I get regular PAP tests. They’ve never been a big deal for me - my doctor even put warm socks on the metal contraptions that hold you feet, so I was never uncomfortable. The speculum they use to keep your vagina open never caused me any discomfort, and I never felt the little brush they use to collect the cells. So when I had a routine PAP test at my doctor’s office about a year ago, I thought nothing of it.
A few weeks later, my doctor called and explained that I had abnormal PAP test results .
Abnormal? What does that mean?
For some people, it is simply a false result, and nothing to worry about.
For me, it turns out I have a strain of HPV (Human papillomavirus), one of the most common STI’s in the world.
It is estimated that 75% of people will have at least 1 HPV infection in their lifetime - many will never know they have it, and it will clear up on its own.
What is HPV?
HPV, as it’s name suggests, is a virus. There are over 100 strains of HPV, most of which are totally harmless and your body gets rid of by itself: 70% of infections go away within 1-2 years. There are some strains, however, that can lead to “low risk” health problems (like genital warts), or “high risk” health problems (like cervical cancer). It can be transmitted by intercourse, “skin to skin” genital contact, and oral sex.
Unless the strain of HPV causes warts, there are no real detectable symptoms. The only way to detect HPV is through a PAP smear.
The strain (or strains - it is common to have multiple strains of the virus at once) that I had were causing changes in my cervical cells that were detected on my PAP smear. My smear showed that I had some atypical cells, but more info was needed to determine what exactly was going on with these cells.
So, what next?
I was scheduled to go to the “Dysplasia” clinic at my local hospital. Dysplasia just means abnormal growth in the cells on the surface layer of the cervix. At the clinic, I would undergo another PAP smear, a biopsy, and a Colposcopy.
Colposcopy and Biopsy
At the clinic, I stripped from the waist down and donned one of those classy backless gowns. The set-up was the same as it would be for a routine PAP - I lay on the examination table with my feet in metal stirrups and my pelvis tilted upwards - with one noticeable exception: there was a giant monitor beside the bed.
Turns out, a colposcope is a binocular microscope that magnifies the cervix under a beam of light. A 3% vinegar solution is applied to the cervix to dehydrate the cells: this makes the abnormal cells appear white under the colposcope. I didn’t feel anything other than slight pressure during this part of the procedure. Seeing my magnified cervix on the monitor was definitely cool, if a bit surreal.
The doctor then applied an iodine solution - abnormal cervical cells stain brown from the iodine, and normal cells do not. Under the colposcope, the change is much easier to see.
With the vinegar and the iodine, the doctor identified the areas where there were abnormal cells: this is where he would take a sample of cells for the biopsy. At this point, I won’t lie… I stopped looking at the monitor. He inserted a special type of forecep that I learned afterwards is called a teneculum. He then instructed me to cough on the count of three.
One, two, three… OWE.
I coughed, which bears down on the cervix, allowing the foreceps to take a “pinch” of cells. This is called a “punch” biopsy. This happened twice. The sensation was more startling than actually painful, although it did cause me to cramp. I would say it is similar to someone punching the underside of your arm - it hurt for a split second, but the pain dissipates quickly. (Another type of biopsy, called a “cone” biopsy, takes a much bigger chunk of cells, and requires local or general anesthesia.)
The doctor then applied a blackish paste to my cervix, which stopped most of the bleeding. About five minutes after the speculum was taken out, I was on my feet and out the door. They booked my next appointment for about 8 months later.
After the Procedure
I had serious cramping for the rest of the day. My body was not pleased with being violated, and was trying to expel the blackish paste that is applied to stop the bleeding. The doctor told me to wear a pad, and I’m REALLY glad I did. (You shouldn’t wear a tampon, since your bits have been agitated and you don’t want to agitate anything further).
At first I noticed a faint brownish yellow stain on the pad - that was the iodine. After a few hours I noticed grainy black discharge that looked like coffee grounds - that was the paste. I also had mild spotting. Basically, I had a blackish-brownish-yellowish, grainy, goopy, slightly bloody discharge for about a day and a half. Delicious…
My next appointment was moved up 2 months because my biopsy results were not totally clear. There were definitely abnormal cells, but it wasn’t clear exactly what kind of abnormal cells they were. So, back I went to the Dysplasia clinic.
This time, the doctor wanted to sample cells higher up my cervix. Cervical cells change from tall, column-like cells to flat cells as you move down the cervix towards the vagina. The doctor wanted to sample cells higher up in the “transformation zone”, to see if there were anything abnormal going on.
This procedure is called an endocervical cutterage. The John Hopkins Center describes it as:
A surgical procedure in which a narrow instrument called a curette is used to scrape the lining of the endocervical canal, an area that cannot be seen from the outside of the cervix.
It basically felt like a normal PAP, except it caused me to cramp a lot more. Some black paste was applied, so I got to deal with the grainy black goopy discharge for another day and a half.
Now I wait. I have another appointment in 6 months, so I’ll keep everyone posted!
We at FYV are not doctors. If you want more information about HPV, or the procedures described above, please contact your health care provider.