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.
What treatments are available if a Pap smear is abnormal?
If a Pap smear is interpreted as abnormal, there are a number of different
management and treatment options including colposcopy, conization,
cryocauterization, laser therapy, and large-loop excision of the transformation zone.
All of these procedures have essentially the same
overall cure rate of over 90%.
However, the procedures do vary considerably in a number of other respects and
so will be discussed separately.
Colposcopy: Colposcopy is a procedure that allows the physician to take a closer
look at the cervix. The colposcope is essentially a magnifying glass for the
cervix. For colposcopy to be adequate, the whole cervical lesion, as well as the
whole transformation zone (the transition between the vagina-like lining and the
uterus-like lining), must be seen.
During colposcopy, the cervix is cleaned and soaked with 3% acetic acid. This
acid not only cleans the surface of the cervix but it also allows cellular
abnormalities to show up as white areas (called acetowhite epithelium or acetowhite lesions).
If suspicious areas of cervical tissue are seen during colposcopy, a biopsy
(tissue sampling) is often done. The sample is sent to the laboratory for
analysis by a pathologist and the biopsy results determine the next step in the treatment.
The procedure is essentially painless and quite simple, usually taking only
several minutes to perform. Generally, the woman is instructed not to have
intercourse, douche, or use tampons for about a week afterwards if a biopsy is
done. Pregnancy is not a contraindication to colposcopy. Colposcopy can
adequately evaluate 90% of women who have abnormal Pap smear results.
In unusual circumstances, colposcopy does not allow an adequate view of the
cervix and another procedure called conization is necessary in order to obtain a
tissue biopsy.
Conization: This is still the standard method to which all other methods are
compared. Conization allows the entire area of abnormal tissue to be removed and
provides the maximum amount of cervical tissue for laboratory evaluation to rule
out the presence of invasive cancer. After the cervical area is visualized,
generally by colposcopy, a cone-shaped specimen of tissue (perhaps 1/2-1 inch
long and 3/4 inch wide) is taken from around the endocervical canal.
Conization is usually done on an out-patient basis under anesthesia in a hospital or surgical facility. For three weeks after the procedure, the woman needs to avoid douching and using tampons and refrain from sexual
intercourse.
Cure rates close to 100% are achieved with conization as long as the cells along
the margins of treatment are normal.
With conization, there are associated risks from anesthesia and postoperative hemorrhage (bleeding-in about 10% of cases) as well as possible future adverse
effects on fertility. Conization is generally performed only on women who have
had unsatisfactory colposcopy results, have adenocarcinoma in situ (a diagnosis
of cancer) already, or whose Pap smears suggest they may have some invasion of
cancer into the nearby tissue.
Hysterectomy (surgical removal of the uterus and the cervix) for non-cancerous
abnormal Pap smears is now rarely done. A hysterectomy is appropriate only for
those women who are finished with childbearing and have severe pre-cancerous
abnormalities that have persisted despite other treatments. It may also be
appropriate for women with certain specific findings after conization.
Cryocauterization: Cryocauterization is a simple and safe procedure. A probe,
called a cryoprobe, is first cooled by carbon dioxide and then touched to the
abnormal cervical area. This freezes and kills the cells, resulting in the
sloughing of the abnormal tissue.
A woman undergoing cryocauterization can expect a watery
vaginal discharge for
several weeks after the procedure.
Laser therapy: Laser therapy
makes use of the principle that laser light can be produced by electricity
running through gas. In the treatment of cervical lesions, the gas is usually
carbon dioxide. This type of laser can instantly boil water and therefore can also be used to kill and vaporize cells.
When a laser beam (using a tiny wand called a
micromanipulator) is directed into the cervix at an area of abnormal cervical
tissue, the light energy is converted to heat, which in turn causes cell death, as occurs with cryocauterization.
However, the laser apparatus is expensive, and its use requires more skill than
other treatment options, such as cryocauterization. The procedure is also
painful and generally requires general anesthesia.
The benefit of laser therapy is that it may cause less cervical scarring as
compared to cryocauterization. This in turn may mean that, should the woman need
colposcopy in the future, the chances of adequately viewing her cervix may be
better after laser therapy.
Large-loop excision (LEEP) of the transformation zone: Large-loop excision of
the transformation zone (LEEP) removes the cervical transformation zone (the area where the vaginal-type lining changes to the uterine-type lining) using a
thin-wire loop to administer electrocautery. It allows samples to be collected
for additional tissue analysis and can be performed in the office under local
anesthesia.
Specialized (more frequent) follow-up is necessary after LEEP. This follow-up
includes Pap smears, colposcopy, and sometimes other techniques. When there is
no more evidence of abnormal cervical tissue, it may be possible to resume
annual screening Pap smears.
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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