Cervical Issues

Cervical Issues

At Fayetteville Woman’s Care, we recommend that women have Pap smears routinely beginning three years after they become sexually active or at the age of 21. We are very careful with giving pelvic exams, ensuring a pain free and quick experience.

Let’s give a cheer to George Papanicolaou for introducing the most successful cancer-screening tool ever invented. One simple swipe of a small instrument on the surface of the cervix and women who die of cancer has decreased by 70 percent since he introduced it in the 1940s.

The amazing thing about the Pap smear is that along with finding abnormal cells that may turn into cancer, it also finds infections.

At Fayetteville Woman’s Care, we recommend that women have Pap smears routinely beginning three years after they become sexually active or at the age of 21.

Patients who meet any of the following criteria should have a Pap smear on annual basis:

  • HIV-positive
  • Exposed to DES (diethylstilbestrol) before birth
  • Have a low immune system
  • Have had abnormal Pap smears in the past
  • Have had cervical, uterine, vaginal or vulvar cancer

Our doctors are very careful with pelvic exams. Making the procedure as quick as possible and pain-free are just a few examples of our care. Three to four days prior to your appointment, avoid using a douche, spermicide or any vaginal medication or lubrication.

We offer an in-house lab service (Lab Corp), which has results within 10-14 days. As long as your insurance accepts Lab Corp, you can take advantage of this service. (Otherwise, you will need to go to Quest Diagnostics, or the lab designated by your insurance, for your lab work). You can retrieve your Lab Corp results from our online service or by phone. If your test result shows an abnormality, your doctor’s nurse will call you as soon as your doctor gets the results.

Pap Smear Classifications

Classification What it Means What to Expect
Abnormal Some abnormalities were found. Your doctor may recommend follow-up tests, like a repeat Pap smear or colposcopy.
ASCUS (Atypical squamous cell of underterminable significance) Squamous cells are on the surface of the cervix. This classification means that the cells are not completely normal, but doctors are unsure what the cell changes mean. ASC-US usually refers to mild abnormalities that are sometimes related to the human papilomavirus (HPV). ASC-H may reflect a higher risk of being precancerous or HPV positive.Your doctor may recommend follow-up tests, like a repeat Pap smear or colposcopy.
AGC (Atypical glandular cell) Some abnormalities were found in your glandular cells, which are found in the lining of the cervix. Your doctor may recommend follow-up tests, like a repeat Pap smear or colposcopy.
HSIL (High-grade squamous intraepithelial lesion) More severe abnormalities were found that have a higher likelihood of progressing to invasive cancer. Your doctor may recommend a colposcopy and close observation with Pap smears.

Don’t Panic if Your Pap Smear is Not Normal

It’s unlikely you have cancer. An abnormal result usually means that there’s only a minor problem with the cervix, one that may not even need treatment. Sometimes results come back as abnormal simply because the lab technician couldn’t get a clear reading from the sample. Most likely, your doctor will request that you have a second Pap smear.

If you’ve ever wondered why doctors are so adamant about patients getting regular pap smears it’s because a pap smear detects abnormal cervical cells and cervical cancer, which makes it one of the most easily detected female cancers. In fact, getting your regular “pap” provides early detection and allows us to prevent almost all the potential cervical cancers we may find.

Cervical cancer forms malignant cells in the tissues of the cervix, the opening of the uterus. While it is a slow-growing cancer and often stays contained within the area of the cervix, in one in 10 cases, the cancer becomes aggressive and invades another area of the body very quickly. In either situation, slow-growing or aggressive, getting a regular pap smear can save your life.

At Fayetteville Woman’s Care, we recommend ANNUAL pap smears for women ages 21 to 70. Women with complete hysterectomies should consult their physician for screening recommendations.

Risk Factors

  • Being a carrier of the human papillomavirus or having genital warts
  • More than one lifetime sexual partner or a male partner who had multiple partners
  • Sexual intercourse before age 18
  • A history of abnormal pap test results
  • A smoking habit
  • A history of uterine, vaginal or vulvar cancer
  • Your mother having taken the hormone diethylstilbestrol (DES) when she was pregnant with you
  • HIV-positive

Signs of Cervical Cancer:

While these can indicate different problems, consult your physician if you experience any of these signs.

Early Stages of Cervical Cancer:

  • Bleeding after sexual intercourse
  • Bloody, watery or bad-smelling discharge between menstrual periods

Advanced Cervical Cancer:

  • Difficulty or pain during urination, possibly with blood in the urine
  • A dull backache and swelling in the legs
  • Diarrhea, pain or bleeding from the rectum after a bowel movement
  • Fatigue and weight loss
  • General malaise

If Your Screening is Positive:

  • Your doctor may perform a second pap smear at a later time or perform a closer examination of the cervix with a special magnifying glass – called colposcopy. He may need to take a biopsy (an in-office procedure where a small tissue sample is removed from your cervix and vagina.
  • Your tissue sample will be examined in a laboratory
  • The results may indicate Dysplasia, which is not cancer, but is considered potentially pre-cancerous, and is due to the activity of the human papilomma virus.
  • If your results indicate the early stages of cervical cancer, your doctor may kill the potentially malignant growth using cryosurgery (freezing the growth off), laser surgery, LEEP (stands for Loop Electrosurgical Excision) or conization (a process in which a cone-shaped piece of cervical tissue is removed).
  • If your results indicate more advanced cancer, your doctor will usually remove the tumor and surrounding tissues, and sometimes reproductive organs (the ovaries are rarely removed in younger women who may want to have children). This surgery may be coupled with chemotherapy, radiation therapy (in which a radioactive beam is aimed at the cancerous area or radioactive beads are temporarily implanted), or both. In advanced cancers, chemotherapy and radiation may be the primary treatment.

While not cancer, cervical dysplasia (an abnormal growth of cells on the cervix) is considered pre-cancerous. It is categorized as either mild (CIN I), moderate (CIN II) or severe (CIN III), which will show up on your results from your labwork.

Most cervical dysplasia occurs in women between the ages of 25 and 35, however, less than 5% of all Pap smear test results find cervical dysplasia. The cause of cervical dysplasia, like many problems with the cervix, is unknown. It also falls into the same risk factors:

  • Multiple sexual partners
  • Starting sexual activity before age 18
  • Having children before age 16
  • DES exposure
  • Having had sexually transmitted diseases, especially HPV (genital warts) or HIV infection

Because there are usually no symptoms it is very important for you to have regular Pap smears. A colposcopy also can help in finding cervical dysplasia by revealing “white epithelium”, a mosaic-like pattern on the cervix. Your doctor may require more information and order a biopsy or endocervical curettage to discover the extent of the dysplasia and rule out cancer.

If your doctor determines you have cervical dysplasia, there are several treatments. While mild dysplasia usually goes away on its own, you will still be required to have close observation with follow-up Pap smears over several months. More severe dysplasia may require treatments like electrocauterization, cryosurgery, laser vaporization or surgical removal to destroy the abnormal tissue. However, expect your doctor to require consistent follow up with regular Pap smears over the months and years ahead.

Luckily, nearly all cervical dysplasia can be cured, but left untreated it could develop into cervical cancer. As with all cervical problems, it is very important that you keep up with your regular Pap smears.

Also, with the development of Gardasil, the medical world is fighting HPV, a major cause of many disorders of the cervix. Fayetteville Woman’s Care recommends that all girls and women, as early as age 9 through 26, get the Gardasil shots (3 in all).

Occasionally, a woman develops a cervical polyp (more than one is rare). These are harmless growths that appear on the cervix or endocervical canal. Typically, your doctor removes them when he finds them during a pelvic exam.

Often, the polyps are infected, so your doctor may prescribe an antibiotic. Cervical polyps are suspected of being associated with chronic inflammation, an abnormal response to increased levels of estrogen or clogged cervical blood vessels and are relatively common, especially in women over age 20 who have had children.

While polyps may not exhibit any symptoms, you may have a cervical polyp if you have:

  • Abnormal vaginal bleeding
  • After intercourse
  • After douching
  • Between periods
  • After menopause
  • Abnormally heavy periods (menorrhagia)
  • White or yellow mucous discharge (leukorrhea)

However, polyps may not exhibit any symptoms.

More than half of all women at some point will be affected by Cervicitis, an inflammation of the cervix, usually as a result of infection. Women who participate in high-risk sexual behavior (multiple partners, a history of STDs (sexually transmitted diseases), partners with STDs) are at an increased risk of getting Cervicitis.

Other risk factors include exposure to chemical devices inserted into the pelvic area, such as a cervical cap, diaphragm or spermicide.

While there may be no symptoms until you have a pelvic exam, make an appointment with your doctor if you exhibit any of the following:

  • Unusual, sometimes persistent, vaginal discharge, often accompanied by an odor
  • Abnormal vaginal bleeding after intercourse, between periods or post menopause
  • Pelvic pressure or heaviness
  • Painful sexual intercourse
  • Vaginal pain

Cervicitis, like other infections, is treated with antibiotics or antifungals.