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Saturday, February 27, 2010

What do I need to know about my cervix and why?

Strange title.  I know.  But maybe you'll just read on.

Your friendly cervix is the end of your vagina and the beginning of your uterus.  You probably remember the doctor talking about your cervix dilating if you've had a baby.  This is where most women's knowledge ends.

But, I believe that you should know much more about your cervix.  You should know about it because it is yours.  You should know about because you need to care for it.  You should know about because a small but evil virus can attack it (HPV).  And change it into cancer.  But not if you don't let it.  And now, you can protect your daughters from these evil invaders.

So, a random zoologist, Dr. Papanicolaou (no, I am not making this up) invented the pap smear in 1941.  And now you have to have one.  Maybe every year. Thats all for the history, here's the rest...

The pap smear is only part of your annual gynecological exam (another post).  The pap smear is the part of the exam after the speculum is inserted when the doctor takes 2 brushes to collect cells from the outside of your cervix.  These brushes are then dipped into a liquid based solution and sent to a [strange] doctor that stares into a microscope all day (aka pathologist).  This doctor then interprets the results.  He is looking for changes in the cells caused by the evil invaders (HPV) that can be minor (pre-cancerous), kind of a big deal, or an uber big deal (cancer, rare, not funny but trying to keep this light-hearted).

So, lets delve a bit deeper into HPV.  HPV stands for Human Papilloma Virus.  Not many can pronounce that and no one can remember it so we'll refer to them as the EVIL INVADERS.   The evil invaders are everywhere and there are many different types.  You get them from sex.  (that's right  CERVICAL CANCER is A SEXUALLY TRANSMITTED DISEASE).  Some are very evil (high risk) and some are sort of evil (low risk).  They cause genital warts and cervical cancer.  And as with many other things, men get off scott free.  No symptoms.  They don't usually even know its there (unless they get genital warts and freak out).  But they pass it to us.  And we have to deal with it.  Thanks a lot.

The evil invaders are so common that almost 75-80% of all sexually active women will have an infection by the age of 50.  Thats right, more than 3/4 of you.  So thats you, you, and you but not you.  You get the point.  Its common.

Your body will do 1 of 3 things with this infection.

1.  You will be exposed but your cells will not allow the invaders to penetrate.  Good job cells.

2.  You will be exposed, and your cells will lose in the first line of defense and the evil invaders will get in.  Then your reserve troops (aka immune system) will launch an all out war and win.  Kicking the evil invaders to the curb.  Adios muchachos.

3.  You will be exposed, lose all battles and have what is called a persistent HPV infection.  This is the bad one.

So, the war takes a long time and the evil invaders are pretty stealth and can evade the immune system by being sneaky.  You may have had some sexual indiscretions in college (don't remind me) and everything was fine, then all the sudden, boom, abnormal pap.  That is common.  It can take up to 7 years to see changes from HPV.  That is why you need a yearly exam.  Even after you're with the love of your life.

So, how is the pap interpreted by this men with the microscope (the pathologist)?

Here are the options.

1.  NORMAL.  Awesome.  Thanks for everything, see you next year (frequency of paps to be discussed later)

2.  ASCUS.  Stands for ATYPICAL SQUAMOUS CELLS OF UNDETERMINED SIGNIFICANCE.  I know.  This is absolutely the MOST ridiculous name ever.  But I didn't make it up.  It means cells don't look exactly normal, but they don't look exactly abnormal either.

If you have this, most doctors will do another test called the HPV test.  This will then tell you if you have the high risk or low risk types of HPV.  If you have the high risk type of HPV, most likely you will need a more specialized test called COLPOSCOPY (later).  If you have the low risk types, you may just need a repeat pap smear in 6-12 months.

(NOTE:  these guidelines may not apply to adolescents <20 because they have an easier time clearing HPV infections)

3.  LSIL.  Stands for LOW GRADE SQUAMOUS INTRAEPITHELIAL LESION. Also ridiculous.  Means the cells may be abnormal and you likely have the 2nd form of HPV where your cells were invaded but your immune system is working on kicking the evil invaders to the curb.  Because 15% of women with this result can develop precancerous changes, a colposcopy is needed.

4.  HSIL.  HIGH GRADE SQUAMOUS INTRAEPITHELIAL LESION.  Advanced changes in the cells consistent with persistent infection.  Needs to be followed closely.  Needs colposcopy.  Changes could be cancerous.  Yuck.

So...just a tad about COLPOSCOPY and this torture lesson will be over.  This is a specialized type of pelvic exam where the doctor looks at your cervix up close with a microscope.  A special solution is placed on the cervix to highlight the abnormal areas and biopies (pieces of tissue) are taken.  These are sent to the pathologist to be looked at under the microscope to see if there are pre-cancerous or cancerous cells.

You may have found this to be more information than you wanted to know, but knowledge is power.  An informed patient is well armed.

Stay tuned...now that you are EVIL INVADER (HPV) experts, we need to discuss GARDISIL, the EVIL INVADER VACCINE.  YAY!

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