LEEP Procedure for Abnormal Pap Results: Seeking a Second Opinion

Question
Hi,
I am writing you today because I need an opinion other than the one from my health care provider. I am 31 years old, never been pregnant and the 4th of Feb 2006. Since 2000 when I had my first abnormal Pap I have been having Colposcopies and Biopsies. My results have always been low grade or normal, and when tested for HPV it came back negative. The last 2 Nurse Practicioners and Doctors have been more than eager to have me undergo a LEEP. Today I had my yearly app. and it started off with "you will not have a Colpo today we are just doing a Pap and an HPV test". Then the NP walked in and said we might as well not do an HPV test because she is "guessing"that because I have had this the past 6 years and there has been no changes that I do have HPV! She explained that even though my test came back negative 3 years ago that HPV lays under the cervics surface and sometimes the test cannot detect it? Then she proceeds to not say anything other than "have you thought about a LEEP"? She did not bother to ask me anything like if I maybe wanted to get pregnant at one point and her explanation for having a LEEP was that I have had this for 6 years and did not get better that usually with women in their 20's it can go away but since I am 31 and with age the chances for it to go away are very small. When I explained I would like to try to get pregnant she just overheard it. During the Colpo she asks me what my decision about the procedure would be if I have advanced to moderate or severe? I am so confused right now. I do not see where the big issue is, I have been consistent for 6 years and I am otherwise in good health. I am not getting younger and we have already tried to get pregnant and it did not happen so I already have a hard time with it. I am wondring if I am so wrong in waiting it out and trying to get pregnant and when I had my children and there has been no change for the worse I can still have the LEEP in lets say 3-4 years. The things that makes me wonder is why they are so insistent on "cutting"? When asked they could not give me a valid reason. I spent all day reading and she told me women do not have problems after a leep whatsoever but apperantly that is not true, some women do have problems it is not a without issues procedure! It just seems like the last 2 providers want slice and dice like I was Sushi. Let me just clarify that I am not usually that confused but we are in the military and our medical personnel is not always the ones with good intentions. They have not given me any alternative options other than surgery. I am just wondering if they are wanting to make their life easier by having one less displasia patient (they have a displasia clinic because so many women are affected by it) or if the Army just ants to cut cost for colpos and biopsies and so on. I just felt wrong and if I ask for another opinion all I will get is another military health care provider that will tell me the same as the first. Please, if you can give me any advice or what I should ask my provider it would be greatly appreciated.
Thank you!

Answer
Most of the time, if a young woman has evidence of high risk DNA types of HPV (as opposed to the type that causes genital warts) the HPV often disappears by the time they are over the age of 30. For that reason, the standard of care is not to test for HPV in women under the age of 30.  When a woman is over the age of 30, we now perform a PAP and an HPV reflex testing. If the PAP is within normal limits and the HPV is negative, we do nothing but repeat the PAP in 1 year. If the PAP is within normal limits and the HPV is positive, we have the patient return in 6 months to 1 year and repeat the test. If the HPV is again positive, we proceed to a colposcopy. If the PAP is mildly abnormal (ASCUS, or LSIL) and the HPV is negative, we can merely repeat the PAP in 6 months to a year. If it again shows up as ASCUS or LSIL, we would proceed to colposcopy. I would not do a LEEP unless there was a definite abnormal PAP smear.  There can, indeed, be complications from a LEEP procedure. You can develop cervical stenosis, making dilatation at the time of delivery difficult. There can be a shortening of the cervix, increasing the risk of preterm labor (the cervix should be greater than 3cm during pregnancy). Of course, by doing a LEEP, it will eliminate any problem at all with abnormal cells, because they will be removed. HOwever, you can continue takng  PAP tests and colposcopies with biopsies. If the biopsy shows pathology, you can have cryotherapy (freezing) instead of the LEEP.