A few years ago, my gynecologist left me a voicemail telling me to call her back. I had recently had my annual exam, but my doctor had given me results via voicemail before. I worried the news could not be good.
My gynecologist is never judgmental and always calm -- two regrettably rare traits in women's medicine. So when she told me my pap smear had come back abnormal and showed traces of HPV, I didn't panic. I was 23 years old and had never had an irregular pap smear before, but my doctor reassured me that everything was probably fine and I just needed to get some follow-up tests.
Thankfully, I received my diagnosis in 2009, three years after Merck released its "One Less" campaign to advertise the first HPV vaccine, Gardasil. I had never received the vaccine, but the news surrounding it lead me to learn a lot simply through osmosis -- and pamphlets at the doctor's office. I knew that HPV was a sexually transmitted infection (STI), and I knew that, in some cases, it could lead to cancer. But I also knew that HPV was not cancer. And I knew that it was incredibly common, which comforted me.
My doctor told me I needed to get a colposcopy -- or a "colpo," as doctors often call it. A colposcopy is basically an extra-thorough pap smear wherein a doctor takes a fancy microscope -- called, guess what, a colposcope -- and examines the cervix for dysplasia, a.k.a. abnormal cells. It sounded easy enough, so my doctor referred me to a colleague of hers, and I made an appointment.
The colposcopy itself was painless, but the new doctor noticed some dysplasia and said she wanted to take a biopsy just to be safe. Luckily, cervical biopsies don't usually hurt (something about the type of tissue), so I was able to relax. The whole procedure lasted about fifteen minutes. When it was over, my doctor told me I'd probably bleed, shouldn't have sex for two weeks, and needed to come back in a few weeks for the results.
The results showed that I had low-grade dysplasia. Low-grade cells have about an equal shot of disappearing on their own as they do of developing into high-grade or cancerous cells. My doctor advised me to have the cells removed via a loop electrosurgical excision procedure, more commonly known (thank goodness) as a LEEP. Both my regular doctor and the specialist had explained to me that I might have to have one depending on my results, so I was already familiar with what would be involved. Basically, a LEEP involves a doctor using a tiny, charged tube to burn off the problematic part of your cervix.
I had been told that LEEPs were relatively common, but I'd never known anyone to have one before. I'm pretty candid when it comes to my personal business (as evidenced by my willingness to talk about my medical history on the Internet), so I mentioned this procedure to a friend of mine. "I had to have one of those a few years ago," she said. "It was awful." At once relieved that someone I knew had undergone a LEEP and terrified that I was in for some serious pain, I spent the weeks leading up to my consultation with the doctor who would perform the LEEP (yes, a different doctor) doing research.
One takeaway from this experience was that the Internet can be a dangerous place to search for medical information. I have since started joking that if you try to self-diagnose using information you find online, you will convince yourself that you are pregnant and have cancer.
I also learned that, despite the awareness of HPV generated by the Gardasil campaign and other cervical cancer education initiatives, there was still a remarkable amount of misinformation circulating among the general public. When I had the colposcopy, I'd told my boyfriend what was going on, mostly because I wanted him to know that I was having a non-routine medical procedure and we wouldn't be able to have sex for a while. His first reaction was "Wait, should I be worried?"
I was disappointed that he was so ignorant of the virus, but I understood that having your partner tell you they have a sexually transmitted anything is unsettling. I told him everything I knew, including that, unfortunately, there is no way to screen for HPV in men. I told him not to worry -- especially since there was no way he could get cervical cancer -- but that it certainly wouldn't hurt for him to a see a general physician or urologist regularly. When he asked me what a urologist was, I realized I had a bigger issue to deal with.
When I consulted with the new doctor, I asked her if the LEEP would affect my ability to have children -- we were talking about my cervix, after all. She said that, while one LEEP would probably have no negative effect, if I had to have the procedure several times, I might suffer something called "cervical insufficiency," which can cause your cervix to dilate too early during pregnancy and lead to miscarriage.
I had already committed to this procedure, but this revelation started to make me worry. I had by then turned 24 (it took about five months from my diagnosis to schedule and have all of these procedures), but I was certainly nowhere close to having kids. And yet, here I was, making a choice between potentially having cancer and potentially not being able to bear children. Still, I trusted my doctors, and went ahead.
A couple of weeks after I had the LEEP (which was certainly not fun but also not that bad), I heard a report on the radio saying that gynecologists now advised women to get biennial instead of annual pap smears because overscreening can often lead to procedures -- like LEEPs -- that may be unnecessary. Remember, those low-grade cells had a decent chance of disappearing on their own, but I'd been advised to burn off part of my cervix to be safe. I almost threw the radio across the room. My doctor had told me I would need to get a pap every six months until two in a row came back normal. What the hell was I supposed to do now, not go?
I figured paps were harmless, and I have insurance, so for the past 3+ years, I have gone to my gynecologist every six months to be screened. I have never had two normal paps in a row, but I have also not developed anymore dysplasia, which means no biopsies or LEEPs. If I am ever advised to get another LEEP though, I have no idea what I'll do.
Which brings me to the reason I wanted to write this piece. As this site noted recently, there are a lot of myths surrounding HPV. But there is a larger problem at work here: We are bad at talking about our sexual health. A couple of months after my LEEP, one of my friends told me she'd been diagnosed with HPV and became upset. She knew all about my ordeal, and I told her what I knew and that there was no reason to worry. She had just started dating someone and said even though she knew she shouldn't worry, she "had thought he was a great guy."
If we live in a world where a woman doubts the goodness of a man because he possibly gave her a virus that half the population has or will have, we have work to do. And when the medical community can't agree on whether we should be vigilant about preventative medicine or wait until something of concern shows up, the only way we can make rational decisions about our health is to gather as much information as possible. And that will start by sharing the information we already have.
If your doctor tells you something is abnormal, ask what it means. If she says you need a procedure, ask what it entails. If you've never heard of this condition or procedure before, ask your friends if they have. If one of your friends mentions that she has the same condition you've already faced, tell her everything you can about it.
To get you started, and in honor of Cervical Cancer Awareness Month, here are the most important things to know about the human papillomavarius, commonly known as HPV:
- HPV is the most common sexually transmitted infection (STI); 50% of sexually active Americans will have it at some point in their lives
- In most cases, HPV exhibits no symptoms and in 90% of cases, the immune system clears it within two years
- There are more than 100 strains of HPV, 30-40 of which are transmitted sexually
- Of the sexually transmitted strains of HPV, about a dozen can lead to cervical cancer
- The HPV vaccine protects against four strains -- the two most commonly linked to cervical cancer and the two most often linked to genital warts
- The HPV vaccine is approved for use in men and women
- While cervical cancer is the most common type of cancer associated with HPV, the virus can also lead to oral and anal cancers in men and women
- The Pap smear can identify if a woman has high-risk HPV but not which strain of HPV she has; there is currently no test to screen men for the virus
- Men and women can pass HPV to each other, and since HPV is often symptomless, if you have had more than one partner, it's impossible to know who passed it to you, even if you are currently monogamous
Now that reminds me... I need to make an appointment with my doctor.