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Cervical Pain
From the Woman's Diagnostic Cyber - Frederick R. Jelovsek MD
Cervix and Pap Smear Problems
   
Chronic cervical pain
The cervix can "evert" somewhat due to OCPs. That puts glandular skin on the outside. Usually the acidity of the vaginal secretions cause a healing over of that glandular epithelium. If there is infection there, it doesn't heal well.
There are nerve endings in the cervix. They are less dense than other areas but some women have a quite sensitive cervix.
I assume the doctors have given you some courses of antibiotics. If not, erythromycin is a good one to use. If you've tried that, and are not allergic to sulfa, some of the topical cervical creams may also be useful.
Make sure your doctor has done a herpes smear. Sometimes a herpes cervicitis can present this way.
As far as topical treatment that you yourself can use, I would guess that douching might help but I'm not sure what to tell you to use. Usually we don't recommend it, but sometimes Betadine® douche can help.
Is all dysplasia HPV related?
Yes. Not all LGSIL or dysplasia comes from HPV. For example we see some related to menopause when estrogens are low. The pathologist is only looking at the nucleus of the cell in relation to the entire cell size. When the nucleus enlarges, it can be due to any infection or repair work on cervical cells. Any irritation can cause this. That's why we usually wait for it to clear up on it's own. It usually does and you probably won't need a LEEP. HPV is associated with much of abnormal Paps but not all by any means.
What is chronic cystic cervicitis?
This is a condition in which the openings to the cervical glands get blocked by skin cells growing over the openings due to repair
(metaplasia). Then the mucous in the glands can't get out and they form pockets of cystic areas. It is usually a benign process although
rarely it can get severe enough to block off the opening to the cervix.
Not at all related to sexually transmitted diseases (STDs).
No. It is noticeable visually on speculum exam as multiple nabothian (mucous filled) cysts of the cervix.
No.There is no relationship to cancer.
Recurrent dysplasia, 2nd LEEP recommended
We need more information to answer this. What are the different grades of dysplasia you've had, when and what grade is the current
biopsy? If the last biopsy is acute cervicitis with koilocytosis, this is a benign inflammatory process that doesn't need further therapy at
this time.
If you are a smoker, these changes can persist for a long time.
If there is just mild dysplasia in biopsy now, I would leave it alone and just follow with Paps and repeat the biopsy if it didn't improve in 9 months.
Stopping smoking would help your body to heal this on it's own. Smoking suppresses the local tissue immune system (IgA) in the
genital tract.
If you keep having a LEEP procedure done to cervix, it eventually affects fertility because it destroys cervical glands. You've had quite a
bit done to the cervix already so I guess another LEEP wouldn't add to that much, but I don't think it's needed for mild dysplasia.
The ECC is an endocervical curettage. A sharp, small rectangular-shaped instrument is used to scrape the inside of the cervix where the doctor cannot see with a colposcope. That is important to
do as part of the biopsy to make sure there is not a more severe lesion in the cervix.
Both LEEP and ECC are office procedures, should take less than 30 minutes. Recovery time is mostly abstaining from sexual relations or
any tampons in vagina, etc. for about 3 weeks.
Is HPV always sexually transmitted?
If it was your Pap smear or a biopsy that was read as HPV changes, then it is only about 85% accurate. They look for what is called
koilocytosis and if the cytologist or pathologist sees it, they call it HPV compatible. Viral cultures or smears for HPV fragments
are the more certain way to diagnose HPV.
Secondly, HPV can exist forever. We've had 80 year old widows (for 30 years) come up with an "HPV" compatible Pap. Exposure can
have been many, many years before.
Thirdly, there's no reason it can't be introduced into the GI tract and from there to the genital tract. We don't know much about how it's
totally transmitted but I'm sure it's not all sexually.
Personally, I'd assume that you don't really have HPV ( I don't recommend you get the smears for it but you could ask your doctor to
do that if you want) and on the remote chance you did have it, It's likely in your case to have been contracted nonsexually, or sometime
before marriage (either you and husband. I wouldn't let that Pap cause problems in a 30 year marriage, It's not that certain!
What is a LEEP procedure?
A LEEP (loop electrical excision procedure) is usually done in office. The cervix is injected with xylocaine. Then a wire loop with electrical current is used to
excise tissue from the cervix that has the abnormal cells. It's sort of like using a melon ball scooper to remove the tissue. Chemical
cautery or electrical cautery is used to make sure that the bleeding is under control. Nothing in the vagina for 3 weeks after that to let it
heal then Paps in 3-4 months to make sure abnormal tissue is gone. It is about 80% effective.
What is HPV?
HPV is human papilloma virus. It is ubiquitous in anyone having sexual relations. Most people's immune system controls the virus
and it doesn't cause abnormal cells. Some people's immune system takes awhile to build antibodies to it and meanwhile it causes
abnormal Paps. Smokers take the longest time to get over it but it persists for awhile in nonsmokers too.
Some people think HPV causes cervical cancer if one's immune system does not get on top of it. I suspect it is a promoter or initiator of
cellular change that sets one up for possible cancer and something else (genetics, smoking, exposure to multiple partners etc.) carries it
on.
Sexual activity after LEEP procedure
He/she means any activity that may disrupt or interfere with the cervix as it heals. The cervix is quite vascular and can bleed extensively if traumatized. Therefore, nothing in the vagina for about 3-4 weeks. Other sexual activity is ok.
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