Hey, did you know that January is Cervical Health Awareness Month? If your response was “oh Lola FUCK you, dude” I’m guessing you are one of the 2-3 million people in the US who found themselves on the freaking-out end of an abnormal pap smear result in the last year. Understandably! Hey APSC (Abnormal Pap Smear Crew), bring your HPV, cervixes, and questions about whether that HPV is cervixes' cancer over here. And let’s talk.
First: what is HPV? HPV stands for Human Papillomavirus, the most common STI, transmitted through skin-to-skin contact with the genitals. This means that you can get it no matter who you are, who you're having sex with or what kind of sex you're having. Penetrative ... or not! Oral, genital, anal! Cis or trans! We’re here, we’re queer, pap smear. Being equal-opportunity is why HPV is so popular — estimates are that about 50-80% of all adults will have it at some point in their lives. There are about 40 strains of genital HPV, divided into “high-risk” and “low-risk” according to their likelihood to cause certain kinds of cancer. So, the “high-risk” HPV strains are high-risk for causing cervical, anal, etc. cancers and the “low-risk” HPV strains are low-risk for causing cancer but are responsible for causing genital warts. The cancer-y strains don't give you warts, and the wart-y strains don't give you cancer. I know, fair in a weird way, right? Now we all feel weird. Weird-er!
Let’s get something out of the way. If you’ve been going to the gyno at least every couple years, you can give yourself a preliminary, reassuring pat (pap) on the back, because I’m not really that worried about your abnormal pap smear being cervical cancer. Why? Because “the majority of cervical cancers in the United States occur in women who have never been screened or who have not been screened within the past 5 years ... additional cases occur in women who do not receive appropriate followup after an abnormal Pap smear.” So the people most at risk for having cervical cancer are not you; they’re people who haven’t gotten an abnormal pap smear result because they didn’t or couldn’t get a pap smear in the first place. The same principle is why 80% of new cervical cancers occur in developing nations, where cervical cancer is the #1 cause of cancer-related death in women and why in the US, although widespread screening has reduced new diagnoses and mortality 60% since being implemented in the 1950s, the rates of both are still so high for medically under-served people that a community’s mortality rate from cervical cancer can be used as “a marker for low access to health care.”
The underlying idea is that having HPV doesn’t matter nearly as much as how long you’ve had it. Seventy percent of healthy young people will clear an HPV infection in a year, and 90% will do it in two. That means two years from now almost all of you APSC will have wasted your time reading this rest of this article. Not sorry! In healthy people, it’s only “persistent infections,” which are high-risk HPV infections that do not clear after about two years, that have any possibility of progressing into cancer, and it takes an average of 13 years (!) to do so. There are a lot of steps between HPV infection and cancer, and at each step, there’s a chance that the process will clear, regress, or stall. Here’s a diagram to help explain all of this. I want to draw your attention to the fact that in this diagram there is no place in which you should shit yourself.
Click for full-size
Sorry that I’m not an artist like you but rather a nurse who saves lives with nothing but her bare hands and raw intuition. (Did you like the little bowties?) First, you have to get HPV, which is seriously so easy to do that almost everybody does it at least once, like dropping your cell phone in the toilet. Then, the HPV you get has to be a high-risk strain — especially either #16 or #18, the two strains responsible for 70% of cervical cancers. Ninety percent of infections clear at this point and never go any further. 90%!! The remaining 10% become persistent, which takes years. After this, the HPV has to get all pissed and cause more changes in your cervical cells (dysplasia). THEN the dysplasia has to progress further and further, but it’s still not cancer until it breaks through the bottom layer of the membrane in a process known as “invasion,” because the people who name things in medicine do so from deep within the irony-free zone. Only after invasion is the diagnosis of cervical cancer made. “CIN” stands not for “Cancer Impossibly Near” but “Cervical Intraepithelial Neoplasia,” the fancy name for the cell changes that HPV makes. The number after the “CIN” stages the proportion of cells affected. With all this said, as slow as it is, HPV turns into CIN3 faster than CIN3 turns into cancer. Seriously, do you see how the cancer part doesn’t happen until that very last cervix all the way on the right? At every step there is something we can do to manage or treat it. All of this is how an estimated one fourth of all women in the US age 14-59 have some strain of genital HPV, and 23% a high-risk strain, but there were only about 12,000 diagnoses of cervical cancer predicted in 2011.
One more thing. If you’re over 30, you most likely got two results: a (normal/abnormal) pap smear result and a (positive/negative) HPV genotype test result. There’s more on it here and here, but real quick, the HPV test detects a current high-risk HPV infection in your cervical cells whereas the pap smear detects cells after HPV has made them abnormal. That’s why you can have a positive HPV test (current infection) but a normal pap smear (hasn’t done anything) or! an abnormal pap smear (you’ve had an HPV infection that made cell changes) and a negative HPV test (but you cleared the virus). The reason we start using both (“co-testing”) at 30 and not earlier is because the younger you are, the more likely you are to both have HPV and to clear it. As you get older, both of those things become less likely, making it more important to find the people who are affected.
Now that we’ve established that you’re going to be okay no matter what, I feel your focus turning to the next important matter: who fucking gave me this shit? Oof we can’t really know who or even when. This is because most HPV infections clear up on their own without any symptoms and are therefore never detected. So a new HPV diagnosis doesn’t necessarily mean that it was the last person you had sex with, or there were more people having sex with the people you were having sex with than you thought. There’s also no HPV test for dudes, even if they say “test me for everything.” And that’s probably the best we’re able to do until someone figures out how to make a cervix talk.
The only thing we can say definitively about how you got HPV is that it wasn’t because you were a slut because sluts don’t exist. That’s right: you are the same person you were 25 minutes ago in the waiting room. There is no reason why you should stop doing anything sexy that made you happy before you got diagnosed. There is no reason why you should not get close to another person again. There is no reason you should now regret something you didn’t regret before; I speak from a place of authority, because regretting sex was my undergraduate major. Having HPV doesn’t mean you did something “bad,” or “dirty,” or “slutty,” ever, at any point, period. It doesn’t mean anything except that you are infected with a strain of a virus which very rarely causes cancer, and that we’re going to monitor you so that doesn’t happen, and if it does we’ll be there with you treating it. If simply having had HPV makes you bad/dirty/slutty, then 80% of adult humans are bad/dirty/slutty, and I always swore that if there were that many bad/dirty/slutty people on this earth I was going to another earth and I’m still here, aren’t I.
The exchange for knowing that there is no reason to judge yourself because you got HPV is that you must also release the other person(s) involved from judgment, too. Again, almost all HPV infections come and go without ever being detected; the vast likelihood is that the person who gave it to you had no idea. But let’s say you got it from A Dude who transmitted it knowingly without disclosing or otherwise misrepresented himself to you. Even there, the incredibly shitty thing is that he lied to you, not fact that his body had germs on it. It’s not easy to do, but I promise if you accept the fact that 1 HPV infection does not equal 1 or more sluts you will feel so, so much better.
Accepting this also lets you maximize your opportunity to Real Talk Express all the honeys/handsomes that will be appearing between your legs. You’ll have read this fantastic Scarleteen article and be able to tell them in your best NPR (No Problem Really) voice how you have HPV and all the stuff you’ve learned about it and how it’s important to be up-front with other people about risks, but also that STIs are like any other illness. Then they’ll tell their friends and those friends will tell their friends and soon enough we’ll have destigmatized 80% of the world in one fragrant wave. I mean I know you were pretty upset about this before, but now you’re thinking, “Whoa, when can I get started?” I know!
Before we get too excited, APSC, let’s go back to where it all began — your abnormal pap smear results — and talk about what’s going to happen next. I totally didn’t even ask you, were you ASC-US? LSIL? HSIL? Check out this “Understanding Pap Results” chart from the ARHP or these tables from the CDC and then come back.
Thanks, ARHP/CDC, catch you guys later. So, you saw that depending on your results, there are three general options for follow-up: a repeat smear, a HPV test, or a colposcopy. We’ve covered the first two but not the last. The term “colposcopy” is defined as “visual examination of the cervix and surrounding structures,” but in practice we use the term to refer to both a “looking at things” part and a “taking a biopsy” part. A colposcopy begins just like a regular pelvic exam: stirrups, speculum. Then, we take a colposcope, which is enchantingly described by others as “a pair of binoculars mounted on a pole” and myself as “an enormous wheely microscope,” and use it to look for anything abnormal inside. We check out your cervix as-is, then we brush some vinegar on it like the most interesting salad and look, throw some colored filters on and look, and sometimes apply a liquid called Lugol’s solution and look. If at any point we do see something suspicious, we biopsy it. If we don’t, we don’t. This may be why some of your friends were like “colposcopy, more like a snoozeoscopy” and other friends were like “yo that shit hurts!” Clinicians err on the side of “let’s get a sample just in case,” because the side of “missed something important” sucks way more than the pinch of a biopsy for you and the pain of causing another person pain for us. I’ve noticed that having a good colposcopy experience has almost nothing to do with if you get biopsied and everything to do with anxiety level, so do what you need to do to relax. Since known > unknown fear-wise, beforehand you could read up on the procedure more. During, ask the provider questions or request that they narrate to you what they’re doing. Also, maybe bringing a cool friend to hold your hand? Gawwww, of course. Just let me know when your appointment is.
Okay, off to insert two IUDs at once blindfolded while getting blasted in the face with a Supersoaker.
References:
http://www.cdc.gov/hpv/
http://www.cdc.gov/std/Hpv/pap/default.htm
http://www.cdc.gov/std/HPV/STDFact-HPV.htm
http://www.cancer.gov/cancertopics/factsheet/detection/Pap-test
http://www.cancer.gov/cancertopics/factsheet/prevention/HPV-vaccine
http://www.cancer.gov/cancertopics/factsheet/cancer-advances-in-focus/cervical
http://onlinelibrary.wiley.com/doi/10.3322/canjclin.55.2.74/pdf
and of course http://en.wikipedia.org/wiki/Human_papillomavirus (of course)
Diagram especially came together from:
http://journals.lww.com/jlgtd/Abstract/2003/07000/2001_Consensus_Guidelines_for_the_Management_of.2.aspx
http://tpx.sagepub.com/content/38/1/171.short
http://cebp.aacrjournals.org/content/17/10/2536.abstract
http://www.merckmedicus.com/pp/us/hcp/diseasemodules/hpvd/natural-history.jsp
P.S. Americans can get low-cost pap smears here and here and of course here (and here!)
P.P.S. I think I might have gotten “We’re here, we’re queer, pap smear” from somewhere but I couldn’t for the life of me find where so if you know please fill me in 4 attribution purposes!
Lola McClure is deeply concerned about the care and feeding of your vagina business. Here is her tumblr.
Hooray! Thank you for posting this; it's always wonderful to read sex-positive health advice. I work on a Pap smear promotion & education campaign in BC (www.lacecampaign.com) and it's so important for ladies of all ages. Cervical cancer is the second most common cancer in women under 45 but is almost always preventable if you just get your Pap! Paps for all folks with cervixes!
Ugh, why did I look at that graph. I had my sixth leep yesterday (initial diagnosis in 1997 with 2 colps and six clear years until 2010) and now I'm freaking out a bit :/
@parallel-lines SIXTH? Girlfriend. Big hugs from Kentucky. Treat yourself, eat lots of ice cream, and fingers crossed that things get cleared out soon.
@parallel-lines Oh man, I would like to buy your vag a bottle of vodka, wine, or anything else high proof that it would like. I had one leep and went home whimpering, swearing them off for good(probably facing another if I ever call my gyno back). Ok, I'll call my gyno back now... stares at phone grumpily...
@maevemealone CALL YOUR GYNO. This has been a message from your Cervix.
@The Everpresent Wordsnatcher Yeah, thank god I have health insurance because if I didn't, who knows where I'd be right now. I feel lucky in that regard, but I'd like to have a clean pap more often than not :/
@The Everpresent Wordsnatcher I give it a day before a new 'pinner shows up with "Message From Your Cervix" as their username.
@Xanthophyllippa It cannot happen soon enough.
@The Everpresent Wordsnatcher
I cannot help but read "CALL YOUR GYNO" to the tune of Robyn's "Call your girlfriend".... Call your gyyynoooo, it's time you had the talk!
@Xanthophyllippa BAM done. I've been reading for months now and have always needed an excuse to register! My usual usernames (Dr Who related, I know, I know) are pretty much always taken.
@Message from your cervix: I love you already. Come here and let me cuddle you affectionately!
@Message from your cervix AAAAAHHHHHHH
This fits in with all of the other cervical googling I've been doing today, because I'm getting an IUD inserted today and am terrified about the pain. It won't be that bad, right? Right?
@klibberfish TAKE ADVIL! TAKE A LOT!
Mine was misery, YMMV. ADVIL!
@klibberfish mine didn't hurt toooo bad, but I did predose with Advil, and I did almost pass out (not from pain tho, just because putting these mammer jammers in hits a nerve that makes your body want to pass out).
@klibberfish It's gonna hurt, but it'll be over super fast. Did they give you pitocin to dilate your cervix? Prepare to feel sick from that if they did, but supposedly it makes insertion way easier. :)
@klibberfish Oh girl, you will be just fine! I had The Worst Reaction Of All Time (like, I freaked out the doctors and they ended up taking it back out) but with a ride home, heat pads, and lots of painkillers, I was back in tip-top shape in two days. So: make sure you have a ride home. Drug yourself up. Make sure you have movies and the number of a pizza delivery place waiting for you at home. And (this is so important!) get yourself some of those athletic heat pads. Stick 'em to the inside-front of your pants when you get home. It's like a hot water bottle that you don't have to worry about moving because it is invisible and in your pants, and it really helps with the aches! Also: DO NOT BE AFRAID TO TELL THOSE DOCTORS EXACTLY WHAT IS GOING ON WITH YOU. Do not be a tough guy. Tell them. They can help!
@klibberfish OH! and my doctors used lidocaine as a topical anesthetic on my cervix... I think that's why mine was so (relatively) easy?
@klibberfish Mine wasn't that bad! I took 4 Advil beforehand and then sat around with a heating pad on my back for a day or two and popped some more advil every once and a while. It was uncomfortable, but in a dull crampy way rather than a sharp stabby way and nowhere near as bad as I thought it would be! Whatever your experience though, it's worth it! Good luck!
@klibberfish Everyone is different! Mine was a breeeeeeze. I took 2 (or 3? I can't remember) advil beforehand, and while the insertion was weird and a little stabby, it lasted all of 15 seconds. Though I then had some dull cramps throughout the day, they were WAY less painful than my normal period cramps. I went to work right away and worked a full 8 hours, no problem. I'm sure you'll be fine!
(OH but I had a hand to hold during insertion, which helped--not because the pain was unbearable, but because I was so nervous!)
@klibberfish my (new) gyno was APPALLED that anyone (e.g. my old gyno) would insert an IUD into someone who'd never had a child without any anesthetic. If you've had a kid, I guess it's cool, but if you haven't, ask to get numbed up. It was a big pile of No Fun for me, but still worth it! Would do it again!
This just happened to a friend of mine, and she nearly puked. If she'd known, she would NOT have driven herself home. Also, I've had natural childbirth, right, and I still find it painful to have someone poke at my cervix.
@klibberfish Oh, girl. Good luck. Take a whole bunch of Advil and maybe even a drink. Get yourself a heating pad and relax. Mine hurt like CRAZY for about 10 seconds - like... almost-kick-the-gyno-in-the-face/felt-like-I-was-going-to-poop-in-the-gyno's-face hurt. ...It calmed right down, though, and then it was just dull and crampy for a few days.
Can I tell you, though? TOTALLY worth it!! You will be fiiiine.
@Are They Biting Ducks? T'wouldn't be pitocin, dear. No receptors until 3rd trimester of pregnancy. Some practitioners use cytotec/misoprostol to soften the cervix. Some use topical lidocaine to the site to numb it some. Ibuprofen works well, too.
--BitchMidwife
@klibberfish The insertion of my IUD prefaced the worst pain I have ever felt! For eight hours I vomited, cried, and had what my gyno would later describe as "minor contractions." MINOR CONTRACTIONS! If that was minor I don't want babies, never ever ever.
This is not to put you off the IUD, I've kept mine in. This is just a tale of precaution. The best things do not come without a painful horrific price.
@Sherlock Dayum, girl! You are one tough cookie. My arms immediately went numb, and I started yelling "get it out! Get it out!" before it was even all the way in. I would NOT have put up with that for eight hours...but I guess this is why I do not get to enjoy the benefits of having an IUD!
@klibberfish Seconded or tenth-ed on the Advil/Ibuprofen bandwagon. I had 24 hours of hell on the day it was inserted (Why I scheduled "Get an IUD" on the same day as "Important Work Meeting" and "Attend Midnight Showing of Harry Potter," I still have no idea). Scheduling aside, months later, it's totally worth it!
@Sherlock Oh. Well that's not comforting at all. Pray for my cervix, and my soul!
@yup. My IUD story: first doc gave me no misoprostal, no anaesthetic, it was HORRIFYING, BLINDING PAIN for over 10 minutes while she tried to jam it in there, and then as soon as she thought it was in, it popped right back out again. I cried for the rest of the day. They told me to come back in a week, gave me miso to take before I went in, the new (awesome! wonderful! reassuring!) doc gave me topical anaesthetic, it was not super fun but only mildly uncomfortable and then I was fine. I asked the doctor WHY the first one wouldn't have given me that stuff in the first place and she said "It's stupid, but there are actually clinical studies that say that taking misoprostal has about the same effect as a placebo in terms of helping with insertion. Anaesthesia is another story, however."
Good luck, @klibberfish!
@klibberfish Um ... I'm due for a new IUD, and I had no idea it was this traumatic. I got my first/current one after doing two natural childbirths in just under two years, and I simply don't remember it being awful. Will it be awful now, 9 years later? How about taking the current little bastard out? I'm ready to throw up just from these comments. (My cervix tilts backward, so even a standard pap is no picnic.)
Anyone? Second IUD for old lady? Anyone?
@klibberfish I found that reading people's internet horror stories was weirdly helpful, because I went in for my IUD insertion expecting to basically be torn limb from limb and fed to sharks. That's probably why I didn't even believe the nurse when she said it was all done - the process took all of about 15 seconds and I only felt mild pressure and some cramping (followed my worse but still manageable cramps throughout the rest of the day). That said, all the anxiety leading up to it was seriously the worst part, so try not to freak yourself out, take some advil, and it will be over before you know it! Congrats on your new uterus bling!
@C_Webb My understanding is that childbirth makes it approximately one gajillion times easier, because your cervix is used to stuff getting crammed through it. So if it was fine the first time, I can't think of any reason for it to be worse the second time.
I'm always torn about how to approach this stuff, because on the one hand I tend to get extremely freaked out by peoples' horror stories but on the other hand I was told it would be "No big deal" for both my IUD and my colposcopy and that turned out to be a complete falsehood on both counts and I felt totally betrayed by everyone who'd told me that. I think preparation is better, but I'm sorry if these stories make anyone more anxious than they need to be!
@acid burn Yes, my colposcopy was miserable. I also had two kids 2 and under when the IUD was put in, so there's the distinct possibility I slept through it. (I fell asleep having my eyebrows waxed back then.)
@klibberfish It's not that bad - seriously, don't be terrified!
My advice (not that you asked): take a Valium or Xanax beforehand (if you have some), and take the Advil that everyone in this thread has recommended. If your doctor is nice (which, everyone should have a nice OB/GYN), he/she won't mind you therapeutically screaming while it goes in (I didn't scream from pain, just from the weirdness of it all).
Have a friend or taxi drive you home (I made the mistake of taking the train, which was a Profoundly Bad Idea). Take the rest of the day off (and maybe the next day?) and spend it in bed, intermittently napping and streaming movies on Netflix. Don't strain when pooping or lift anything heavy.
I was afraid to sit down for about a week, but not for any rational reason; I just had a fear of feeling "it". Four years later, and I am completely unaware of it.
Bonus: my stepmother told me they make fabulous, conversation-piece keychains in the post-removal years!
@LilyMarlene KEYCHAINS! I love it!!!
I'm just remembering that the same day I had mine inserted (which was soon after my 4th miscarriage in a single year, and I was still struggling with The Sad) some asshole pickpursed me and ran up about $600 on my credit cards, which I contested and got back, BUT STILL!!! whatta day. Thank god for my girlfriend who met up with me shortly before it happened, then took me home and did my nails and let me cry.
@Are They Biting Ducks? My doc had me come in on the heaviest day of my period, because apparently ye olde cervix is optimally dilated then anyway? It was a bit awkward to be Niagra-Falls-bleeding all over the doc, nurse, table, instruments, walls, ceiling, floor, etc. while they were rummaging around down there, but I guess you don't go into that profession without expecting to see some carnage. :0/
@teenie OH FOR FUCKS SAKE. Mad, mad hugs, for all the many sads in your story. May the pickpurser be poked with an IUD in his sensitive bits for punishment, and then have to pay for the experience with his own damn credit cards. >:0/
And yes, thanks be to the universe for girlfriends on those (and every) day(s). :)
@C_Webb No advice, just a *high five* from the retroverted cervix club, which is a literal pain in the ass in these circumstances.
@LilyMarlene Seriously. I totally hoped that childbirth would sort of sproing it back in the right direction, but there was no sproinging. Rats.
@klibberfish
So, does this mean that if I am scheduling an IUD, I should schedule it the day after my root canal, so that I'll already be taking prescription pain killers? That seems like a great idea, right?
@klibberfish I had no misoprostol, no anesthetic, took two Advil an hour beforehand, have never had kids, had a uterus *barely* big enough to accept the IUD, and did fine. (Mirena, btw, not copper.) Five seconds, tops, of the weirdest stabby feeling ever, not exactly pain but not comfortable, and it was over. I had very mild, forgettable cramps for about six hours afterwards.
The strange part was feeling the arms of the IUD unfold in my uterus. That was totally not painful, but odd--I sensed the exact dimensions of something on the inside of something on the inside of my body. Cool!
I did almost pass out when I sat up, but that was from relief. I had been expecting much, much worse and was thrilled it was so breezy. BE NOT AFRAID.
@Mingus_Thurber I didn't read your comment until after my insertion, but I am happy to report that my experience was similar! I took 800mg of ibuprofen ahead of time and then was absolutely fine. I felt crampy when the doctor clamped my cervix (weird) and then felt some pain, but really more of a weird, "I've never felt anything quite like this" feeling. Like I was saying things like "Huh" and "That's different" in a curious tone, and then she said, "You are the proud owner of a Paragard IUD!" and I literally asked, "Wait, it's in me? It's over?" Then I laughed out loud because I had been SO worried about it. Then I got a McFlurry.
@klibberfish Yay! Glad it went well and thanks for following up!
@LilyMarlene This is exactly what I did. Except I holed up in a hotel and had some wine as well. Except for the cramping, it was a nice mini-break.
@klibberfish I took no painkillers beforehand, felt about three seconds of "whoops, you're sticking something up my cervix!" vague-crampiness, and Bob's yer uncle. I had no idea until reading this thread that IUD insertion was such a problem for ladies.
@everyone - sorry to keep this going, I've made the executive decision to have my IUD taken out after my wedding later this year due to: seven day (or longer) extremely heavy and crampy periods, periods every two weeks, constant cramping, loss of libido and yeah, bleeding for half the friggen month. Is it as bad on the way out as it is on the way in? Because oh lord, I really don't know if I could take that again....
@parallel-lines After my numb-arms, soaked-in-sweat nightmare of an insertion, I made them take mine out and it was a breeze! You'll barely feel it, don't you worry!
Nice timing, I JUST came back from my annual gyno appointment, complete with pap smear partytime. I always ask a million questions and my doctor talked a lot about the same stuff you do, Lola - thank you! Open and un-scary conversation about women's health for all! The more widespread this type of info is, the better.
I want to be this Lola person when I'm all growed up and out of nursing and midwife school. I shall now devote the next several hours of my non-productive workday to dissecting her tumbler. Thx.
@teenie Meeeee toooo--I keep thinking of steering towards women's health, I hope I can be an eighth as awesome of a nurse as she is here.
@parallel-lines DOOOO ITTTTT I've never wanted anything (vocation-wise) as much as getting into women's health.
this gurl is funnny.... from her tumblr:
me: have you ever been pregnant before?
patient: yes. i had a magical abortion.
me: (all-accepting all-receiving show-nothing slow nod aka “the doc nod”)
patient: …the kind with the pills…?
me: oh. medical abortion!
patient: yes!
me and patient: hahaha
me: i am going to be honest, i have never wanted to correct a patient less in my entire life.
@teenie (I think I sort of know her in a friend of friends way. Small world!)
@teenie Ha! That is awesome.
@teenie Wait, where is the tumblr? I want to read it all!
@fabel it's in her byline, above...
@parallel-lines @teenie you guuuuuuys. thank you. i highly recommend joining the speculum squad. ! what's your connection, @parallel-lines? you live in nyc, right?
@Lola McClure Indeed I do (Brooklyn). We share a couple of friends who have inhabited a certain apartment on Broadway at various points in time and I think we might have met briefly at a party there a few years back--you told me about school (I was pre-PA at the time, have moved to nursing since then for a great many reasons). I totally didn't make the connection until I saw your blog and recognized one of the aforementioned folks. I hope that wasn't totally creepy (uh, it was) but I'm glad you're doing well and this article is aces. Congrats on school and all the good things going on in your life.
@teenie Oy yeah, I see it now! Thanks
It so happens I did like the little bowties, thanks for asking!
@leastimportantperson That raw intuition of hers is good!
@leastimportantperson Bow ties are cool.
Thank you for this! I had a Leep last year and an insensetive gyno who told me "this is what you get for having sex with so many people". I switched gyn's and upon talking to my friends, realized half of them had gone through the same thing. I found it hard to find coherent information on the internet all in one place...and will def. be bookmarking this.
@Chuck Bass I hate people like your old gyn. Seriously, report them. That is bullshit and mathematically flawed (see: you can have sex with ONE PERSON and get HPV).
But seriously, you can report them. DO IT.
@Chuck Bass I broke up with a gyno for less than that - during one annual she asked, "So just how many people did you sleep with THIS year?" I don't know, all of them? When I answered five she made a snide comment about how age is slowing me down.
@parallel-lines I hope you were like, "I'm sorry, I can't keep seeing a doctor who is so embarrassingly jealous of me."
@Chuck Bass OMG, are you fucking kidding me?? That is so appalling.
I guess I've just been lucky with medical providers.
@Chuck Bass @parallel-lines WHAT? That is appalling. I don't know that I would have been able to restrain myself from setting those people on fire.
I got told the news about my initial abnormal results/HPV by some tech from my GP's office over the phone while I was in the car, late to work. GUH. That was a less-than-fun day. Thankfully I got to work (in tears) and told my boss what was going on and she immediately recommended her gyno, who is AMAZING and supportive and calm and absolutely not into anything even remotely close to slut-shaming.
@Chuck Bass My BFF went to the doctor, who was asking her the barrage of "Do you smoke tobacco or marijuana? Do you drink? Do you do drugs? Are you sexually active?" and she responded "no" to all of them. So her doctor SNORTED and said "God, you're boring."
@The Lady of Shalott WHAT?? WTF is up with judge-y doctors I can't even??
@Chuck Bass Every one of you women who have been told demeaning sexist bullshytte like this needs to report the MD to their medical societies - if they are board certified ob-gynes it would be ACOG (American College of Obstetricians-Gynecologists) and the licensing board of their state. If more women would actually file complaints it might make an impact. There are still plenty of old white male OBGs out there spouting this crap. They have NO business in women's health. (Some female OBGs might be this way, too.)
@Chuck Bass good advice-but to clarify, they'll want to also contact ABOG-the american board of obgyn. ACOG is voluntary, but does a lot with patient advocacy; ABOG is the board-certification, which can be revoked.
@Chuck Bass UGH that is so shitty. My first gyno was terrible, and then she left the practice where she was and opened her own office, and so when I called to make an appointment they were like, oh I can give you the new phone number, and I was like, NOPE JUST GIVE ME AN APPOINTMENT WHEN LITERALLY ANYONE ELSE. And amazingly I got really lucky and ended up with a really cool (male) doctor who is super nice! It sucks that shitty people are allowed to be obgyns at all.
@sophi Oh god all of these are awful. I could seriously wax poetic about how much I love my gyn (she is BADASS and I'm convinced that she's God's Gift to Humanity), and now I'm wondering about the etiquette for sending brownies/cookies/thank-you cards to your gyn for a routine pap? Because I want to bake everyone in her office cookies and brownies made with love and ALL the chocolate.
I had my first pap a few months ago (I was so flipped out that I was afraid of going and just didn't), and everyone was super cool. I didn't want to know how much I weigh? No biggie, just turn around. I had a panic attack and needed to pop an Ativan? No problem, let them know if I need some more water. Abnormal pap? "Come back in 3 months. It's probably inflammation but we'll check you for HPV because it's routine, don't worry." Number of sexual partners was not asked. When asked if I was sexually active, I was like "um, I'm gay, so, um, what are we defining as sexually active, and um?" and the nurse was like "So I'll pull a really small spec," and it was done.
God almighty, my gyn is awesome. I want to make her office baked goods and write her thank-you notes because seriously, asskickery of winning.
@sophi my gyn opened something called a medispa next to her office that does like...laser hair removal and "women's wellness" stuff (???) and her office is plastered with advertisements. It makes me a little uncomfortable/kind of respect her less as a physician. Though, she does have these knock off Fraberge egg things called "MY LAST EGG" with some terrible poem scrawled on them. I almost bought one for my mom.
@contrary "Let's remove all of your body hair. Now step into the office next door for your annual pap!" Ew. Right?
@S. Elizabeth YES, EW. I don't really love my gyn/the other physicians/nurses in the office but I'm afraid to switch. They have never said anything rude about sexual partners or anything like that, but they habitually switch shifts/charts/whatever so I go in thinking I'm going to show my vagina to one person and end up showing it to another (sometimes a stranger?) Also, recently when I went in for my annual, they forgot I was in the room and left me sitting there without underwear for over an hour (this was one of the times a got a stranger doctor, too!)
@Chuck Bass WHAT??? Punch him/her/it in the junk and begone! And report them, too. Although, I'm sure neurosurgeons tell brain tumor patients all the time, "this is what you get for having all those thoughts, geez."
My most favorite OB/GYN ever was an kind, old, white dude who was an ex-Marine and slightly resembled Santa Claus (not as creepy as it sounds, promise). I went to him after having a really awful one-night stand, demanding to be tested for everything under the sun. Expecting to be branded a whore and burned at the stake, he actually said that if I didn't find one-night stands emotionally traumatizing, it's fine to keep on going (safely); but he also gave an honest explanation of the potential risks in a non-shame-y way. But he probably killed people with his bare hands in his previous career, so the looming biological threat of multiple randoms' penii probably doesn't intimidate him.
@The Lady of Shalott: I would actually like that doctor, because when they ask me all those questions and I say "no" to each one, I then punctuate it with a deadpan stare and a flat, "Yes, I'm boring."
Then again, under "form of birth control" on a GYN form I once wrote "my personality," so perhaps I'm not the best judge of medical appropriateness.
@Xanthophyllippa "my personality"- YOU ARE AMAZING. I really hope your doctor appreciated that (if they didn't DTMFA?)
@contrary Once she got the joke, she did. She said, "oh - that's what I THOUGHT you meant, but some tiny part of me thought it might be a new drug."
@Xanthophyllippa You are my new favorite person.
@S. Elizabeth Your gyno sounds great! Hooray! My gyno is a very kindly olderish dude who is JUST AWESOME and extremely calming (such a fantastic trait in doctors in general) who is fantastic in pretty much every way. After I got my HPV/abnormal pap from my GP and went in to my gyno to get secondary testing and such, he sat me down and made sure that I understood that this does not mean that my boyfriend cheated on me, these things can be in your system FOREVER, he doesn't want this to ruin me/my relationship/everything...it was great. Hooray!
@everyone who is hunting for a new gyno: GET RECOMMENDATIONS if at all possible. Seriously. Ask coworkers, friends, random ladies on the street. It is so much cheaper/less traumatic than finding a random place and getting a pap and hopefully clicking with them.
@The Everpresent Wordsnatcher *bats eyelashes*
@The Everpresent Wordsnatcher I feel like we all need to post our cities and gyno recommendations somewhere. Edith, anonymous pinner forum for the lady health???
@S. Elizabeth YES. Seconded!
@Chuck Bass I've gotten weird looks from gynos after admitting that I haven't had sex with anyone in the past year. They're all like, "what? really? how is that possible?....*pitying stare.*" I also hate how they ask "are you sexually active?" I just want to be like, "with another person, or just in general?"
@The Everpresent Wordsnatcher Weirdly enough, the nicest gyno I ever had was a middle aged man. He was so kindly and non-judgey and FAST (most important trait in a gyno). I usually have women gynos and they have ranged from brisk/impatient to judgmental, to rude, to semi-brutal. I wonder why that is (probably something to do with patriarchy).
@WaityKatie I would LOVE it if you came back with that. Or with something like, "Well, I do spend a lot of quality time with my dildo, so yes, I guess I'm sexually active."
I did. Also: said gyno always wore a bow tie!
I work for a health publishing company, and I'm so so glad that we now use the term Pap test in our copy--it's tricky to convince women it's a good idea to subject themselves regularly to something involving the word smear.
@SuperGogo One other thing to add that I tend to hear a lot about because of my job: testing frequency guidelines. The American College of Obstetricians and Gynecologists updated their guidelines recently. They now say you can wait until 21 to start testing, even if you've already been sexually active for more than three years by then. Also, most women younger than 30 can now be tested every other year instead of annually. Those older than 30 can be tested once every three years if they have had three consecutive Pap tests with normal results. Women at high risk for cervical cancer may need more frequent screenings, though. In short, don't assume you have to get it done annually and ask your doctor what your frequency should be.
@SuperGogo Have you heard anything regarding sexually active vs. non-sexually active testing frequencies? I've been told conflicting things by two primary cares - if you've never been sexually active (even in mid-20s), don't worry about it/it doesn't matter if you've ever been active, get yourself a yearly test. It's very confusing!
@@serenityfound I don't think there's official recommendations one way or the other for 21+ but not sexually active. But it make sense to me that testing is really not needed until you've had intercourse. Even if you've been exposed to the more harmless varieties of HPV (i.e. the wart-causing kind) via oral or genital contact, it's going to be very tricky for HPV to end up on your cervix without penile or toy penetration. But I'm far from an expert or qualified medical-type person, so I would have to say your doctors' advice is the way to go...conflicting though it may be!
Ah, thank you! This was just the push I needed to find a gyno out here as opposed to avoiding it past my annual's anniversary. Excellent timing, as always, The Hairpin!
@hulia Having a gyno at the ready is always a good idea, but if you've had normal test results in the past you may not need annual testing (see my comment above).
@hulia Any of you now inspired to find a gyno might want to look for a women's health care practitioner (nurse practitioner) or NURSE MIDWIFE. Family or adult nurse practitioners also do Pap tests and well woman gyne exams. These providers are more woman-friendly and more likely to teach you about what's what.
--BitchMidwife, CNM
@SuperGogo Yup, I did know that, but unfortunately, this article is more relevant than I would like, so I'm on the annual schedule. It's a good point to bring up, though, that I was surprised by when my gyno told me about it before.
And @BitchMidwife, a good point as well. It also helps to remember that if the first provider I find (be it a gyno or a nurse practitioner) is not for me, I have zero obligation to go back.
@BitchMidwife And can I add that what matters in Pap tests is how often your practitioner does them? It's a matter of practice. Many OB/GYN MDs don't do that many, relatively speaking, and thus have more chance of missing transitional zone cells and other stuff you want to show up on your Pap.
The tl;dr of this is CNMs, NPs, and women's health RNs FTW.
I created an account just so that I could comment on this. Thank you, thank you, thank you!!! This kind of information is so important for women to have. I only wish that it had existed when I woke up one morning two years ago and was totally convinced that I had an STD. I went through all of the "I will never be able to date/have sex/get married/I am dirty/slutty/disgusting" stuff and had absolutely nowhere to turn. Turns out that it was just some sort of irritation that "happens sometimes" (I was sure it was genital warts). The whole experience made me want to go into women's health so that I could do things like this for ladies. Thank you!!!
This post is awesomeee, the doctor I have is great, but I find myself trying to relay information like this to my friends whose gynos aren't as great. Now I can just send them this!
Lola, I loved this and/but can you talk about how some strains of HPV cause genital warts (if I indeed have that correct) and does that also potentially link to cervical cancer?
@sox She says above: "So, the 'high-risk' HPV strains are high-risk for causing cervical, anal, etc. cancers and the 'low-risk' HPV strains are low-risk for causing cancer but are responsible for causing genital warts. The cancer-y strains don't give you warts, and the wart-y strains don't give you cancer."
@SarahP Oh, right there. This reminds me of the time I ruined pork carnitas because my eyes managed to be blind to the sentence where it said to cover the meat with water before you cook it on low for two hours and I couldn't for the life of me figure out what I was doing wrong...
In that case, Lola will you promise to come back again and write about more women's health topics? Pleeeease?
Thank you, thank you, thank you for this. I knew I had HPV, but am still freaking out about my abnormal Pap results (LSIL) and upcoming colposcopy.
@AliGator Deep breaths! When's your colp?
@AliGator I've had two of them--definitely not fun, but I promise not as bad as it sounds. If you think you might get too anxious, sometimes the doctor doing the colp will be willing to give you something nice (like a Valium) for it.
@The Everpresent Wordsnatcher I'm waiting to hear back from PP about it. They called Friday with the results, and said they'd be in touch this week.
@applestoapples Thanks. :)
@AliGator Keep us updated! And HELLS to the yes on the Valium front--I didn't have any for my colp, but when they told me I needed to get a LEEP (removal of some of the cells on your cervix) done, I told them I was anxious/freaking out and boom, Valium scrip! It made all the difference in the world, highly suggested if you're worried!
@The Everpresent Wordsnatcher Will do! Thanks again for the support...
@AliGator My gyno recommended bringing an ipod during my LEEP and it totally helped me relax during it. However Kanye's first album now makes my vagina cringe, so you take the good with the bad.
@nevernude cutoffs OOH! Yes, I forgot about this! I also brought an iPod during my LEEP with David Sedaris's Live at Carnegie Hall loaded into it. Ordinarily: fucking funny. When you're high on Valium: EVEN MORE FUCKING FUNNY. I giggled all the way through my LEEP. Also highly recommended.
@AliGator One thing no one mentioned to me is that your cervix can flip out and have this weird reaction to being poked and biopsied. I forget what it's called, but your blood pressure drops really fast and you can pass out. Happened to me, and I luckily had the best team to help me out. They wouldn't let me drive home and I couldn't get anyone to pick me up, so the doctor ended up driving me home! Anyway, all that is to suggest that you have someone drive you to the appointment in case it happens. Better safe than sorry, and it's always good to bring a friend along :)
@beaniebeans A vasovagal reaction? I got a little swoony during my IUD insertion and I think that's what they called it.
@beaniebeans Yes, please have a ride. Especially if you end up with some delicious delicious Valium! That stuff is awesome but I have no business driving whilst on it.
@The Everpresent Wordsnatcher That is hilarious. I'm going to check that out.
This article was fantastic. Thanks to Lola for writing it and the Hairpin for running it--you all rock!
LOLA. You are amazing and I wish this had been around a year and a half ago when I got a phone call telling me I had abnormal pap results and HPV and I freaked.the.fuck.out. (Procedure for me went: pap, abnormal results, second pap within a week or so, STILL abnormal results, colp, biopsy, LEEP within a couple months, clear margins, pap every three months for a year, and now I'm up to a pap every 4 months with my next one in February. Good results from all so far!)
I didn't know ANYONE who'd dealt with that so I was absolutely terrified. Wish this had been around!
And to my fellow APSC-ers, big hugs, love to all of you. It is not fun but at least we're not alone.
@The Everpresent Wordsnatcher Yes it is horrible. Horrible!I went though it too and I kinda thought I was over it and now I am left with a horrible fear about anal cancer. I mean in the article about it says HPV can be transmitted non-penitratively and then they talk about bum cancer ... and how would you ever know? Does anyone know anything about that? I don't need a new fear I really don't!!!!
@The Everpresent Wordsnatcher I needed this when I got my results!
Good luck with your tests and I am sending out big hugs!
And like sugarmagnolia, I signed up expressly to comment on this. Thank you again, Lola.
You had me at an "enormous wheely microscope.”
I'm so glad you exist in a world of gynos who slut shame and get exasperated when you cry. You are awesome!
I couldn't love this more! I love this Lola. I love the cervical bowties. I am also a APSC member, of the abnormal pap/negative HPV variety. I see my gyno a lot for paps (every 6 months for the last year and a half) and have had 2 colposcopies too, but aside from the fact that doc appointments are rarely ever exactly fun, my gyno RULES so I don't mind too much. They just keep saying it's low-grade and we keep watching it. I cannot believe the horror stories from people about the horrifying doc experiences they've had. So infuriating that that exists.
I LOVE THIS.
More Health columns, preferably by Lola, please!
Can we talk about HPV as a pre-existing condition? Anyone else lied/been denied?
@TooCool4School ME. I had an abnormal pap/colposcopy earlier this month and I got a letter from my insurance company (BC/BS) basically saying "oh! we see you had an abnormal pap! you better prove this isn't a pre-existing condition or else we won't pay for anything! muah ha ha!" soooo i have to have PP send over all my medical records saying I didn't lie on my insurance application. I'm pretty worried about it.
@eristotle I think I'm going to a planned parenthood for my next pap and have it be "off the record" until im clear. INSURANCE HERE IS THE SCARIEST/WORST
This is so, so, so great AND USEFUL.
I wish this article had existed when I got diagnosed. My GP called me on the phone, did not ask "Is this an okay time to talk," and then proceeded to tell me that I had an abnormal pap and HPV, WHILE I WAS SITTING IN A CAR FILLED WITH PEOPLE. I said (pushing the phone to my ear as hard as possible so that my friends wouldn't hear what she was saying) "Um. Okay. Can I please call you back another time because I have some questions but I don't want to get into it right now?" and she acted really annoyed and told me I could call her back at exactly 5pm the next day because that's when she would be done with appointments.
The next day she told me: I needed to have a colposcopy IMMEDIATELY (not strictly true). I asked her if it was dangerous for my boyfriend and I to have sex without condoms (I'd just gone on the pill) and she told me that if we did that we'd just keep re-infecting each other over and over again (completely untrue). She told me what I had were pre-cancerous cells (way to phrase that in the scariest way possible). And some other stuff I can't remember but that also turned out not to be true.
When I went in for the colpo, terrified and confused (I BASICALLY HAD CANCER) the gyno was incredibly unsympathetic and when I told her I was really confused about how I'd gotten it due to my extremely boring sex history, she told me "This is very common among young people because of all the promiscuity." Instead of screaming "I'M NOT FUCKING PROMISCUOUS AND EVEN IF I WAS, WHO THE FUCK ARE YOU TO JUDGE ME" in her face, I let her snip off a piece of my cervix and (to her annoyance) sobbed quietly for hours because the pain was the worst thing I had ever experienced. And then six months later I was clear, buuuuuuuut I was still denied health insurance because having ONE abnormal pap EVER qualifies as a pre-existing condition!
Can you tell I'm still angry about this experience, over three years later?
SET HER ON FIRE.
@Nicole Cliffe I just want to clarify, there are actually TWO DIFFERENT terrible doctors in that story. FIRE FOR EVERYONE.
EVERYONE. I fired my first Utah ob-gyn after he did my breast exam through street clothes while looking away, and told me that I needed to have babies right away or I would never be able to because of old eggs (I was 26). Why do people who hate women and sex become ob-gyns? Now I have a bitchin' care provider, who I love.
@Nicole Cliffe Christ! I've actually just this year started pursuing nursing school for the express purpose of becoming an awesome, non-hateful ladyparts expert like the author of this article. SOMEDAY!
@acid burn blerrrrghhhh....this is not making me dread finding a new ladydoc ANY LESS. I have a recommendation from a friend but I am afraid to call only to hear that her practice is full... :(:(:(:(:(:( DREAD
ANYWAYS. I have never had an abnormal pap but I once got a call from the lady doc and they were all LOLOL YOU HAVE A YEAST INFECTION, over the phone, while I was on vaca. I was too too too embarrassed to ask my friend with the car to drive me to the drug store :-| (Also 28 and never had a yeast infection before = weird or awesome?)
@phipsi Awesome. I got my first one when I went on antibiotics for an ear infection. Lovely and horrifying at age 18. Also, who gets ear infections in college instead of 1st grade? This chick.
@S. Elizabeth Don't worry, honey; a lot of perfectly nice people started out as late bloomers.
Also, 37 and never had a yeast infection. Thank you, cranberry juice!
@Xanthophyllippa Cranberry juice is for UTIs. Yogurt is for yeast infections.
@S. Elizabeth Yeah, I knew I got something wrong there. I'm excusing myself because 37 and never had a yeast infection. Booyah!
@S. Elizabeth That sounds like a nightmare. Ear infection plus bonus yeast infection? Blergh.
@S. Elizabeth I managed to get an ear infection AND pinkeye at the ripe ol' age of 24. REPRESENT.
@phipsi IMPRESSIVE!
I'm really grateful for articles like this, because I get really weird psychosomatic sex anxiety basically, where after getting it on with somebody new, I get really itchy in certain places and spend a whole lotta unnecessary time with a mirror freaking out about the tiniest little not a big deal freckle that "wasn't there before"
thanks catholicism! (I'm gonna blame catholicism for this one)
i'll still feel relieved in april when i have my final hpv shot.
@redheadedandcrazy You're justified. Catholicism hates people with ladyparts. But you knew that.
@redheadedandcrazy Catholicism did the same thing to me; so don't worry, we're both crazy!!
@redheadedandcrazy YES. i would like to share something my friend noah wrote about growing up catholic that i found instructive: "every single person i know who was raised catholic suffers from extreme guilt and will never accept that they're intrinsically valuable and none of them are still catholic. it really is like giving your child a disease on purpose."
Hooray for this article, and an addendum on HPV: See your dentist twice a year for an oral cancer screening, please. The same strains of HPV that cause cervical abnormalities can also cause abnormalities in the tissue in your mouth. Trust me, you do not want to end up with bits missing out of the inside of your head.
@Mingus_Thurber ohhhh great another reason to be terrified of going to the dentist!
@Mingus_Thurber Yes. HPV increases risk of head/neck/oral cancer in those who have oral sex - BOTH men and women! It is MUCH more treatable if caught EARLY.
@Mingus_Thurber Crud, now I gotta go to the dentist. (After becoming a member of the APSC, I am the most annoying person in the world about GO TO THE DOCTOR GET A PAP SMEAR EVERY YEAR NO EXCUSE, so I would be a bit of a dumbass/hypocrite if I didn't go to the doctor for the same reason...)
@BitchMidwife Yep. Been there, done that, look like I've been attacked by the one zombie who flunked anatomy. My soft palate and half my hard palate are missing and I wear a prosthetic.
THAT SAID, and boy did that year suck rocks beyond belief, if my hygienist had not seen the bump on the border of my right hard palate, I would have been much, much worse off. I needed no radiation, just surgery, and am fine and dandy now. Except that I sound like one of the adults from the Peanuts cartoons if I don't have my prosthetic in.
Go to the damn dentist is what I'm saying. And if you're younger than 27, get the freaking HPV vaccine.
Ahhh!!! I have had so many abnormal paps. And then I've had biopsies, and HOLY SHIT THEY HURT and I always pass out afterwards. But pro tip: coughing as they snip off your cervix helps with the pain (I swear). So anyway what I was told is that being a smoker can lead to abnormal paps - I used to be a heavy constant over a pack a day smoker and I was also having lots of sex at the time but once I quit smoking the paps stopped being abnormal. Either, the HPV cleared or smoking really lead to a false positive. Anyway I do want to get Gardasil but I ain't sweating it anymore because my last few paps have all been fine. /storytime
@kneesup I second the coughing tip, which was recommended to me by my awesome gyno. Another one she swears by: push down on your abdomen about halfway between your belly button and bikini line while they give your cervix The Business. The more yooooou knoooooooww...
Thanks for writing this! After reading this and your blog, I've decided that you are thoroughly hilarious, and, as a future nurse, my new idol.
@heyad :')
This is very awesome and informative, but only serves to remind me that I have to find a new OBGYN/lady doc in the next few months. DO NOT WANT.
I just, just, literally just twenty minutes ago got a call from my gyno's office that was like "your Pap be abnormal, yo. You know you got an appointment tomorrow, right?" Which I didn't. And I am all of twenty and got HPV in the most screwed up way and I am so irrationally terrified right now but this has made me feel better. You are the best, Lola.
@SaltMoon i want to go to your gyno - if my doctor called me and said things like that? I'd be stoked.
@teenie My gyno's office is full of seriously chill people. Also they never make you wait more than a week for an appointment, which is apparently rare?
@SaltMoon Your gyno is Santana from Glee? I'd be down wi' that.
@Xanthophyllippa The only straight she is is straight up bitch.
I think this article is great and I so don't want to be the "THAT'S NOT WHAT I HEARD" lady, but a friend of mine had cancer in her peritoneum this year as a result of (wartless) HPV, and she'd never had a bad pap; they discovered it because her gyno thought her episiotomy scar looked weird and sent her for a biopsy. Luckily they found it in the earliest stage, but that scared the bejeebus out of me.
@C_Webb Again, not trying to be a pill, just wondering if Lovely Lola has any info on this pap-evading possibility?????
@C_Webb whoa i'm so sorry to hear that! i'm glad they caught it early. no pill taken, it's a valid question. it's entirely possible that she is one of the very few exceptions to the rule that cancer takes a long time to develop; they do exist. i honestly don't know too much about peritoneal cancer.
Okay, read about 3 paragraphs so far, and jumped down to say, this is great! So funny! AND, thanks, I will, today, call to schedule my annual exam, which I have been putting off.
@lue And, Lola, I love you, can you also sometime tell us what the fuck we're supposed to be looking for when we do self breast exams? Because once at my annual the woman asked if I drink a lot of caffeine (yep) and she said, "Yeah, your breasts are really ropey." So many bumps and things in there! What the hell is a 'lump'?!
@lue i'm so psyched i inspired you to pick up the phone!! ahhh what an honor okay boob education time.
"ohh you don't know what you're supposed to be looking for with your breast exam? hm, guess someone doesn't really DESERVE their boobs. thanks for your comment!" just kidding normal healthy boob-consistencies vary so widely that best answer is: CHANGES. you're lookin for changes.
normal boobs are fundamentally lumpy, bumpy, textured, ropey as you were so kindly informed, etc. you can have one lumpy boob and one smooth boob. you can even have distinct lumps and bumps that are totally benign (google "fibroadenoma" or "fibrocystic changes") what the self breast exam does is teach you what "normal boobs" feels like for you so that if anything changed, you'd be aware of it. so think more like "oh, that's not my normal weird bumpy area at 3 o'clock in my right boob" as opposed to suddenly, whoa, golf ball. lumps are one thing that you should be thinking about as an early sign of breast cancer but here are some other signs: http://ww5.komen.org/BreastCancer/WarningSigns.html
So... can forgetting you have an appointment scheduled and having penetrative sex the night before (with no barrier because yay IUD) lead to an abnormal pap smear?
@mustelid I know it can lead to weird test results, but I don't presume to know more than that/why that is. Lola! We have a question here!
@The Everpresent Wordsnatcher @mustelid
at your service!
i couldn't immediately find good evidence about this but i'm going to give it my best shot. the thing about the pap smear is that it's not a lab test where you put a sample in a special little machine that says yes/no in a chilling computer voice. we ship your sample to a real live nerd, who sits down at a microscope, looks at the cells, and writes the report.
my thinking is that having blood/jizz/booze/old encyclopedias in your vagina when you got a pap smear might interfere with the accuracy of the test by preventing the nerds from seeing what they need to see. but i don't think that if the nerd sees sperm they're going to be like, "oh god, this is the most unique case of...cervical dysplasia...i've seen...is it sentient" although their glasses might fog. my thinking is that the report would come back not "abnormal" but "equivocal," or "unsatisfactory for analysis," and then we'd re-do it.
here's the cancer.gov answer to the question "When is the best time to have a Pap test?"
A woman should have this test when she is not menstruating; the best time is between 10 and 20 days after the first day of her last menstrual period. For about 2 days before a Pap test, she should avoid douching or using vaginal medicines or spermicidal foams, creams, or jellies (except as directed by a doctor) because they may wash away or hide abnormal cells. After the test, she can go back to her normal activities and return to work right away.
@Lola McClure My crush on you deepens. Thanks for the answer, this is fantastic!
@Lola McClure DAMN. I was going to go for a physical tomorrow, but I just put in a new set of old encyclopedias earlier today. Good thing you warned me!
@Lola McClure Thanks Lola! That clears up my confusion.
Oh, Lola, I'm throwing off my lurker hat and posting for the first time to say THANK YOU on behalf of all women who have been balls of anxiety over this. Although I've been in for an annual pap as long as I've be sexually active, I recently had a HSIL pap, a colpo with biopsy (revealing CIN II), and a successful(!) LEEP. I knew of only one friend who has ever had an abnormal pap, and I felt incredibly isolated and embarrassed to tell anyone. I finally gathered the courage to tell someone other than my incredibly supportive boyfriend, and for my efforts I got a "Oh no, I'm so sorry...but I don't think *I* could get HPV" from two friends in long-term monogamous relationships. Not helpful.
But you, so helpful!
Oh, please say you'll do follow-up post about LEEP.
@categoricalimperative Fuck those "Oh, how horrible, *I* could never get *that*" types. Seriously, they can go fuck themselves (alone, monogamously, without any viral issues).
@S. Elizabeth Totally agree. Your friends were being "captain fuckhats".
@S. Elizabeth They won't have any viral issues, but they'll go blind and grow hair on their palms.
@categoricalimperative !! so welcome. also, fuck those friends! thanks for going through that then so that i may appreciate the term "captain fuckhats" being brought into my life today. congrats on yr successful LEEP.
@categoricalimperative Captains Fuckhats indeed! You tell them that I got HPV after--*calculates*--FOUR YEARS of long-term-monogamous-etc-relationship. And then you tell them to set themselves on fire. And then you tell them...drat, I don't know what else to tell them, but it won't matter, because they'll be on fire.
Congrats on a successful LEEP! High five!
@Lola McClure @S. Elizabeth @Over_It Thankfully, there were other friends I eventually told who offered unequivocal sympathy.
There should be a fuckhat emoticon, a variation on the dunce cap one: <:X
@categoricalimperative Yeah, I just want to smack people who pull that shit. You know what? Stigma is for bullies and bigots. Nobody would be a juicebox if you had the common cold, or the stomach flu, or some sort of itchy skin thing but SHUT THE FRONT DOOR, if you have this certain type of virus, obviously there's something horrid. HORRID.
Let's be really clear with the bigots and bullies of the world:
a. A virus is a virus is a virus. Some are deadly, some mutate quickly, one killed a bunch of lovely brilliant beautiful gay men in the 1980s-1990s (and still kills them and still kills others), some go away with a few days of watching TV on the couch waiting for the stomach bug to go away, and some cause cervical cancer, and some do other shit, and some go undetected, but they're all viruses. It's science. The differences between them that aren't related to epidemiology have to do with what we think of the bodies of people that carry them around, and judging people because of a virus they carry is dumb as shit. Seriously, a human being's beauty and worth should not be determined by microorganisms or infective agents. That is bullshit logic.
b. Adults have sex. Okay, not all. But generally, sex is one of those facts of life. Guess what, bullies of the world? Sex is an AWESOME way to transmit any type of virus, including the ones that give you the 24 hour stomach bug. You are in close proximity to another human being and they are breathing all over you and stuff. So judging someone for getting one virus over the other when we can say for hypothetical purposes that everyone in the scenario is having sex is dumb as shit.
c. Judgment doesn't kill a virus. So stigma doesn't help anything, except becoming bullying, bigoted juiceboxes.
See also: The Best Time I Figured Out Abstinence-Only Sex Ed was a Crock of Shit.
See, bigots and bullies? You all suck.
@The Everpresent Wordsnatcher I was made speechless by both and could not squeak out a proper riposte of "But you could...Any day, really..." People will say the most impolitic things to allay their own fears.
From your comment below, can I safely assume you're in the clear post-LEEP as well? I hope so!
@S. Elizabeth xoxo, YES. I waited too long to delurk.
@S. Elizabeth Teach it like you preach it S. Elizabeth! Damn.
@contrary Sometimes I deal with my frustration issues by going batshit on the 'pin and ranting. I'm glad some people think it's charming. Those who don't find it charming can shove it.
@categoricalimperative Yes, clear and healthy for over a year now! HOORAY.
@S. Elizabeth YOU ARE AWESOME.
@The Everpresent Wordsnatcher YOU ARE AWESOME.
@S. Elizabeth :D
Oh man, thank you for this article! I found an incredible gyno last month who explained all this to me because for some reason I was tested for HPV? I'm way too young for it and she was surprised that I'd ever been tested at all. Anyway last year I had an abnormal pap and then this year I cleared out and she had to explain what it all meant and why I could take the paper bag away from my mouth and breathe at a normal rate again. LADYPARTS, amiright?
@Diana you are welcome! if you don't mind my asking, did you get the hpv test after yr abnormal pap? that's a pretty standard option for people younger than 30 to figure out if the abnormal pap was caused by a current or past infection. otherwise...gynecological unsolved mysteries
@Diana How young is too young to be tested for HPV?
@Lola McClure Oh God - this gave me the most unholy image involving Robert Stack, a speculum, and that sonnnnng...!
@LilyMarlene a-ha, then my work is done here. **fades into sparkles, then mist**
Having gone through the WHOLE experience over the course of 3 years and being told I had CIN2 the next steps were colposcopy tests. Finally ended up having laser treatments to finally clear all the damaged cells. Maybe you can expand on "what happens after colposcopy"... I think this was the point I was most afraid. Finding out things were bad enough that I had to book a hospital appointment. There wasn't a lot of information about it and I had a lot of questions. I wanted to know does it affect the possibility of having children, will it come back again, should I have ghardisil injections.. etc etc.
For anyone who is out there with CIN2, CIN3 or CIN 4... I am sending some hugs.
@Over_It Ditto to all this! Having to get a LEEP was what terrified me most. Because throughout the whole process you're hearing "It's probably nothing...it'll probably clear itself...it probably isn't a problem...it probably isn't malignant..." etc., but when you get to the point where you have to get a LEEP or more drastic measurements, it kind of hits home that "Oh shit, I'm the exception. This must be bad." So yes, follow-up please! And I'd love a ruling on the "should I get the vaccine" too!
@Over_It I have SO MANY of these same questions! Honestly, I'm not too concerned about the cancer part (this is why we go to the doc and have regular paps, etc.), I'm mostly concerned about my first ever in-hospital procedure, and whether any of this will one day affect my ability to have children. Thanks for posting this!
@Over_It I had a CIN 3 and went through the whole LEEP thing. I have had a child subsequently and everything went to plan and it was fine. There is no impact on fertility of your ability to carry a child. Hope that helps!
Don't ask how I ended up there from this post (no, really, I couldn't tell you if I tried, but if you're wondering how to pluralize your cervix, clitoris, or your partner's penis, this article from The Straight Dope" will tell you.
@Xanthophyllippa Well. That was a poorly edited and formatted comment. Oops.
@Xanthophyllippa Woahhhhh that article is SO GREAT!!! (Opinion of a former Latin student....)
@gigglefest Nerds unite!
is HPV called anything else??
I've never heard of it outside of American news, and it sound like something that Australian's could probably get too...
Also, my last pap smear, my doc had some not so elegant words about my downstairs grooming..
She also said that there's UTIs can't be a strange hangover symptom even though all my anecdotal evidence is to the contrary.
A good doc is hard to find.
as far as the "you don't know who gave it to you" blame game, if it's the super fun genital warts kind, the appearance of warts from infection is generally about 2 to 6 months, so assuming you're a position to do so, you can pretty much figure it out.
This is so fantastic, Lola! Forwarding it to all the nurses I know. I wish all patient education materials were this funny, accessible, and kind.
This is so informative and timely! I had an abnormal pap 2 years ago with no result - still confused about that. And another abnormal one last year, with my first colp/biopsy a few weeks ago. I have always gone to my lovely internist for all my gyno needs, so imagine my surprise about how HORRIBLE the CHIEF OF GYNECOLOGY was when I saw her for my colposcopy. She didn't even tell me that she would be doing a biopsy so when I screamed and literally jumped, she told me to hold still. Then, she told me that I would have "coffee grind" like substance coming out of my vadge? Which was actually really painful and horrifying in-itself, since apparently "coffee grinds" is medical code for large clumps of dried blood. Yum! 3 weeks later, still no results, and the doc was so unhelpful and basically left me to figure it out on my own. I left the office bewildered and crying and can't believe this woman is the chief of gyno at a major hospital. Ugh fucking doctors sometimes.
@DrFeelGood you are so welcome! your experience sounds awful--sometimes people who have been doing this for a while (i.e., a chief of gynecology) are all burnt out and respond to people in pain with brusque dismissiveness because they are all out of empathy juice, which blows and is damaging to the profession and (YEP as you learned) patient care. ugh.
the one thing that might make you feel better is that the coffee grinds you saw wasn't dried blood in this case--swear--it's dried monsel's solution, which is this gross paste that smells like mustard that we use to help stop any bleeding after biopsy. i wish she had explained better so that you didn't feel like that scene in the shining! except with i guess coffee grinds.
Ditto to the "I just registered on The Hairpin all because of YOU, Lola!" Also ditto to "Please please please please puhleeease do a follow-up on LEEP!" crowd.
I had my first colpo a year and a half ago, and my second colpo last month. I'm now CIN3, and have a consultation this Friday with a gynecological oncologist (that's a real thing, right?) to go over my questions before they schedule a LEEP.
First of all, SCARY to have an appointment with an oncologist!!! Second, what should I ask the doc? What should I do to prepare/recover? And can you please draw more cervices (thanks @Xanthophyllippa for the plural) with bow ties when telling us all about LEEP? Pretty please??? Kthx!
@Jelafo Sister friend! Big huge hugs. Several things:
You can be put under completely for your LEEP. I know people who have done this. Sometimes, depending on your cevix's particular needs, they will automatically do this. But if you're especially anxious, the option's there! If you don't go that route, they will/should give you a local anesthetic to help deal with pain. If your LEEP is anything like mine was, it will be SUPER quick!
Things that helped me:
1. VALIUM. My gyno was more than happy to prescribe me some and it helped immensely.
2. An iPod. Preferably with something very distracting on it--I mentioned above that I had David Sedaris on there, which was perfect.
3. Take a pile of your painkiller of choice beforehand, and please don't schedule anything for the rest of the day.
4. Make sure to have someone to drive you home (especially if you're on Valium, please!) and then take the day off. Your body's had a tough day and you need to take time to chill and recover!
5. Recovery is a lot of blergh...just generally uncomfortable/unpleasant. I had some weird odor issues, YMMV? Worst part for me was having to do a period without tampons, something I hadn't done in a long-ass time. BUT, good news: recovered fully, clear margins on my LEEP, resumed a normal and awesome sex life (I heard some scary stuff about this on health board forums and was worried as hell), and clean pap results ever since! It's a few unpleasant weeks, but the payoff is great.
Again, big huge hugs. It is scary but much better than the alternative! Also, let me know if you'd like my email address!
@The Everpresent Wordsnatcher Thanks so much for your advice! It's real comforting to hear from someone who's been through this and to be reassured that, while unpleasant, this LEEP isn't going to ruin my life (especially my sex life).
And seriously - no tampons for a month? I should probably just skip my period altogether.
Big huge hugs received and appreciated! And congrats to you on your normal post-LEEP paps!
@Jelafo No tampons. It was not pleasant. If you have the option of skipping your period with no ill-effects, I would recommend it!
Lola! Lola! Do cyrotherapy/LEEP next! Explain explain!