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I'm posting this note for another member of our community who wishes
to remain anonymous for now.
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Dear Anon,
I am all too familiar with cervical dysplasia, and would like to share
my experiences with you. I have no problem having this appear as an
anonymous reply in *wn*, because it may help other members of our
community now or down the road. (If you would like to contact me via
VAXmail, please tell Liz Augustine, *wn* moderator, and I'd be happy
to speak to you offline.)
I apologize to everyone in advance -- this reply is rather long, but
necessarily so, in order to get all of the information across. I have
something to suggest to the basenote author, that she ask her doctor,
as an alternative to the laser procedure.
I have an 8-year history of "bad" Pap tests. My cervical dysplasia has
been described by my doctor as "moderate".
For readers who don't understand what dysplasia is, an adequate descrip-
tion is "abnormal cell growth". My doctor explained that on a rating scale
of 1 to 5, "normal" Pap tests come back as 1s or 2s. A reading of 3.0-3.xx
indicates mild to moderate dysplasia. A reading of 4.0-5.0 runs the range
of severe dysplasia to malignancy. From a discussion he and I had recently,
it is my understanding that the Pap ratings are no longer numbered in this
manner, but the conventional description I have provided still explains it
best.
Normal (1-2) cells are almost perfectly round, with a small dark nucleus.
As the dysplasia progresses, the cell becomes more elongated (resembling
more an oval than a circle). The nucleus becomes larger and darker and
move away from the center of the cell, towards one side. Cancerous cells
are ovals with a large nucleus "clinging" to the inside wall of one of the
long sides. I could draw a great picture for you, but it wouldn't look right
in Notes.
It's rather difficult to pinpoint what causes this progressive cell change.
It could be from a number of different reasons, in any number of women.
My doctor believes my problems stem from the fact that my Mom took DES
(diethylstilbestrol) in the 50s. To the best of my knowledge, DES was a drug
given to women with histories of miscarriage. My mother had already lost one
fetus prior to conceiving me. Unfortunately, my mother was only 19 (and naive)
when she conceived me; her doctor told her that he was prescribing "vitamins"
so she would be "stronger", and would stand a better chance of carrying me
full-term. I was born in March of 1957. It wasn't until 1980, when my prob-
lems emerged, that we discovered that the "vitamins" were, in fact, DES.
The facts came out after my ob/gyn reviewed the hospital records that my Mom
had held onto for so many years...
Each time my Pap test comes back questionable, my doctor performs the same
procedure on me that you had -- he examines me under the colposcope (which,
for other members of the community, is a special instrument that magnifies
the cervix) and takes tissue samples of "questionable" areas for biopsy.
Fortunately, so far, all of the biopsies have come back negative.
He does, however, perform a PAINLESS surgical procedure on me to halt what-
ever process that's causing this cellular change. This surgical procedure
does not involve cutting, but does involve freezing the cervix with liquid
nitrogen. The description may sound horrifying to some readers, but trust me
when I say it's 99% painless.
The procedure is called cervical cryosurgery. (It's use is not limited to my
problem. Cryosurgery is a broad term for "surgery by freezing".)
Cryosurgery "burns" (and blisters) the skin in much the same way that heat
would. The procedure involves the following: The doctor has a cannister of
liquid nitrogen with a nylon pipe running from it. At the end of the pipe
is a metal "applicator" (can't think of a better name for it...). The metal
applicator has a nipple on the end of it. The doctor carefully inserts the
applicator through the vagina, and presses it lightly against the cervix.
The little nipple rests against the cervical opening. The nitrogen is turned
on, flows through the pipe, into the applicator. He holds the applicator
against the cervix for 3 minutes. He then carefully removes the applicator
(being cautious not to touch any of the vaginal tissue for fear of freezing
them). I "defrost" for 3 minutes, and he then repeats the application.
Thankfully, there are no nerve endings on the surface of the cervix. I
CANNOT feel my skin freezing inside of me. The only discomfort I feel is
when the coldness penetrates all the way through the cervix and starts
to go into the uterus. This only happens at the very end, when there's only
a few seconds left to go before the 3 minutes is up.
The surface of the cervix forms a very watery blister. The "bad" cells are
shed when the blister breaks and falls off. The only inconvenience is having
to wear panty liners for 2-3 weeks (because of the weeping blister) and
abstaining from intercourse for up to 6 weeks. Three weeks after the pro-
cedure, I go back to his office for an examination, to make sure that every-
thing's healing properly, and that everything looks fine.
I go to him every 6-8 months religiously. For the 1-3 times following the
procedure, my follow-up Pap tests come back as the equivalent of the old
"1" rating. Then, for unknown reasons, 18-24 months down the road, the whole
vicious cycle starts again. Bad Pap result, colposcopic exam/biopsy, cryo]-
surgery, etc.
This procedure works for me. Granted, having to repeat the process every
couple of years is a nuisance, but I deal quite well with it. Laser surgery
makes me nervous, but <ONLY!> because I am <TOTALLY> uninformed about what
is involved, and the technology admittedly frightens me.
Perhaps our individual situations are too different to compare one-for-one.
But I would encourage and highly recommend that you ask your doctor if
cryosurgery is a viable option. If your doctor says no, with the risk of
sounding nosy, I would be very curious as to his/her reasons. This is an
issue with me that I'm all too close to.
One drawback to cryosurgery:
Because my cervix has been frozen so many times, I would be an automatic
candidate for caesarian childbirth -- since the cervix has lost its most
of its natural elasticity, a baby wouldn't make it through my birth canal.
If I were planning on having children, this would not concern me in the
least. It would not affect my ability to carry a child full-term. It is
not, however, even a consideration in my case, since I will not be having
children.
Perhaps the end result of cryo and laser surgeries are the same. Perhaps
laser surgery would not result in the loss of cervical elasticity, if that
is a concern of yours. Perhaps your doctor has more practice and/or a better
success rate with laser. Perhaps your doctor has negative feelings about
cryo. I would very much like to know why your doctor has suggested laser.
Perhaps it is something I could consider if/when the need arises with me
in the future.
One thing I would like to stress again: Regardless of the technique that is
ultimately chosen for you, be thankful that the cervix has no nerve endings,
thus the pain is practically non-existent. I have to be one of the biggest
babies when it comes to pain! (And there is no pain following the procedure,
either..)
I hope something, if not everything, I've said will help you overcome any
fears, or quell any anxieties, or even answer some questions you may have
that you didn't think to ask your doctor.
Peace and best wishes.
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| Hello,
First of all, relax. The wonderful thing about pap smears is their
incredible ability to detect problems at their earliest stages.
Fourteen years ago I had a (what they then called) class III -- it might
have even been a IV --- pap smear, or very severe dysplasia with carcinoma
en situ (a very localized cancer). The first procedure of course was a
stain applied to the cervix, a colposcopy, and then a biopsy in the
doctor's office.
After the doctor confirmed the class III smear and dysplasia, he explained the
surgical procedure that he would need to perform (there was no question as
to whether I would have it). The procedure was done under a general
anasthesia and was called a conization of the cervix. He took a cone-shaped
area tissue off of my cervix which he was later able to confirm was where
most of the dysplasia was. The pathologist was able to see the "border"
where the dyslpasia stopped and the normal cells began again (higher up).
There was little discomfort afterwards and I recovered fairly rapidbly.
The only small problem I had was a period that had to be coaxed
to start several weeks later.
After that, there was a follow up of pap smears every three months of about
a year, then every six months for another year or so. Now I only get them
every year and everything has been fine since then. I remember my doctor
telling me that after a conization, most women (85%-90%) will continue to
have normal pap smears just as anyone else who had never undergone the
procedure would have.
The only resulting problem I had from this was years later, when I was
pregnant, I had a miscarriage during my sixth month of pregnancy. I was
living out of the country then where my prenatal care left something to be
desired. When I was back in this country, my doctor attributed the
miscarriage to my shortened cervix not being able to retain the weight of
the growing fetus which forced open my cervix as it grew. He claims that
had I been in this country, receiving proper prenatal care, the cervix
could have been "rubber-banded" closed, thus allowing the fetus to develop
normally.
I wish you luck and am sure you will be fine.
Diana
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