Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Which women are at increased risk for having an abnormal Pap smear?
A number of risk factors have been identified for the development of cervical cancer and precancerous changes in the cervix.
HPV:
The principal risk factor is
infection with the genital wart virus, also called the
human papillomavirus
(HPV), although most women with HPV infection do not get cervical cancer. (See below for details). About 95%-100% of cervical cancers are related to HPV infection.
Some women are more likely to have abnormal Pap smears than other women.
Smoking: One common risk factor for
premalignant and malignant changes in the cervix is
smoking. Although
smoking is associated with many different cancers, many women do not realize
that smoking is strongly linked to cervical cancer. Smoking increased the
risk of cervical cancer about two to four fold.
Weakened immune system:
Women whose immune systems are weakened or have become
weakened by medications (for example, those taken after an organ transplant) also have a higher risk of precancerous changes in the cervix.
Medications: Women whose mothers took the drug
diethylstilbestrol (DES) during pregnancy also are at increased risk.
Other risk factors:
Other risk factors for precancerous changes in the cervix and an abnormal Pap testing include having multiple sexual partners and becoming sexually active at a young age.
How is a Pap smear done?
A woman should have a Pap smear when she is not
menstruating. The best time
for screening is between 10 and 20 days after the first day of her menstrual
period. For about two days before testing, a woman
should avoid douching or using
spermicidal foams, creams, or jellies or vaginal medicines (except as directed
by a physician). These agents may wash away or hide any abnormal cervical cells.
A Pap smear can be done in a doctor's office, a clinic, or a hospital by either
a physician or other specially trained health care professional, such as a
physician assistant, a nurse practitioner, or
a nurse midwife.
With the woman
positioned on her back, the clinician will often first examine the outside of
the patient's genital and
rectal areas, including the
urethra (the opening where
urine leaves the body), to assure that they look normal.
A speculum is then
inserted into the vaginal area (the birth canal). (A speculum is an instrument
that allows the vagina and the cervix to be viewed and examined.)
A cotton swab
is sometimes used to clear away mucus that might interfere with an optimal
sample.
A small brush called a cervical brush is then inserted into the opening of the
cervix (the cervical os) and twirled around to collect a sample of cells.
Because this sample comes from inside the cervix, is called the endocervical
sample ("endo" meaning inside).
A second sample is also collected as part of the
Pap smear and is called the ectocervical sample ("ecto" meaning outside).
These
cells are collected from a scraping of the area surrounding, but not entering,
the cervical os.
Both the endocervical and the ectocervical samples are gently
smeared on a glass slide and a fixative (a preservative) is used to prepare the
cells on the slide for laboratory evaluation.
A bimanual (both hands) pelvic exam usually
follows the collection of the two samples for the Pap smear. The bimanual
examination involves the physician or health care practitioner inserting two fingers of one hand inside the
vaginal canal while feeling the ovaries and uterus with the other hand on top of
the abdomen (belly).
The results of the Pap smear are usually available within two to three weeks. At the end
of Pap smear testing, each woman should ask how she should expect to be informed
about the results of her Pap smear. If a woman has not learned of her results
after a month, she should contact her health care practitioner's office.
Yeast vaginitis is a yeast infection of the vagina. Symptoms include itching, burning, soreness, pain during intercourse and urination, and vaginal discharge. Yeast infections can be treated with over-the-counter and prescription medications.
There are many types of ovarian cancer, epithelial carcinoma is the most common. Women with a family history of ovarian cancer have an increased risk of developing the disease. Some ovarian cancer symptoms include abdominal pain, nausea, diarrhea, constipation, and abnormal vaginal bleeding, however, they usually do not present until the disease has progressed. Early diagnosis is important for successful treatment.
Sexually transmitted diseases, or STDs,
are infections that are transmitted during any type of sexual exposure,
including intercourse (vaginal or anal), oral sex, and the sharing of sexual
devices, such as vibrators. Women can contract all of the STDs, but may have no symptoms, or have different symptoms than men do.
Cervical cancer is cancer of the entrance to the womb (uterus). Regular pelvic exams and Pap testing can detect precancerous changes in the cervix. Precancerous changes in the cervix may be treated with cryosurgery, cauterization, or laser surgery. The most common symptom of cancer of the cervix is abnormal bleeding.
Menopause is the time in a woman's life when menstrual periods permanently stop, also called the “change of life." Menopause symptoms include hot flashes, night sweats, irregular vaginal bleeding, vaginal dryness, painful intercourse, urinary incontinence, weight gain, and emotional symptoms such as mood swings. Treatment of menopausal symptoms varies, and should be discussed with your physician.
Chlamydia, a type of bacteria that causes an infection, is spread through sexual contact. Most of the time, women with chlamydia have no symptoms. Antibiotics are an effective treatment for chlamydia.
Cervical dysplasia is a condition in which the cells of the inner lining of the cervix have precancerous changes. There are two types of cervical dysplasia; 1) squamous intraepithelial lesion, and 2) cervical intraepithelial neoplasia. Cervical dysplasia is caused by infection of the cervix with HPV (human papillomavirus). There are various diagnostic measures for cervical dysplasia. Treatment generally depends upon the progression of the dysplasia, mild, moderate, or severe.
Human papillomavirus (HPV) infection is the most common sexually transmitted infection in the U.S. HPV is primarily transmitted by sexual contact. While some people develop warts in the genital region after infection, others experience no symptoms. Though genital warts can be removed, there is no cure for HPV infection. There is a vaccine to prevent infection from four common HPV types.
Vaginal cancer is fairly uncommon. There are two types of vaginal cancer: squamous cell carcinoma and adenocarcinoma. Risk factors include being 60 or older, exposure to DES while in the womb, HPV infection, and having a history of abnormal cervical cells. Painful intercourse, pelvic pain, vaginal lumps, and abnormal vaginal bleeding or discharge are all symptoms of vaginal cancer. Treatment depends upon the stage of the vaginal cancer and may involve surgery, radiation therapy, chemotherapy, and the use of radiosensitizers.
Benign uterine growths are tissue enlargements of the female womb (uterus). Three types of benign uterine growths are uterine fibroids, adenomyosis, and uterine polyps. Symptoms include: abdominal pressure, pelvic pain, and pain during intercourse. Diagnosis and treatment of benign uterine growths depends upon the type of growth.
Syphilis, a sexually transmitted disease, is caused by a microscopic, wormlike bacterial organism called a spirochete. There are three stages of syphilis. The first involves the formation of the chancre. The second stage often includes hair loss, a sore throat, white patches in the nose, mouth, and vagina, fever, headaches, and a skin rash. The third stage can cause extensive damage to the internal organs and the brain, and can lead to death. Though early infection often resolves on its own, treatment usually varies based on the stage of the infection at the time of diagnosis.
Sexual dysfunction refers to a problem that arises during any phase of the sexual response cycle, preventing an individual or couple from experiencing sexual satisfaction. Physical, medical, and psychological conditions may affect sexual functioning, resulting in inhibited sexual desire, inability to become aroused, lack of orgasm, and painful intercourse. Treating the underlying physical and psychological problems usually resolves most female sexual problems.
Sexual health information including birth control, impotence, herpes, sexually transmitted diseases, staying healthy, women's sexual health concerns, and men's sexual health concerns. Learn about the most common sexual conditions affecting men and women.
When you are pregnant, many sexually transmitted diseases (STDs) can be especially harmful to you and your baby. These STDs include herpes, HIV/AIDS, genital warts (HPV), hepatitis B, chlamydia, syphilis, gonorrhea, and trichomoniasis. Symptoms include bumps, sores, warts, swelling, itching, or redness in the genital region. Treatment of STDs while pregnant depends on how far along you are in the pregnancy and the progression of the infection.
Disease prevention in women includes screening tests that are a basic part of prevention medicine. All screening tests
are commonly available through your general doctor. Some specialized tests may be available elsewhere.
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