Hello,

First of all, thanks group! A wonderful resource and great forum to just have others to 'listen' without judgment. (I haven't been able to tell my parents about this, and have only confided in very close friends, so this is a lifesaver.)

My first irregular PAP was in May 2008. I since had two follow-up PAPs (Sept 2008 and April 2009). An HPV test showed that I have the high risk strain.

From Sept to April, the cellular changes increased (from Pap IIw to Pap IIID: CIN I - low grade dysplasia).

My doctor told me not to be worried, despite the fact that the cells have changed more in the past 6 months. She likened the HPV-related changes to a body responding to any infection: "when a body is trying to fight off an illness, a fever raises and peaks in this effort". The cellular changes might be occurring due to similar reasons, as my body fights this, 'it reaches a peak'.

1. One year out from my initial diagnosis, should I be having surgery instead of merely 'watching and waiting'?

2. I'll be going in for my next PAP in mid-July. Any recommendations for questions I should ask the doctor at that time? Are there any other tests she should be performing? Has she been too laid-back in her approach?

3. I'm 31 and haven't yet had children, but hope to do so. How could this condition, or subsequent surgeries, affect a pregnancy?

4. My insurance company will not pay for the Gardasil vaccination (since I'm over 26). Would it still be advisable to get it?

5. Any advice for how to help your body clear this? I eat well, take a multivitamin, exercise and try to think about this the least amount as possible. (I guess my coping mechanism has been to educate myself, but then not to revisit the information too frequently - certainly obsessing about it isn't healthy!) Perhaps I'm in denial.

Thank you, thank you for your feedback and advice!

One year out from my initial diagnosis, should I be having surgery instead of merely 'watching and waiting'?

It's not unusual for health care providers to take a variety of approaches with women who have had a colposcopy/biopsy that returns results of CIN-1: This might involve follow-up Pap tests at 6-12 months or HPV testing every 12 months. Women who have abnormal Paps or are HPV positive at this point are usually referred for another colposcopy. If the CIN-1 is present for a couple of years, they usually do treatment.

Women with CIN-1 who initially had a Pap test that found more moderate/severe abnormalities typically either have a LEEP (which can serve as both a diagnostic and therapeutic procedure) or observation with colposcopy and Paps every six months for a year. If the CIN remains, then a LEEP might be in order.

Keep in mind these are guidelines, not written in stone, and management isn't the same in every case. CIN-1 is typically not dangerous and some approach of "watch and wait" is common here with women your age. On your next visit you might ask your doctor what your options are if the Pap and/or colposcopy remains abnormal.

I'm 31 and haven't yet had children, but hope to do so. How could this condition, or subsequent surgeries, affect a pregnancy?

The short answer is most women treated for CIN are able to have children, but it depends on the procedure and how many treatments you might need. In many cases, there are procedures that restore the integrity of the cervix after surgery. Infertility, then, is not the usual outcome but discuss this with your doctor given your own specific case.

My insurance company will not pay for the Gardasil vaccination (since I'm over 26). Would it still be advisable to get it?

It won't help with any HPV types you already have, but if you will have a new partner then it would offer protection against any HPV types included in the vaccine that you may not have.

Any advice for how to help your body clear this? I eat well, take a multivitamin, exercise and try to think about this the least amount as possible. (I guess my coping mechanism has been to educate myself, but then not to revisit the information too frequently - certainly obsessing about it isn't healthy!) Perhaps I'm in denial.

Check out this thread: http://www.ashastd.org/phpbb/viewtopic.php?t=5083

I hope this helps!

Best,
Fredo

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ASHA Moderator

How painful is the surgery to have your tubes clipped? I'm having surgery tomorrow to have my tubes clamped at the ends since I don't want another child. It's going to be done with a hole near my belly button and a small scope. The dr acts like it won't really hurt, but other women say it's very painful afterwards. I'm curious to hear of an experience with the same kind of surgery. I'm pretty scared.
Thanks.

Wanting,
Did you infact have a colposcopy/biopsy to confirm your pap smear results? You didn't mention that specifically. I ask because my paps were coming back as mildly abnormal (CIN I) but once I had the colposcopy/biopsy, I was diagnosed with CIN III and had surgery a few months ago. I just want to stress that if you doctor has not performed a colposcopy/biopsy at this point and is relying only on your pap results, then yes she is being too lax in this situation.