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.
Why is a woman's past Pap smear history pertinent?
If a woman has had a history of a cellular abnormality on a previous Pap smear,
it is important for her to inform the health care practitioner performing the current Pap
smear. The patient should provide the details of any previous problems and
treatments so that this information can be noted on the lab form. The past
history of the woman helps the person who is reading (interpreting) the current
Pap smear, because a particular abnormality on previous screening alerts the
health care practitioner to look more carefully for specific findings on the current Pap smear.
When might a Pap smear not be adequate for interpretation?
It is a requirement that the report comment on the adequacy of the smear sample
for Pap analysis. If the sample is inadequate, the report details the reason.
Examples of problems that might be listed under "sample adequacy" include
"drying artifact" or "excessive blood." These comments refer to factors that the
person analyzing the smear feels may have interfered with his or her ability to
interpret the sample.
Sometimes, a Pap smear report will read "unsatisfactory due to excessive inflammation." Inflammation that is present in the woman's cervical area may make it difficult to interpret the Pap smear. Examples of causes of inflammation might include infections or irritation. Inflammation is a common finding on pap smears. If it is severe, your doctor may want to try to determine the cause of the inflammation. In many cases, a repeat pap smear is recommended to determine if the inflammation has resolved and to obtain a sample that is adequate for interpretation.
How is the final Pap smear diagnosis made?
The final Pap smear diagnosis is based on three determining factors:
The patient's history: The reader (the person reading the smear)
takes into account the woman's history as noted on the lab request by the
clinician performing the smear.
Sample adequacy: The reader then decides whether the sample was
adequate for interpretation.
The presence or absence of cellular
abnormalities: The reader then notes whether cellular abnormalities were
seen on the slides. If the appearance of the Pap smear does not seem to coincide
with the woman's clinical history, a comment may also be made to that effect.
The final diagnosis is a short statement that summarizes what the reader has
found. Examples of final diagnoses include:
Within normal limits;
Absence of endocervical cells on the Pap smear;
Unreliable Pap smear due to inflammation;
Atypical squamous cells of undetermined significance
(ASCUS);
Low-grade squamous intraepithelial lesion (LSIL); or
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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