What Is the Pap Smear?
The pap smear is a screening test for cervical cancer. Usually done annually, it collects cells from the cervix, which are then reviewed by a pathologist for evidence of abnormal cells. The pap smear is an ideal screening test because cervical cancer usually takes several years to develop, so regular pap smears allow us to diagnose the pre-cancerous changes so that we can intervene before they develop into cancer.
The results of your pap smear will be reported in several different categories:
- Negative (normal).
- Negative cells with positive HPV.
- Atypical squamous cells of undetermined significance (ASC-US).
- Atypical squamous cells suspicious for high-grade intraepithelial lesion (ASC-H).
- Low-grade intraepithelial lesions (LSIL); the LSIL category includes changes .consistent with HPV, mild dysplasia or CIN I (grade 1 cervical intraepithelial neoplasia).
- High-grade intraepithelial lesions (HSIL); HSIL includes changes consistent with moderate or severe dysplasia, CIN II or III and carcinoma in situ (CIS).
- Atypical glandular cells (AGC) may be endocervical, endometrial or other glandular cells.
- Endocervical adenocarcinoma in situ (AIS).
What Causes Abnormal Paps?
The most common abnormal paps that we see are ASCUS and LSIL. The majority of abnormal paps are caused by an infection with a virus known as the human papillomavirus (HPV). HPV is the most common sexually transmitted disease. By age 50, over 80 percent of women will have been infected with HPV. The majority of people do not have any symptoms of the infection and will clear the infection on their own.
There are over 100 strains of HPV, and over 30 of them are involved with genital infections. The different strains are categorized into "low-risk" and "high-risk" groups. High-risk strains cause abnormal paps and can lead to cancer of the cervix, vagina, vulva, anus or penis. Low-risk strains can cause mildly abnormal changes in pap smears and also cause genital warts.
How Do We Manage Abnormal Paps?
Once you have an abnormal result on your pap smear, your doctor will probably recommend that you undergo colposcopy. Colposcopy is a procedure done in the office during which your doctor will look carefully at your cervix with a colposcope (a kind of microscope for the cervix). If any abnormal cells are seen, biopsies will be taken. The procedure takes 15-20 minutes and does not require any anesthesia. You may want to take 600-800 mg of ibuprofen before the procedure to help with cramping.
If the biopsy shows evidence of dysplasia, management may include simply repeating your pap in four to six months, cryotherapy (freezing of the abnormal cells on the cervix) or removal of the infected part of the cervix (a procedure called a LEEP or a cone). Your doctor will tell you which is the best choice for you after the biopsy results come back.
You can also make some lifestyle changes that will help your body to clear the infection on its own. If you smoke, quit! Cigarette smoking helps the HPV virus to grow more quickly. If you are currently a smoker, quitting may be enough to return your pap smear to normal. Also, recent evidence suggests that increasing your folic acid to 800 micrograms a day may also help your body get rid of the infection.
What Do I Do If I Missed One or Two Days of Birth Control Pills?
First, read the instructions that came with your pill. Generally speaking, if you miss one pill, take two pills the next day. If you miss two pills, take two pills on each of the next two days. If you miss three or more, discontinue the pack, use backup birth control and start a new pack with your next period. It's best to use a backup contraception method such as condoms for the remainder of the month.
Can I Have a Pap Smear If I Have My Period?
You should try to schedule your annual exam for when you are not having your period. However, you can have a pap smear during your period as long as the flow is not very heavy.
I Skipped One of My Birth Control Pills, and I Am Now Experiencing Vaginal Bleeding. What Should I Do?
The skipping of just one birth control pill can potentially produce a hormone imbalance, which can cause a symptom referred to as "breakthrough bleeding." This is a relatively normal occurrence and you should take the missed pill as soon as you realize you've skipped it. If you have skipped more than two birth control pills, you should use condoms for the remainder of the month.
What Other Contraceptive Methods Are Available?
In addition to the 28-day birth control pills, you can obtain the following:
Nuva Ring – A soft plastic ring containing estrogen and progesterone, which is inserted into the vagina, where the hormone is absorbed through the vaginal mucosa. The method is 99 percent effective when used as directed and is based on a 28-day cycle like BCPs & Ortho Evra.
Depo Provera Injection – A progesterone-only method, which is injected intramuscularly within the first five days of an established period. The method is immediately 99 percent effective when started in this manner. Injections are repeated every 11 to 13 weeks. Women on Depo Provera usually stop having periods. The menstrual cycle resumes when Depo Provera is discontinued.
Intrauterine Device – IUDs are available for insertion. An IUD is a small, plastic device, which is put into the uterus to stop a woman from getting pregnant. A Paraguard or Copper IUD contains copper. The other has the hormone levonorgestrel, which is released slowly into the uterus, helping to prevent pregnancy. These types are called the Mirena or the Skyla. For every 100 women using the IUD, less than one per year will get pregnant.
Sterilization – Surgical sterilization is available for both men and women. This option should be discussed with your primary care clinician to determine if it best meets your needs.
Barrier Methods – Barrier methods include the diaphragm, the cervical cap and spermicides. Diaphragms and cervical caps require fitting by a clinician and a prescription. Barrier methods have few side effects, although some people may be allergic to latex or spermicides. The average one-year failure rate for the diaphragm ranges between 12 to 18 percent.
Ortho Evra Patch – This is a patch containing estrogen and progesterone that is applied firmly to the skin. The hormone is absorbed through the skin and is 99 percent effective when used as directed. It contains hormones that are released through the skin and into the bloodstream. The patch is used on a weekly 28-day cycle, similar to birth control pills.
How Much Can I Exercise While Pregnant?
For people who regularly maintain active lifestyles, it is safe to continue to do so during pregnancy, though women should strive to stick to an exercise pace that is not too vigorous or exhausting. For women who don't regularly keep an active lifestyle, it is recommended that at least some light exercise be incorporated into their daily life; just walking a moderate pace every day should suffice.
What Should I Avoid Eating While Pregnant?
Women are strongly urged to avoid alcohol during pregnancy and to limit caffeine to no more than 300 mg per day, which equals roughly two five-ounce cups of coffee. Women are also encouraged to avoid the use of saccharin, soft or unpasteurized cheeses, raw meats and fish, and unpasteurized deli meats.
Can I Continue to Eat and Drink Foods That Contain Artificial Sweeteners?
Women are encouraged to avoid anything that contains aspartame, which is found in products like Sweet 'N Low. However, the artificial sweetener Splenda is deemed to be okay to consume while pregnant, since it is made from all-natural ingredients.
How Should I Treat a Cold?
It is recommended that you do not take anything with ibuprofen in it. Aside from drinking fluids and resting, pregnant women that are past their first trimester are permitted to take Sudafed, Tylenol, Dimetapp and Robitussin.
May I Travel While Pregnant?
For uncomplicated pregnancies, travel is not a problem, though steps should be taken to avoid unnecessary stress on both you and the baby. When traveling by car, make plans to stop at least every two hours to get out and walk. Additionally, any women at the 34-week mark should consult with their physician before engaging in travel.
Are Dental X-Rays Okay?
Yes, but be sure that your abdomen is completely shielded when having the X-rays taken.
What Symptoms Should Be Reported to My Physician?
Just some of the symptoms that should be reported to your physician include contractions, bleeding, intense headaches, cramping, decreased movement of the baby, a fever of over 100 degrees, loss of fluid from the vagina or any other symptoms that seem abnormal.
What Are Some Suggestions for Dealing With Morning Sickness?
Some recommendations for easing morning sickness include:
- Get out of bed slowly in the morning and try to avoid sudden or jolty movements.
- Eat several small meals during the day so your stomach doesn't remain empty for long.
- Avoid fried, greasy and spicy foods.
- Drink soups and other liquids between meals.
- Eat a piece of bread or a few crackers before you get out of bed in the morning, or whenever you feel nauseated.
- Have some juice, milk, yogurt or cottage cheese before you go to bed or when you wake up.
- Ginger candy or tea can help nausea.
- Vitamin B supplements can also help relieve nausea.
What Can I Do About Constipation?
To ease constipation during pregnancy, women are encouraged to try adding high-fiber foods to their diet like bran, fruit and vegetables, on top of increasing their daily water intake. You may also try products like Fibercon, Metamucil, Citrucel and Colace.