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HPV/Vaginal Dysplasia
DiannJ posted:
I would love to get some information from a health professional to help me understand what is happening to me and what steps to take next.

I'm 60 yrs old, and i've been married to the same man for 40 years, and had no other sexual partners, however I've was diagnosed with HPV about 6 yrs ago after two abnormal pap screenings. Ultimately a LEEP was performed and I had three normal paps afterwards, so was back to doing annual exams. Last month my ob/gyn performed a pap and HPV screening, the pap came back normal but the HPV came back positive for a high/intermediate HPV.

A side note here, I have had to return to my Dr. more than once, for repeat Paps because my cervix is closed up and they could not get an adequate swab. So, although my pap comes back negative, how can that be reliable when apparently they are not able to get enough cells to test?

Last week my Dr. performed a colposcopy and biopsy of vaginal tissue. Again, the cervix was closed so she could not get a biopsy from the cervix. She said the cervix looked normal and felt normal. The biopsies from the vagina came back with "mild dysplasia", "lichenoid Chronic Inflammation", "negative for invasive neoplasm".

I am scheduled to go back to the Dr. next week to have some cream applied to the spots in vagina (the nurse said it will burn, but I don't know what exactly will be used). Then I'm going to return in 3 months for another colposcopy.

My main question is this: since I haven't had a swab or biopsy of the cervix in several years, how likely is it that I have pre-cancerous (or worse) lesions growing there? Should I entertain having a complete hysterectomy as my child bearing days are over? I'm really scared I'm going to get invasive cancer and want to be very aggressive with my treatment.

I have a wonderful, female, ob/gyn, but sometimes I feel she is trying to be overly optimistic. I would appreciate another opinion.

Thank you.
Jane Harrison Hohner, RN, RNP responded:
Dear DiannJ: Let's start with the easier question first, OK? As we age (and especially after menopause) the junction between squamous cells (skin type found on face of cervix & vagina) and columnar cells (cell type found in cervical canal and above) retreats back up further into the cervical canal. That can make it harder to sample with the little brush. Add to that two other factors, the opening to cervical canal gets smaller, and in your case, history of a LEEP. All of this can make it very difficult to get an adequate sample of the cervical canal.

It sounds like your GYN kept repeating your PAP smears until she got an adequate sample. That is, your PAP results showed cells typical for the squamous-columnar junction area. To get up that far she may have used a special, tiny device. I have used a male urethra swab, or even a tiny wire dilator to open the entry to the cervical canal. It is also true that if there is even enough room for cells to pass out of the canal, they can be picked up from the usual PAP sweep on the face of the cervix. This is how we sometimes find abnormal cells from inside the lining of the uterus via a routine PAP smear. Thus, if you had a big, abnormal lesion there might be some evidence found.

In the "olden days" of our youth, a normal PAP result was sufficient. Now, the HPV test gives an additional result to follow up. Your GYN is being very thorough in watching you because of the intermediate to high risk HPV DNA identified. That she did the three vaginal biopies suggests that she is being very thorough as well. One was normal, one showed thickening from chronic inflammation, and the other mild dysplasia (that will be the one treated--possibly with 5FU cream).

If hysterectomy was without any untoward side effects, GYNs would be fine to perform them per patient request. But there can be unanticipated problems ranging from complications with the surgery itself/anesthesia risks to loss of support for the bladder (more incontinence problems), and the questions about whether to remove ovaries or not. If a woman has cancer, fibroids the size of grapefruits, or other issues which have not responded to medical treatments then surgery is the last resort.

DiannJ, you have every right to get a second opinion from another GYN. I cannot give you the most "for sure" answer. Yet I can tell you that, in my OPINION, your current GYN sounds both very conscientious and congruent with current standards of good practice.

In Support,
DiannJ replied to Jane Harrison Hohner, RN, RNP's response:
Thank you Jane. Your response definitely gave me much information. When I have my next appointment with my GYN, I will also pump her for more information and what I can expect in the coming months/years.

This is all very unsettling to me, and there are no absolute answers. I'll just have to go down this road and see where I come out. I do feel that my GYN is very competent and I have alot of confidence in her to give me the right treatment.

Again, thank you for your professional opinion.


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