Pap Smears and Colposcopy: Your Questions Answered

Cervical smear and colposcopy?

Hello Doctor, I would like to ask about Pap smears and colposcopy.
1.
I had a general health check-up at my family medicine clinic and also had a Pap smear done.
I have undergone two Pap smear tests so far.
The first one was in September 2011, and the result was normal.
The family medicine doctor examined me and found everything to be normal, and I did not feel any abnormalities.
However, last month, in December 2013, the Pap smear showed abnormal results with LSIL, and HSIL could not be ruled out.
I had my first sexual intercourse in January 2011.
It was only once, and the partner did not use a condom.
Since my first Pap smear in September 2011 was normal and I did not feel any abnormalities, can I rule out that my first sexual encounter caused the abnormality in my recent Pap smear?
2.
The Pap smear in December 2013 was conducted at a different clinic.
The results indicated LSIL, with HSIL not being ruled out.
This clinic referred me to a gynecologist for a colposcopy and biopsy.
I underwent the colposcopy today, and the gynecologist said everything looked normal, with no reaction to the acetic acid test, and everything appeared smooth.
There was no need for a biopsy.
The whole process was very quick, and I even thought about asking if they could look more closely.
I don't understand why the Pap smear was abnormal, but the colposcopy was fine.
Is this a possibility? What is the reasoning behind this?
3.
The gynecologist said not to worry and that I could just have future Pap smears.
However, since I know my Pap smear results are abnormal, am I not just "waiting for disaster"? What if my future Pap smears show the same LSIL-H or something more severe? Why was I told not to worry? Shouldn't I be treated now instead of waiting for future problems? I don't understand this reasoning.
Since the Pap smear does not rule out high-grade lesions (HSIL), how can they say I shouldn't worry? What do you think, Doctor?
4.
Before the December 2013 Pap smear, I had a partner who was unwilling to use a condom in May 2013.
If my December 2013 Pap smear is abnormal, can I infer that my infection came from that encounter in May 2013? I ask this because I am unsure how recent infections or issues can be detected through Pap smears and colposcopy.
I do not know if the abnormal result is due to the sexual encounter in 2011 or the one in May 2013.
If the abnormal result is due to the 2011 encounter, does that mean the infection from 2013 has not yet been detected and may take years to "surface"? Or can my December 2013 test already indicate issues from the May 2013 encounter? (My question is, how recent of an infection can Pap smears and colposcopy detect? All my unsafe encounters occurred at least six months prior, so can the December 2013 test detect infections from within the past year?)
Thank you for your response and expertise! I look forward to hearing from you!

Lucy, 20~29 year old female. Ask Date: 2014/01/14

Dr. Lin Wenbin reply Obstetrics and Gynecology

1.
It cannot be ruled out.
Human papillomavirus (HPV) infection does not present symptoms initially; cellular changes may occur several years later.

2.
This is possible.
The sampling site is extensive, including the cervical os.
Abnormal cells may have been detected.
However, a colposcopy cannot visualize the cervical os, or the lesions may be too small to be seen.

3.
Low-grade squamous intraepithelial lesion (LSIL) does not necessarily indicate a problem.
It is essential to monitor for any further changes.
Even without treatment, the natural progression may take some time before it develops into cervical intraepithelial neoplasia (CIN) or carcinoma in situ (CIS).
During this process, as long as you have regular check-ups, any issues will generally be detected.
Transitioning from CIN1 to CIN2 typically takes about five years.
With regular screenings, there is no need to fear being passive or inactive.

4.
Such speculation cannot be made.
The effects of the virus are not immediate and may manifest years later.
The body's response is cumulative, and issues will naturally surface after several years.
However, if the immune system is strong and further exposure to the virus is avoided, the body may be capable of eliminating the virus over time.
Using condoms is the best method; agreeing to unprotected intercourse means you must accept all consequences.
Despite a physician's advice, only you can protect yourself.
Refusing unprotected sexual activity is crucial to avoiding infections and maintaining health.
Even if a couple wishes to conceive, they should use condoms regularly and only forgo them during ovulation (the fertile period).
Understanding this is a way for the male partner to show care and respect for the female partner.

Reply Date: 2014/01/14

More Info

Understanding Pap Smears and Colposcopy is crucial for women's health, particularly in the early detection of cervical abnormalities that could lead to cancer. Let's address your questions one by one.

1. Regarding the Timing of Sexual Activity and Abnormal Pap Results: It is important to note that cervical changes due to HPV (Human Papillomavirus) infection can take years to manifest. The fact that your first Pap smear in September 2011 was normal suggests that any potential HPV infection from your first sexual encounter in January 2011 was not present or detectable at that time. However, HPV can remain dormant for years, and it is possible that the abnormal results in December 2013 (LSIL - Low-grade Squamous Intraepithelial Lesion, with a possibility of HSIL - High-grade Squamous Intraepithelial Lesion) could be due to an infection that occurred after your first Pap smear, possibly from your sexual encounter in May 2013. Therefore, while the first encounter may not have caused the current abnormality, it is essential to understand that HPV can be transmitted and may not show immediate effects.

2. Discrepancy Between Pap Smear and Colposcopy Results: It is indeed possible for a Pap smear to show abnormal cells while a colposcopy appears normal. The Pap smear is a screening tool that detects cellular changes, while colposcopy is a diagnostic procedure that allows the physician to closely examine the cervix. The vinegar solution used during colposcopy highlights abnormal areas, but not all abnormalities will be visible. The absence of visible lesions during colposcopy does not negate the Pap smear results; it may indicate that the abnormal cells are not yet significant enough to be seen or that they are in a transitional phase.

3. Concerns About Waiting for Further Testing: Your concern about "waiting" after receiving an abnormal Pap result is valid. The recommendation to continue regular Pap smears is based on the understanding that many LSIL lesions can resolve on their own without treatment. The rationale is to monitor the situation rather than intervene immediately, as unnecessary treatments can lead to complications. However, it is essential to have a clear follow-up plan. If subsequent Pap smears continue to show abnormalities, further evaluation or treatment may be warranted. It’s important to maintain open communication with your healthcare provider about your concerns and the rationale behind their recommendations.

4. Timing of Infections and Detection: Pap smears can detect changes that may have occurred over several months to years, but they do not pinpoint the exact timing of an infection. The abnormal cells detected in December 2013 could be a result of an infection from either the 2011 or 2013 encounters. HPV infections can take time to cause detectable changes, and it is possible for a recent infection to be reflected in a Pap smear. However, if you had unprotected intercourse in May 2013, it is plausible that this encounter could have contributed to the abnormal results observed in December 2013.

In summary, it is essential to follow up with your healthcare provider regarding your abnormal Pap smear results. Regular screenings and open discussions about your sexual health and any concerns you may have are vital for early detection and prevention of cervical cancer. If you have further questions or need clarification, do not hesitate to reach out to your healthcare provider for personalized advice and support.

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