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abnormal paps after hysterectomy


I'm a 48 year old woman, who has had abnormal paps for the last 10+ years.  I do have HPV, I think the type that is more likely to cause cancer.  I have had paps 3-4 times a year, and colps, laser treatments, etc.. when the results are LSIL.......at most it reverts to ASCUS, never 'normal'.  I had a hysterectomy a year ago, to end this cycle.  However, at my pap 6 months ago, it came back LSIL, the dr. seemed very surprised, mentioned talking to a oncology gyn, but then said to wait til the next pap.  At my Nov pap appt, I asked her about the onc gyn and she said she was told having abnormal pap after hysterectomy could happen, and will likely revert to normal.  I just called for my results (assuming 'good' ones, since they didnt' call me) from last month's pap, and was told it was LSIL, and to come back in march.  I am waiting for the dr. herself to call me back, as I am not comfortable with this!  So, I've had LSIL for a year at least, I dont' want to wait until it turns high grade.  Does this sound reasonable to wait?  Is this odd?  With no cervix, what are my options?  It makes me very nervous to have bad cells, and what other treatment can take care of this LSIL since I've already had a hysterectomy?

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It (unfortunately) is quite common for that pap to come back abnormal after a hysterectomy.  I have lots of patients who have persistent low grade dysplasia that we just can't beat!  It is a real pain in the neck (or elsewhere if you will).
If you were my patient, at this point, I would refer you to a gyn oncologist for vaginal colposcopy and possibly biopsies.  A vaginal colposcopy is more difficult than a cervical one, and so I would have a specialist do the first one.  
Then, depending upon the results, and upon your wishes, I think there are two options ( a gyn oncologist might have more suggestions too ) I would offer you the option of a laser to attempt to clear the HPV, OR continued surveillance with vaginal paps and colposcopies--I would ask the Gyn-onc how often they need to be done--I anticipate once to twice a year.

The good news is that vaginal cancer is EXTREMELY rare, and if you were going to get cancer, you probably would have it by now.  The bad news is--most of my patients never get "normal" on their paps--blah!
Good luck!
Dr B
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