Your annual gynecologic examination consists of a full medical history and physical examination to identify health risk factors and to assure ongoing health and well-being. At Santa Fe Ob/Gyn we focus on preventative medicine to avoid illness. Yearly breast exams and pelvic exams are part of overall health and well being. We perform and order health care screening tests such as pap smears, mammograms, and colonoscopy, as well as blood work evaluation.
The most current recommendations for pap smear screening for cervical cancer are to begin pap smears at age 21. We do age based screening for Human Papilloma Virus (HPV) as this virus is the cause of abnormal pap smears. If your pap smear is normal and your HPV test is negative, and you do not have exposure to a new sexual partner, you can have your pap smear every 3 years. If you have a new sexual partner, we recommend a yearly screen to assess for the HPV virus as the virus is transmitted sexually.
Human Papilloma virus(HPV)
HPV is a virus that is transmitted via sexual activity. There are dozens of different strains of HPV virus and they fall into low risk and high risk categories. Low risk HPV is associated with genital warts. High risk HPV is associated with abnormal pap smears with HPV 16 and 18 being the higher risk types. HPV is very common and has no symptoms of a sexually transmitted disease. There is no vaginal burning, itching, or discharge. Often, the first time you will know you have HPV is at the time of pap testing. HPV is not a routine test for STD screening, it is primarily done in combination with the pap smear. Men are not routinely tested for HPV, but they are carriers of the virus.
If you are positive for HPV, we will not be able to tell you when you contracted HPV. The virus can be present for years, although, it is thought that HPV will clear from your system within a few years. There is no specific treatment for HPV, however, we do recommend optimizing your immune system function to help your body clear the virus. This consists of a healthy diet, routine exercise, regular sleep patterns and stress reduction.
Gardasil is a vaccine to help prevent HPV infection and is given to boys and girls ages 9-24, although it is optimally given prior to age 15. Gardasil protects against 90% of the high risk strains, so there is still risk of contracting the HPV strains that it is not effective against.
A diagnosis of HPV is very stressful for many patients as they worry about their own personal health as well as the potential to transmit the virus to a partner. Unfortunately, it is thought that condoms may not be protective against HPV due to the small size of the viral particle. We understand your concerns and want to reassure you and your partner that this diagnosis is concerning, but with monitoring and evaluation, it is unlikely that there will be any long term consequences from this diagnosis. The virus will often clear from your system spontaneously and with recommended monitoring, we will identify and treat the cervical cellular changes caused by HPV before there is progression to cervical cancer.
Abnormal Pap Smear
When you receive a call from our office asking you to come in to discuss an abnormal pap smear we understand your immediate concern and need for information. Please be aware that it is important that we discuss these results in person so that we are clear on the information we give you and can spend time to discuss your questions and concerns.
There are three different categories of abnormality in the pap smear that are based on the level of cellular change that has occurred. Normal squamous cells have a small nucleus and a characteristic appearance. Atypical cells have a slightly larger nucleus within the cell. Atypia is a step in the progression to abnormal cells or dysplasia, however, atypia can also be caused by having sexual intercourse prior to a pap, use of tampons prior to a pap, or a vaginal infection such as yeast at the time of the pap smear. Menopausal women can also have an atypical pap smear due to lack of estrogen in the vagina.
Dysplasia is a term used for abnormal cellular appearance in which the squamous cells of the cervix have a much larger nucleus and abnormal cellular appearance. We characterize abnormal pap smears as having either low grade or high grade dysplasia. Low grade dysplasia will often heal on its own in 70% of cases. High grade dysplasia is less likely to heal without treatments that are done in the office setting.
Pap smears are screening tests. When we identify abnormal cells by pap smear, we proceed to a more accurate test called colposcopy. Colposcopy is done by looking at your cervix under a microscope to identify abnormal appearing cells or blood vessel changes of the cervix. When we see areas of concern, we take small pinch-biopsies of these areas and send the tissue to a pathologist who is able to more accurately evaluate the cellular abnormalities. The procedure is very well tolerated in the office. You might want to take two ibuprofen tablets 200 mg prior to the procedure, but you would return to routine activity after the procedure. We do advise pelvic rest, no tampons or intercourse for 5 days after the procedure to avoid infection of the biopsy sites.