[Listen to an audio version of this blog HERE.]
**This blog serves as a Public Service Announcement to get your pap smear, and as a personal account of my lived experience. I am not a doctor or even remotely medically literate. Seek professional care if you are concerned or have further questions about your own reproductive health.
Just over a year ago, I had cancerous cells removed from my cervix. I initially went to my gynecologist to have an IUD inserted, and while he was up in there, he did a standard pap smear even though I wasn't "due" for one for another year.
Fast forward a few weeks, and a nurse called me to tell me the pap smear came back, and she had some bad news. There were some abnormal cells detected, and I needed to have a biopsy done. The biopsy was painful and weird; I could hear my doc snip samples from my cervix to test different areas and worse yet, I could feel the snips. He took seven samples in total, apologizing the entire time because, as you can imagine, the process was wildly uncomfortable.
The samples were tested and the tissue was considered "high-risk" meaning that if it wasn't removed, there was a strong chance it would spread and I'd need more aggressive treatment. Cervical cancer is the fourth most common type of cancer afflicting women worldwide. In the United States, 13,000 women are diagnosed with cervical cancer each year and more than 4,000 women die.
The procedure to remove cancerous tissue is called a loop electrosurgical excision procedure (LEEP). My gynecologist essentially numbed my cervix, stuck a big metal tool up there, and cut the high-risk tissue out with a hot circular blade. Pleasant, right? Because I was numb, I didn't feel anything until the following day. I had cramps, and that was mostly it. By far the most uncomfortable part of the entire experience was the biopsy. My doc sent me home from the procedure with some thick pads, some Tylenol, and instructions to refrain from penetrative sexual activity for at least two weeks. My mother (God bless) came to stay with me after the procedure, and we spent a lot of time relaxing, going on hikes, and generally "taking it easy."
Fast forward another year, and I revisit my gyno for a follow-up pap smear. He takes a peak and tells me everything looks good: scar tissue looks minimal and I should be in the clear. He ran a few tests and a week later, a nurse called me to tell me some more stellar news: the pap smear revealed more abnormalities and I need to come back for a second biopsy. This biopsy was worse, because now my cervix has scar tissue so accessing "clean" tissue was more difficult. The nurse told me to take a Tylenol before I arrived but I was still writhing in pain as the doctor took multiple samples. And that's currently where I'm at: awaiting the results of my second biopsy to see if I'll need to have more tissue removed. It isn't exactly bad news, and I'm grateful for the medical care I've received so far. But nobody really talks about this, so I thought I'd do my civic duty and tell you a bit about cervical cancer.
What causes cervical cancer?
Human papillomavirus (HPV) causes about 91% of cervical cancers. There are over 100 different types of HPV, most of which are considered low-risk and do not cause cervical cancer. More than 70 percent of cervical cancer cases can be attributed to two types of the virus, HPV-16 and HPV-18, often referred to as high-risk HPV types.
You can get HPV by having vaginal, anal, or oral sex with someone who has the virus, but it is most commonly spread during vaginal or anal sex. HPV can be passed even when an infected person has no signs or symptoms. Anyone who is sexually active can get HPV, even if you have had sex with only one person. You also can develop symptoms years after you have sex with someone who is infected, which makes it hard to tell when you first became infected. To muddy the waters even further, there is currently no approved test for HPV in men, so there is no way to tell if your partner may have it.
HPV is estimated to be the most common sexually transmitted infection in the United States. By age 50 approximately 80% of women have been infected with some type of HPV. The good news is that the majority of women infected with the HPV virus do not develop cervical cancer. For most women, the HPV infection does not last long; 90% of HPV infections resolve on their own within 2 years. A small number of women do not clear the HPV virus and are considered to have “persistent infection." A woman with a persistent HPV infection is at greater risk of developing cervical cell abnormalities and cancer than a woman whose infection resolves on its own.
Prevention & Care
Pap smears are the primary way to detect precancerous or cancerous tissue. Most gynecologists recommend pap smears every three years. Since I'm now considered "high-risk" I'll be having annual pap smears for the foreseeable future. After a pap smear, a biopsy can confirm the presence of two types of abnormal cells CIN2 or CIN3, and a LEEP procedure removes the tissue. About half a million women undergo a LEEP procedure in the United States each year. Most women requiring LEEP are of child bearing age, so preserving fertility is paramount. The impact of LEEP on fertility is not firmly established, although there seems to be minor impacts. In addition, some women experience sexual dysfunction after a LEEP procedure (read more about that here).
While it might seem inevitable to be exposed to HPV at some point in your life, there are some easy things you can do to stay safe. Use protection (duh), talk to your sexual partners about their health (also duh), get regularly tested, and for the love of God don't flake on your pap smear. Finally, talk to your family; research shows that genetics plays a large role in how well our bodies fight off HPV.
P.S. Read more about cervical cancer here; survivor stories here; alternatives to the LEEP procedure here; the HPV vaccine here; or read more about potential risk factors (including family history, the use of oral contraceptives, and economic status) here.