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Prior Hysterectomy and HPV
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Prior Hysterectomy and HPV

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!
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The sexually acquired types of HPV can affect any genital, anal, and surrounding tissues.  However, the high-risk (cancer-associated) types cause the vast majority of their problems on the cervix or, less commonly, the anus.  Although vulvar and vaginal cancers also are related to the same HPV types, those diseases are very rare, far less common than cervical cancer and pre-cancerous problems.

1) Not having a cervix or uterus has no known effect on HPV disease at other anatomic sites.  HPV does not spread in the body; it only causes problems at the places where infection starts.

2) "HPV effects" is redundant.  The LGSIL and dysplasia themselves are the HPV effects.

3, 4) I am not a gynecologist, have never done a cervical or vaginal biopsy, and am not an expert and do not give advice on management of abnormal pap smears, dysplasia, etc.  Your own provider is the best source of this information.  But I believe the description of the biopsy is exactly right; it's not a big deal.

5) Even if you did nothing, the odds are strong you would never have a serious problem.  I'm definitely not suggesting you blow this off; you must follow your provider's advice.  But with proper treatment, you can be 100% confident nothing dangerous will come of your HPV infection.

6) You already have a pretty good set of questions for your provider.  The main thing I don't understand is where the pap abnormalities are: vagina, vulva, anal area, or wherever.  You should be clear on this, and also confirm with your ObG that s/he has managed cases like yours before; and if uncertain, ask for a second opinion.  If the abnormality is external, like vulva or anus, you might want to consult with a dermatologist as well as your ObG.

I hope this helps.  Best wishes--  HHH, MD
3 Comments
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Thank you very much for your professional opinion.  You honesty and professionalism are to be commended.  It is really sad all in the medical profession couldn't have this same integrity!  Again, thank you.
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Abnormal Pap Reading from the inside vaginal walls.
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A related discussion, Will it ever go away was started.
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H. Hunter Handsfield, M.D.Blank
University of Washington
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Edward W Hook, MDBlank
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