of my life. It's just kind of embarrassing to have a new doctor see you at your absolute worst, but I'm over it. She seemed okay when I called her on Wednesday--which, by the way, was for her to tell me that I do NOT have cancer, woohoo!
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I hope some of the stress is subsiding for you, and I'm glad you're developing a positive relationship with a health care provider.
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Besides, I'm sure doctors would rather have a patient who tells them everything (whether in an emotional state or not) than a patient who plays tough (and thus, withholds key information). If you think about it, you're actually making her job easier by informing her of all the stressors in your life!
I hope things get easier for you. I wish I could answer your other questions, but I'm sure there are some knowledgeable folks here who can do that. :)
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Also, the other thing I wanted to point out is that when you have STD testing done, unless they specifically request the HPV test, they don't test for that, so you might want to find out if they did that test or not when you get your results. And even if they did test for it, it's only the strands that can cause cancer that will show up.
If you have precancerous cells, there are a number of options, but most of the time, a LEEP is used. If you do a google search on LEEP, you can get answers to a lot of questions about the procedure. And if you have any more, let me know. My mom has had it done and I've done a lot of research as it was reccomended for me by a clinic, though I never had it becuase my GYN said she would rather just do more frequent paps to keep an eye on things for now.
Also, I would wait the 2 weeks before using a menstrual cup. I know I was told no sex, no tampons, no anything up there for 2 weeks.
Finally, as to your last question, I wouldn't be too concerned about breaking down in front of her. It sounds like she handled it pretty well which is a good sign for her ability to handle care for patients, actually. I know it might make you nervous that she has seen you upset, but at least she knows what kinds of stress you are under, which will help her to understand things better for your care. Sometimes, that sort of information is very relevent to your care, even if it doesn't seem it. So it can only help her to know.
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Oh, I definitely have HPV. The test my primary care doctor did came back positive for that. It just never showed up before because, despite what my (again primary care doc, not the GYN I just started seeing) said, they're not testing for STDs with a Pap, they're testing for the effects of a particular STD (HPV). I didn't know that until the gynecologist explained it to me. She said that it's like getting exposed to the virus for chicken pox but never developing the skin eruptions--the virus is there, but unless you're tested for it, you wouldn't know if you didn't have the symptoms.
Thank you for mentioning the LEEP procedure, I'd seen it mentioned before but, to be honest, didn't have the courage to google it once I realized it might apply to me. I just did a search and the first entry I found was pretty clear and reassuring. If I have to have it done, I'll just do it. Hell, a few months ago, I'd never have thought I could handle having a biopsy, but I did it, and the doctor and nurse even said I handled it really well. That'll teach me to forget my own motto: If I have to, I can do anything. (Thanks, Helen Reddy!)
Also, I would wait the 2 weeks before using a menstrual cup. I know I was told no sex, no tampons, no anything up there for 2 weeks.
That's where my confusion comes in, because it's been slightly more than two weeks. I don't want to push it, though, so I'll just keep using pantyliners until I call her tomorrow. I really, really hope she has my results by then.
Thank you so much for your reply! I feel better now that I've gotten an idea of what I may need to do, one way or the other. :-)
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Here's my $.02 for your questions:
-In my experience, the bad/scary test results get sent back to the doctor as soon as possible. If she didn't get my results back yet, I'm assuming they were okay. Thoughts?
Find out for certain, by speaking to the doctor herself, prefereably in person with her showing you your chart. That way you can make sure there are no more mixups, and ask questions until everything is clear.
-Also, if the Pap was normal, then I'm guessing I probably don't have any cancerous cells...right?
If the pap was normal, you do not have any precancerous (or otherwise abnormal) cells in the area tested by the pap. You may wish to be re-tested more often than standard for your age/health group (say, yearly or 6monthly instead of every three years), to keep tabs on the progress of your HPV infection and its effects on your cervix. Since you had positive results for both high-risk (potentialy cancer-causing) and low-risk (potentially wart-causing) HPV, plus PCOS, there's a lot going on in your reproductive tract! You may be able to manage symptoms, improve possible outcomes, and ease your worries by making a plan to take more than ordinary care.
-If I do, what comes next? Do I have choices, or is there only one treatment option? I felt kind of ambushed the day I had the biopsies done. She said I didn't have to have them done that day, but I wanted to get it over with.
You have several choices for treating (pre)cancerous lesions on the cervix, and which one(s) are best for your situation is something you should discuss with your doc, after doing some research. Options I can recall off the top of my head are LEEP, cryotherapy and laser removal.
-Has anyone ever heard of women with PCOS needing an endometrial biopsy? My doctor said she didn't think there was anything wrong but that she wouldn't feel comfortable telling me I was fine unless she checked. O...kay? I guess.
I haven't researched PCOS, but waving that in front of the common-sense-o-meter, that does seem a reasonable, if painful, extra precaution.
(BTW, if you were wondering why you were advised to have colposcopy and cervical biopsies instead of another pap, that was probably because of the HPV. Colposcopy and biopsy are standard diagnostic proceedures following a positive test for high-risk HPV.)
-I *think* she told me to wait two weeks to have sex, but I wasn't sure and I didn't get to ask on Friday. Now, I've got my period and I'm wondering if it's okay to use my DivaCup. Does anyone who's had cervical biopsies know if that would be okay?
Two weeks wait is standard for minor biopsies, I think; it's what I was told when I had colposcopy & biopsy. during those 2 weeks, you're not to insert anything in your vagina. After that, you can return to 'normal use', including penetrative sex and menstrual inserts (I was SO glad to be able to use tampons for the last few days of my period, having had most of it within those 2 weeks).
Best wishes... with all the stress, sounds like you need them!
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As for the rest: Her plan for the PCOS involves me getting my blood tested and then starting metformin, which is something I've been wanting to do since I first read about it a few years ago. And since it's been more than two weeks, I'm cleared to use my cup (I know what you mean, I was so happy to pop that sucker in as soon as I got off the phone with her!) and for sex (thank you, gods!).
Anyway, thank you for the advice and encouragement, I really appreciate it!