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2nd opinion- from low to moderate = surgery??
I was first diagnosed with HPV in September of 2010 after an abnormal pap smear. The colposcopy had no alarming results. In Jan, 2011 I had a clean pap. Sept. 2011 I had another abnormal pap. The follow-up colposcopy didn't go well- the HPV infection had gone from "low" to "moderate" PRE-cervical cancer. My doctor recommended I have surgery to remove the particular spot from my cervix with a hot wire. Lots of questions:
1. My doctor said that after the surgery if I still had an abnormal pap smear it would be a problem- my interpretation: this surgery should get rid of the HPV. Is that true? I thought HPV was systemic rather than localized, so it would still be in my system after a surgery, even if not affecting particular cells yet. Or is that incorrect?
2. Having a home birth is really important to me. One possible side-effects of surgery is "Cervical Incompetence" (horrible and upsetting name!) = likely miscarriage in my mind (is that right?). My doctor told me about something where they could tie my cervix closed to insure that that doesn't happen. Would I still be able to have a home-birth if my cervix was tied shut, or is taking that off a procedure that a doctor would have to do? Would it be a surgery? Would there be any way of knowing if I had cervical incompetence before I get pregnant, so that I know whether or not I have to get my cervix tied?
3. Another possible side effect: my cervix would heal closed- the infected area is right around the opening. Wouldn't my cervix have to be opened so that I could menstruate? My cervix would have to be opened to get pregnant, right?
4. Even though this has moved from "low" to "moderate" this is still HPV, and it could still just go away, right? How big is that risk for getting cervical cancer at this point? Should I just start processing the sad reality that I can't have a home-birth?
Thank you in advance- it's such a relief to be able to talk to an informed professional!
1. My doctor said that after the surgery if I still had an abnormal pap smear it would be a problem- my interpretation: this surgery should get rid of the HPV. Is that true? I thought HPV was systemic rather than localized, so it would still be in my system after a surgery, even if not affecting particular cells yet. Or is that incorrect?
2. Having a home birth is really important to me. One possible side-effects of surgery is "Cervical Incompetence" (horrible and upsetting name!) = likely miscarriage in my mind (is that right?). My doctor told me about something where they could tie my cervix closed to insure that that doesn't happen. Would I still be able to have a home-birth if my cervix was tied shut, or is taking that off a procedure that a doctor would have to do? Would it be a surgery? Would there be any way of knowing if I had cervical incompetence before I get pregnant, so that I know whether or not I have to get my cervix tied?
3. Another possible side effect: my cervix would heal closed- the infected area is right around the opening. Wouldn't my cervix have to be opened so that I could menstruate? My cervix would have to be opened to get pregnant, right?
4. Even though this has moved from "low" to "moderate" this is still HPV, and it could still just go away, right? How big is that risk for getting cervical cancer at this point? Should I just start processing the sad reality that I can't have a home-birth?
Thank you in advance- it's such a relief to be able to talk to an informed professional!
Thanks for answering what you could! I appreciate it.
MEDICAL PROFESSIONAL
Welcome to the forum. I'll try to help. But unfortunately, I can't adequately address some of your questions. Most STD specialists and clinics have little direct experience with LEEP, cone biopsy, or other cervical surgical procedures for HPV and pre-cancerous cervical disease. These are really issues for a gynecologist.
1) HPV is not systemic, only local. The surgery probably will remove all the infected tissues, but not necessarily. There could be involvement in nearby tissus that appear normal and are not removed by surgery. However, any such residual infection can be expected to clear up on its own. Still, your doctor will recommend follow-up pap smears to be certain.
2,3) I cannot comment on the chance of either cervical incompetence or constriction of the opening. My understanding is that the risk is low for any single patient.
4) I'm not sure how to interpret the "low to moderate" comments. Conceivably you had more than one HPV strain, one "low risk" type (i.e. a wart-causing but not cancer-causing) and also one that is "moderate risk" for pre-cancerous disease. Or perhaps he meant the cellular changes themselves, e.g. from a less to somewhat more advanced stage. You'll have to clarify it with your doctor.
The most important thing is to follow your doctor's advice. With proper care, there is no significant chance you will ever have serious disease, i.e. actual cervical cancer. The large majority of women in your situation have no future problems after cervical surgery and have healthy and successful pregnancies and delivery.
Best wishes-- HHH, MD
1) HPV is not systemic, only local. The surgery probably will remove all the infected tissues, but not necessarily. There could be involvement in nearby tissus that appear normal and are not removed by surgery. However, any such residual infection can be expected to clear up on its own. Still, your doctor will recommend follow-up pap smears to be certain.
2,3) I cannot comment on the chance of either cervical incompetence or constriction of the opening. My understanding is that the risk is low for any single patient.
4) I'm not sure how to interpret the "low to moderate" comments. Conceivably you had more than one HPV strain, one "low risk" type (i.e. a wart-causing but not cancer-causing) and also one that is "moderate risk" for pre-cancerous disease. Or perhaps he meant the cellular changes themselves, e.g. from a less to somewhat more advanced stage. You'll have to clarify it with your doctor.
The most important thing is to follow your doctor's advice. With proper care, there is no significant chance you will ever have serious disease, i.e. actual cervical cancer. The large majority of women in your situation have no future problems after cervical surgery and have healthy and successful pregnancies and delivery.
Best wishes-- HHH, MD
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