The
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"We treat people, not just problems." |
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John L. Pfenninger, M.D. |
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Lori Oswald,
P.A.-C. |
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(989) 631-4545 |
Visit our Website at http://www.MPCenter.net
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Colposcopy |
Colposcopy is a relatively painless thirty-minute office
procedure for examining the female cervix when an abnormal Pap smear has
been detected or there has been exposure to genital warts. This is done using a
special microscope called the colposcope,
which we have in our office. It usually cannot be done if you are
flowing heavily on your period, but if you are only spotting, keep your
appointment.
Colposcopy identifies areas on the cervix which might
be causing the abnormality on the Pap smear and which may be considered premalignant (precancerous). The changes may vary from mild
to severe. If left alone, these changes may revert to normal, may stay the
same, or may progress to malignancy (cancer) over a period of years. After
proper evaluation, these abnormal cells can usually be treated with a freezing
technique called cryocautery or with surgical
removal. In certain cases, laser therapy may be recommended. In this way,
cancer can usually be prevented. As with any procedure, there is no
guarantee that the doctor can always eliminate the precancerous area.
Therefore, close follow-up is always needed. If you are found to have a premalignant lesion, there is about a 1% lifetime chance of
developing cancer even after treatment. PLEASE FOLLOW YOUR DOCTOR’S
RECOMMENDATIONS FOR FOLLOW-UP.
Research has shown that infection with the human papilloma
virus is closely associated with cancer of the cervix. This is the same
virus that causes warts in the genital areas, including inside the vagina
and on the cervix. The medical term for these warts is condyloma
acuminata. These lesions are very contagious
and are passed readily by sexual intercourse. It is rare that people can be
infected in other ways than through sexual contact. These wart viruses can
remain dormant or inactive for up to 20 years after initial infection.
If there is evidence of infection in the female (seen by an abnormal Pap smear
or obvious warts around the genitals), then the male sexual partner(s) is
also infected. In some instances, it may be advised that the man be
examined. That procedure is called androscopy.
A separate handout is available which describes androscopy.
Men may need to be treated if they have warts or have symptoms. If you have
already had unprotected sex with your partner, a condom (rubber) is not
necessary for future sex with the same person.
DESCRIPTION OF PROCEDURE (Colposcopy)
This procedure will take 30 minutes. You will be asked to undress from the
waist down and will be draped appropriately. You will be asked to lie back and
put your feet in stirrups just like when you had the Pap smear taken. You may
want to take (4) 200 mg ibuprofen (Advil, Nuprin,
etc.) two hours before your appointment time, but do not take any aspirin.
The speculum will be inserted and the Pap smear will be repeated.
The doctor will then look through the fancy microscope (colposcope)
at the cervix and note if there are any abnormalities (see diagram). He will
next stain the cervix with a vinegar douche. This makes abnormal cells turn
white. If such changes are seen, the doctor will take a small biopsy of
these areas. This is generally not painful. (The biopsies are very small, about
2-3 mm [1/8 inch].) If a biopsy is taken, it does not mean you have cancer.
It only means there are abnormal cells that need closer inspection. The
biopsies will be sent to the hospital laboratory for further evaluation. The
hospital laboratory will bill you separately for looking at those biopsies.
Because the biopsies are so small, there are very few complications from this
procedure except possibly some spotting.
The final step is to do a scraping inside the cervix. This is called an endocervical curettage (ECC).
This will cause cramping. This part of the procedure lasts only 15-20 seconds.
Many women find it helpful to take four (4) 200 mg ibuprofen (Advil, Nuprin, etc,) two hours prior to the procedure to decrease
this cramping. Occasionally there will be some spotting afterwards for several
days. Bring a sanitary pad with you to the office.
No time off work is needed
except for the time in the doctor’s office. Normal activities, including sex,
may be resumed. As long as you are with the same partner, condoms are not
needed.
Depending on the results of the biopsies and the ECC which take about a week to
return, your physician will advise you on the treatment of your condition.
Remember to have your partner screened, too. If we do not call you within 2
weeks, please call our office for results.
OTHER INFORMATION
There have been about 90 different types of warts identified. They are all
numbered. Types 6, 11, 16, and 18 are the most common warts in the genital
area. Patients often ask if these warts can be transmitted to the hands, feet,
etc. Generally this does not happen. Genital warts for some reason stay in the
genital area and usually are not transmitted to other parts of the body. Only
20% of these warts can be seen with the naked eye. The remaining 80% need to be
stained to be seen and properly evaluated.
Unfortunately, once someone has
the wart virus in the vagina or rectum or on the penis, it is almost impossible
to totally eliminate it. Treatment can put them in "remission", but
they can come back anytime. THE CERVIX IS AT VERY HIGH RISK OF DEVELOPING
CANCER IF EXPOSED TO THE WART VIRUS SO IT MUST BE EVALUATED AND TREATED IF
THERE ARE SIGNIFICANT CHANGES THERE. THERE IS A 99% CHANCE OF
CURE/PREVENTION IF THE CERVIX IS TREATED IN TIME. Since the warts can come back
into the vagina anytime, you can spread the disease around anytime. Most
experts strongly recommend that you remain monogamous. This means that
you have intercourse with only one partner - the same partner - the rest of
your life. As long as you are with the same partner, you do not need to use
condoms. You already have whatever he’s got. Using condoms does not cut down on
reinfection if you are with the same partner.
However, if you have a new partner, then you can "catch" new and
different types of viruses, so a condom is necessary. Remember, though a
condom provides protection, it never makes sex "totally safe."
We now know, too, that if you smoke your chance of developing cervical cancer
is markedly increased. Even if your partner smokes, your risks go up! You
must stop smoking and your sexual partner should too. Also, diet is very
important. You should eat at least five servings of vegetables and fruits
every day. A handout is available from the receptionist regarding this. Many
authorities now also suggest extra vitamins with folic acid and antioxidants.
Remember that even after you are treated, you will need 3 or 4 Pap smears
during the next 12 months, and then Pap smears at least every year for the rest
of your life. Your doctor may also recommend periodic colposcopy
since we know that the Pap smear may miss up to 25% of lesions on the cervix.
You should notify any new sexual partners that you have been treated for condyloma.
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