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Women's Health Issues

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HPV, Cervical Dysplasia, and Cervical Cancer

So you've had an abnormal Pap...Now what?
 
Your OB/GYN should discuss what will happen next after receiving your Pap test results.  Depending on the severity of the abnormality, s/he may choose to do a second Pap to confirm the results, or he may order a colposcopy and possibly a biopsy.
 
Colposcopy
 
The colposcope is attached to a large metal arm and, if you can imagine, looks like a large pair of binoculars with a tube sticking out of the middle of it.  This tube looks to be about the size of a vacuum cleaner tube attachment (well, what can I say?  I go with what I know!).  The speculum (that wretched cold piece of metal they use to hold our vaginas open for the Pap smear) is a little larger than what they use for the Pap.  I'd say it's about the size of the average mallard duck-bill.
Inside the tube is a small camara that magnifies the cervix (the opening to the uterus).  This runs a feed to a monitor, which allows you to see what the doctor sees.  Once the colposcope is in position, the doctor will clean the cervix, then spread a solution over the surface.  This will bring any dysplastic, or abnormal, cells to the foreground.  S/He will then decide whether or not a biopsy is necessary, and this is the icky part.  The doctor will "pinch off" some of these cells, which feels a little like biting down on a piece of tin foil, only you don't feel it in your teeth.  Some women only experience a mild cramping sensation when this is done.  The sample is then sent to a lab, and a diagnosis is made.
 
 
Human Papillomavirus (HPV)
 
This virus can cause common warts on the hands, feet, arms, legs, genitals, and anus.  This is not always the case, though.  Some strains give no outward signs of infection.  Others are highly likely to cause cervical cancer.  Often, the only way to find out if you have the virus is to have a regular Pap smear.  I'm still trying to find out how straight men who show no symptoms (warts) are tested for it.  I know that it can cause warts on the anus and penis, as well as causing anal cancer.  Ladies, please, if you haven't scheduled your annual Pap, do so as soon as possible.  If I had put it off another 6 months (I was originally told 3-5 years), I would likely have been fighting cancer instead of coping with minor surgery to remove cervical dysplasia.  I know it's uncomfortable, awkward, and even a bit embarrassing, but that 15 minutes of unpleasantness can save your life!
A side-note:  If you've been in a monogomous relationship for a long time and suddenly are being diagnosed with HPV, PLEASE, don't automatically suspect infidelity on your partner's part.  This virus can lie dormant for up to 20 years, and according to my OB/GYN and the GYN/Oncologist I consulted, if the entire population were to be tested, it is likely that 80% of sexually active persons would be found to be carrying HPV.
As for prevention, the only guarantee is abstinance.  A condom may slow the virus down, but it is small enough to pass through the pores of a condom.  Even if the condom could stop it, it can still be transmitted by skin contact in the genital area, where the condom doesn't cover.
 
Genital Warts
 
These look similar to the warts that grow on hands and feet.  There are several treatment options available:
Cryotherapy:  freezing and removing the wart
Imiquimod:  induces production of chemicals in the body that fight cancers and viruses
Podofilox solutions:  dissolves warts much like the OTC products for other types of warts (do NOT use the OTC products, they can cause serious lesions in the genital area!!!)
 
Diagnosis~Cervical Dysplasia (pre-cancer)
 
There are 3 classifications for cervical dysplasia: Mild, Moderate and Severe.
Depending on the severity of your dysplasia, there are several options.  The first is, if the dysplasia is very mild, your doctor may choose to give it the opportunity to go away on its own.  Then there are three surgical options for removing the dysplasia:
 
Cryotherapy
 
Freezing the cells and scraping them away.
 
LEEP (Loop Electrosurgical Excision Procedure)
 
A wire is heated electrically and is used to slice the dysplastic cells off.
I have some personal experience to add to this now.  I would highly recommend having some kind of focal point, a photo, music, or something to help keep you focused on something other than what the doctor is doing.  If you can have someone there with you, make sure it's someone who won't take anything you say in the fear of the moment too personally. (I.e., my hubby told me to be brave, and I told him we'd see how brave he was feeling when they slice 1/4" off the head of his penis.  HA!)  Also, ask your doctor if he has knee rests for the table.  My thighs were extremely sore from trying to hold my legs still and in one position so that the only thing that got cut WAS my cervix.
 
Laser
 
Vaporizing the dysplastic area.
 
Endocervical Curettage
 
This is a minor procedure to take some cell samples of the interior of the cervix.  They use a small, spoon-shaped instrument called a curette to scrape the inside walls of the cervix; it's still uncomfortable and causes some cramping, however.
 
There are also some that are singing the high praises of a fairly new vitamin supplement called Beta-Mannan.  The producers of this supplement claim that it can actually cure cervical dysplasia and HPV.  I can't say whether it does or not, but I have personally spoken with some women who have used it without any surgical intervention at all and gone from dysplasia to no signs that they ever had an abnormal Pap in 3 months.  It's nothing more than a vitamin supplement, so I figure it's really up to the individual...it can't hurt, and if it helps, so much the better!  The University of Columbia in New York is even running a clinical trial on Beta-Mannan.  I hope it works as well as the testimonials I've read claim it does.  Wouldn't it be great if a hefty dose of vitamins could replace the painful surgeries?
I'll post links to the Beta-Mannan home page and the site listing the info for the clinical trials on my links page for those who are interested.
 

Hysterectomy

My second PAP came back abnormal, showing Severe (Type III) dysplasia again. I'm waiting on the results of my ECC and second biopsy still. My doctor has suggested that if the ECC comes back showing positive for dysplasia, the best route for me may be hysterectomy. As per my norm, I've spent some time researching the various procedures, and this is what I've found:

Most hysterectomies are performed through a large abdominal incision. Healing takes about 6 weeks
Vaginal hysterectomy is the second most common procedure: In this method, the uterus is removed through the vagina. An abdominal incision is avoided, thus minimizing pain and scarring. Healing is faster, which is about 4 weeks
Laparoscopic hysterectomy uses small half-inch incisions. The uterus is removed from the pelvis through the vagina. This method even further minimizes pain and post-operative recuperation.
I didn't find a length of healing time on this procedure

Risks of Hysterectomy:

  • Infection
  • Postoperative hemorrhage (bleeding)
  • Possible nerve damage
  • Chronic irritation at the scar at the top of the vagina
  • Bowel obstruction
  • Urinary tract injury
  • Blood clots
  • Persistent pain
  • Complications of general anesthesia
  • Risks from blood transfusions (if necessary)
  • Vaginal prolapse (vaginal canal dropping out of vaginal opening)
  • Enterocele (a hernia of the vagina protruding into the pelvic cavity)
  • Pulmonary embolism (a blood clot, fat, air, or tumor tissue blocking an artery
  • Pre-op Screening
    For my screening, the doctor ordered several tests to be run.
    • Bloodwork - to type my blood so they can have extra ready "just in case", and to check for any blood-borne diseases (hepatitis and the like):  This involved a needle and 4 vials of blood...take a cookie or grab lunch afterwards!
    • EKG - to check for heart disease and/or heart murmur:  They stuck about a dozen sticky things all over my chest and hooked wires up to them with little clips.  It was over before I knew it, and I didn't feel anything during the test.  The adhesive on the tabs didn't even pull the hairs on my body.
    • Chest X-ray - to check for pulmonary disease:  Also simple and painless, she took shots of my chest from the back with me standing with my left shoulder against the thing that holds the plate.
     

    Granulation
    This is a skin tag that grows on the surface of a wound that is healing (in my case, where my cervix was). It grows new capillaries (tiny blood vessels) that are very prone to rupture, causing abnormal bleeding. They treated this with silver nitrate, which cauterized and acted as an antiseptic.
    Good Luck, and Blessed Be
     

    Poly Cystic Ovary Syndrome
     
    I just learned about this syndrome while trying to learn about ovarian cysts.  This seems to be fairly common, and if you exhibit any of the following symptoms and are dealing with fertility issues, it may be a good time to schedule a visit with your OB/GYN.
     
    Symptoms
     
    ~Menstrual disturbance
      Absent, irregular or infrequent periods, signifying ovulation problems
    ~Acne, excessively oily skin, male-pattern hair loss, or hirsutism (excessive hairiness)
    Weight gain
     
    PCOS-related Long-term Risks
     
    The long-term risks of having PCOS include insulin resistance, Type II Diabetes, and ovarian cancer.  The hormone changes can also increase blood pressure and cholesterol levels.  Infrequent periods can also contribute to the risk of endometrial (lining of the uterus) cancer.
     
    Treatment Options
     
    Unfortunately, there is no one, cut-and-dry method for treating PCOS.  The treatments can be as unique as the woman experiencing the symptoms, as that's what will be treated.
     
    For Irregular Periods
     
    The first objective in treating irregular periods is to reduce weight in overweight patients.  Often, this brings on regular menses without further treatment.  If not, then other pregesterone-simulating drugs may be called for.  It could be something as simple as the birth control pill.
     
    Hirsutism
     
    Not all occasions of excess hair are due to PCOS.  This could be the result of genetic or racial variations.  However, it is a fairly common symptom of PCOS, and there are some treatments available.
    The first step usually includes electrolysis and bleaching, although this is a little drastic if the hair is not in a visible area.  It also doesn't treat the cause of the problem.
    Again, the birth control pill may be called in to play.  The oestregen (progesterone-simulater) can help couteract the androgens, or male hormones.  There is another formula, known as Dianette, which can reduce these androgens further.  If you and your doctor discuss this treatment, be sure that you ARE NOT PREGNANT.  These drugs can cause fetal abnormalities.  Side effects of the anti-androgens include tiredness, mood changes and reduced sex drive.All hirsutism treatments must be continued for 8-18 months before a response can be expected, due to the slow rate of hair growth.
     
    Weight Loss
     
    I know, I know, you've heard it all before, but the best thing to do is to talk to your doctor about diet and excercise.  Don't try any of those "lose 50 pounds in 30 days" diets or pills or drinks without talking to the doc.  Many of these are nothing more than legallized methamphetamines, and a lot of them take that weight of by drawing the water out of your body, thus leaving you dehydrated.  Most of them are not approved by the FDA.  Very serious stuff, get a professional opinion.
     
    There is yet another MSN Community dealing with this syndrome.  I strongly encourage those who have PCOS or have a family member suffering from it to join this very supportive and informative group.  I'll have the link posted on my Favorite Links page.

    Minor Issues
     
    Vaginal Yeast Infection
     
    Okay, it may not seem minor at first, especially if it's your first one.  But thanks to some nifty drugs, a yeast infection can be cleared up within a day.  It's not something that you're likely to pass on you your partner (and if you do, it's nothing more serious than a case of jock itch - the male answer to the vaginal yeast infection.)
    The symptoms include:
    • Itching/burning in the vaginal area
    • Thick white discharge (for some, it may look like cottage cheese, mine looked like semen, I think it depends on the severity of the infection)
    • Abdominal pain during sex (if you've ever had an ovarian cyst, the pain is similar but not as severe)
    • Unpleasant odor

    Not all of these symptoms have to occur at the same time.  If you have any of them, you should see your doctor.  I wouldn't recommend self-treatment before diagnosis, because these symptoms could be the result of a more serious problem than yeast infection, and the various treatments could disguise the real issue.

    When Bladders Rebel...
     
    Sometimes, due to various stresses and injuries incurred during childbirth, surgery, or just time and life in general, things just don't function the way they were supposed to anymore.  Then, the things that we always took for granted, like running, jumping, dancing, sneezing, coughing, laughing like we mean it, suddenly or gradually become things we avoid, thanks to a little condition the doctors like to call Stress Incontinence.  It sounds horrible, like something that great-granny might have to deal with because she's senile.  This doesn't sound like a condition for a young woman with young children that aren't yet afraid to be seen running and jumping around with her.  But there may be hope and help.  I've tried medication, and now that I know that didn't help, I've chosen the option of surgery.
     
    Pubovaginal Sling
     
    There are two basic parts to this surgery.  First, I was subjected to a test called "filling CMG."
     
    Filling CMG
     
    This test involves the placement of three catheters.  One is used to fill the bladder to retention capacity - in other words, until the patient feels like she can't hold it anymore.  Another is inserted alongside the first to measure intravesicular pressure - or the pressure along the urethra, which is the body's tube that leads from the bladder to the outside.  Yet another is inserted in the rectum to measure abdominal pressure.
    Next, two EKG-type leads are placed near the rectum and one, a ground, is placed on a thigh.  During the test, I was asked to cough and bear down in a manner resembling childbirth, to exhibit my personal degree of bladder instability.
     
     

    Surgery

     
    The way the surgery was explained to me, my doctor will be using a strip of my own abdominal fascia, which is muscle lining, to create the sling.  The basic idea is that the strip of fascia will be used to form a lift that will allow my urethra to rest in a more normal position, allowing it to return to normal function.  There will be more info when this is all done.