QuestionHi Dr. Rappaport,
My name is Zoe and I am 22 years old. I have been diagnosed with HPV high risk about 2 years ago. Also, ever since I can remember I have always had quite an unpleasant vaginal discharge, kinda yellowish/green color. I always get a pap smear done every 6 months as I was told to and it always comes back abnormal. A year ago I went for my regular check up and they again did the pap and it again came back abnormal, but this time the doctor suggested biopsy, they took some samples from the cervix and found out it was a dysplasia. The doctor decided to do cryosurgery. So I had the cryo done in September 2003. Unfortunately, I moved to a different city, so I had to find a new doctor. I found a very good one and I told him the whole story. He again did the pap smear just as a routine follow-up after 4 months from the surgery and it came back normal.Boy, was I happy about that! I 100% believed that the cryo worked and I am healthy now... But, just last week I had another routine pap smear with the same doctor and I got the results today reading ABNORMAL again! I just don't understand this anymore. Doctor thinks it's ok. I just really need to know how successful the cryosurgery really was?! How do I know that it really worked for me? I am desperate. I am so tired of having this discharge all the time, having painful periods and always getting these abnormal pap smear results. What can I do? Is there any other surgery I can have to get rid of this problem?
Is it ever gonna stop?
Please, help!
thank you
zoe
AnswerA PAP smear detects changes in the cells of the cervix. There is a spectrum of PAP results: Normal, ASCUS (atypical squamous cells of undetermined significance), LSIL (low grade lesion), HSIL (high grade lesion), CIS (carcinoma in situ) and Cancer. ASCUS, LSIL, and HSIL used to be called mild, moderate, severe dysplasia. These abnormal PAP smears keep shifting from Normal to abnormal and our jub as gynecologists is to return the cells to normal. When we see cervical dysplasia, the first step is to perform a Colposcopy and take biopsies of the cervix. If there is any abnormality, we freeze the cervix (cryotherapy), which returns the cells to normal for awhile. This can change back to abnormal at any time. That is why we take a PAP smear every year or every six months (if your PAP keeps showing abnormal results). If you remained normal all the time, there would be no need to do a PAP smear every six months. The cryosugery works for awhile and each time you get an abnormal PAP, you have to repeat the colposcipy and the cryosurgery. It is nothing to worry about. It is not cancer. Unfortunately, HPV can cause repetative changes in the cervix that will, from time to time, cause an abnormal PAP. Don't worry. Your doctor is doing a good job.
