Precancerous Conditions in Women's Health: What You Need to Know

Precancerous lesions

Hello Doctor: In 2016, I visited a gynecologist due to irregular menstrual periods and had my first Pap smear (result coded as 7).
I was very scared at that time, so I followed the doctor's advice and underwent HPV screening, which came back positive for types 16 and 18.
Later, the doctor recommended that I receive the nine-valent HPV vaccine.
Six months later, I had another Pap smear (result showed inflammation), and I thought everything was fine.
Recently, due to significant stress, I experienced menstrual irregularities again and returned to the gynecologist.
The doctor noticed that I had not kept up with my scheduled screenings and had me undergo another Pap smear (result coded as 16).
I am very scared, and when I was notified to return for a follow-up, the doctor referred me for a colposcopy and biopsy.
I would like to ask you, am I at risk of developing cancer, and could this affect my ability to conceive?

Niming, 30~39 year old female. Ask Date: 2019/08/18

Dr. Huang Jianzhong reply Obstetrics and Gynecology

In 2016, I visited a gynecologist due to irregular menstrual periods, and it was my first time undergoing a Pap smear (result coded as 7).
I was very scared, so I followed the doctor's advice and had an HPV screening, which came back positive for types 16 and 18.
Later, the doctor recommended that I receive the nine-valent HPV vaccine.
Six months later, I had another Pap smear (result showed inflammation), and I thought everything was fine.
Recently, due to excessive stress, I experienced menstrual irregularities again and returned to the gynecologist.
The doctor noticed that I hadn't had my check-up on time and had me undergo another Pap smear (result coded as 16).
I am very scared, and when I was notified to return for a follow-up, the doctor referred me for a colposcopy and biopsy.
I would like to ask, am I at risk of cancer, and could this affect my fertility? Answer: A colposcopy and biopsy are necessary; please wait for the report results.

Reply Date: 2019/08/18

More Info

Understanding precancerous conditions in women's health is crucial, especially when it comes to cervical health and the implications of abnormal Pap smear results. Your concerns about the results of your Pap smear and HPV testing are valid, and it's important to address them with accurate information and reassurance.

Firstly, let's clarify what the results you mentioned mean. A Pap smear result coded as "7" typically indicates a high-grade squamous intraepithelial lesion (HSIL), which is a precancerous condition. The HPV types 16 and 18 are known high-risk strains that can lead to cervical cancer if persistent. The fact that you received the nine-valent HPV vaccine is a positive step, as it protects against several strains of HPV, including 16 and 18, which are responsible for a significant percentage of cervical cancer cases.

The subsequent Pap smear result indicating inflammation is not uncommon, especially after an HPV diagnosis. Inflammation can occur for various reasons, including infections or irritation, and does not necessarily indicate cancer. However, the recent result indicating HPV type 16 is concerning, as it is one of the high-risk types associated with cervical cancer.

Your referral for colposcopy and biopsy is a standard procedure when abnormal Pap results are found. During a colposcopy, the doctor will examine your cervix more closely using a special magnifying instrument. If any areas appear abnormal, a biopsy may be performed to determine if there are any precancerous or cancerous cells present. This process is essential for early detection and treatment, which significantly improves outcomes.

Regarding your fears about cancer and fertility, it's important to remember that not all women with abnormal Pap results or HPV will develop cervical cancer. Many women clear the virus naturally, and even those with precancerous lesions can often be treated successfully. Early intervention is key. If the biopsy shows precancerous changes, treatment options are available that can preserve fertility, such as excisional procedures that remove the abnormal tissue while leaving the rest of the cervix intact.

Stress and anxiety can exacerbate health issues, including menstrual irregularities. It's essential to manage stress through healthy coping mechanisms, such as exercise, mindfulness, or counseling. Maintaining a healthy lifestyle, including a balanced diet and regular check-ups, can also support your overall health.

In summary, while your situation may seem alarming, it is essential to follow through with the recommended colposcopy and biopsy. These steps are crucial for determining the next course of action. Remember that many women with similar conditions go on to have healthy pregnancies and lives. Open communication with your healthcare provider about your concerns and treatment options will empower you to make informed decisions about your health.

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