Abnormal pap 15 years after hysterectomy

[BMNS]

I had a total hysterectomy in 1991 due to endometriosis.No precancer or cancer.Diligent about yearly annual exams but due to prior hysterectomy, my last pap was in 1999 without cultures and was normal.My most recent pap 4 weeks ago came back with LGSIL, Mild Dysplasia and HPV effects present.I have done alot of research, but still am unclear on some topics and have the following questions:
1.With only a vagina and no female organs, is there a higher possibility that HPV could spread to other organs easier than if I had them? Does HPV spread within the body?
2.What is meant by HPV effects present?Did I have an HPV test along with the pap or would a pap alone show HPV effects?Having a tough time getting answers from my dr.
3.What is the "normal" next step with this result? Is it to re-test in 3-4 months or coloposcopy and biopsy?If colposcopy and biopsy, is it possible to have the biopsy with some type of numming agent or relaxant prior to the injection of local antisetic?
4.How painful should the biopsy be?I was told it would just be a very brief pinch and then over....that was so far from the truth that we had to stop with the initial local antisetic injection.Is this normal? or is it possible to have it be a less painful and stressful event?
5.How serious is this reading? From my own research, It seems to be very treatable and has a high rate of cure with the knowledge that re-checks are critical to be sure it doesn't come back.Is this correct?
6.What questions/requests should I ask my next Gyn when I see her in a week or so?
I am trying very hard to educate myself as I can't seem to get answers from my medical "professionals." I am scared because there is so much different information out there on this topic centering on HPV and the cervix and really very little that deals with HPV after hysterectomy. Any current information, data or advise that you have regarding this specific topic would be greatly appreciated.
Thank you very much!

[Machelle Seibel, MD]

A. HPV is a virus that can irritate the cells in the reproductive tract to become abnormal and eventually malignant.  Not all strains of HPV can do that, only a few of the many strains that exist. If it is caught at this early time, there is an overwhelmingly good chance it will be cured before it becomes malignant. The new pap tests show these changes and doesn’t require a separate test. Some doctors will just repeat in 3 months. Others will ask you to do a colposcopy which is like looking at the vagina with a pair of special binoculars mounted on a stand. The doctor uses a type of mild acid like vinegar to make the changes stand out and show where to biopsy.  It is usually a small pinch but local anesthesia can be used. The experience might be more uncomfortable after a hysterectomy because the cervix (neck of the uterus) has very little nerve endings compared with the vagina.

Ask your gyn if he/she is comfortable treating this and does so regularly. If you have any concerns, you can ask for a referral to an oncologist for a second opinion – not because it is extremely dangerous but because they are very used to this type of problem.
Machelle M. Seibel, MD

[poco1023]

hello. I'm not a doctor just have some personal experience with hpv. I'm 45 and I have had normal pap smears for a very long time. This june I decided to have my annual pap and decided t take the hpv test. The hpv test came back positive and my pap was normal. I had the coposcopy done. I'm not going to say it wasn't painful, but it was quite uncomfortable. Not sure why they don't numb you, but I'm sure there's a reason. After my diagnosis the doctor said to come back next year for my yearly exam. I didn't need to go back again to be checked. I not sure if this is because my pap was normal, but maybe. To find out if you have hpv you need the hpv test. I would've never known if I didn't take the test since my pap was normal.  hope this helps and good luck to you.

[BMNS]

Thank you so much for your clear and concise explanation.  I have one further question:

What is the difference between a Pap Smear without cultures and one with cultures?  Does one give more detailed/significant information or????
Thank you!