internal warts?

[lagrimas]

Hi, Doc, I have a question and a couple confessions to make that I'm sure you will not approve of, but here goes...Last November I discovered that I had external genital warts.  I treated them myself without ever seeing a doctor (probably not the best idea, I know).  I used one of those OTC liquid nitrogen kits and the warts went away within a month or two and have not returned since.  Shameful confession 2: I have not had a Pap smear since January 2004 (yep, way before the warts popped up).  What is the likelihood that I could be harboring internal warts (I mean from this particular infection, not taking into account the possibility that I could have caught a completely different infection/strain).  I have made an appointment for a Pap, but am really worried and would like some answers in the meantime.  I have recently found a new partner and am concerned about passing this on to him. Thanks so much for your help and for this great forum!

PS.  Not an STD question, but do you have any idea why Pap smears are *excruciatingly* painful for me, and do you know of anything that can help ease the pain?  (This is the reason I haven't had one in almost 2 years).

[H. Hunter Handsfield, M.D.]

Internal warts aren't especially rare, but most women with external genital warts don't have internal ones.  But as you apparently know, the only way to find out is to have an exam by an experienced health care provider.

I am not a gynegologist and have no explanation or advice about your pain during pelvic exams.  The person who posted a reply before me (just below) seems to be on the righ track about vaginismus, but I don't know enough to vouch for that diagnosis.  If not confident about your own provider, you might find one who is likely to be senstive to the issue.  Without attempting to criticize all gynecologists of my gender or age, I suspect you might have the best luck by seeking out a reasonably young (i.e., recently trained) female provider.

Good luck--  HHH, MD

[MLWTR]

One possibility that can cause very painful Pap smears is vaginismus -- meaning that the muscles of the vagina contract in reaction to something, such as the doctor's finger, being inserted. Some people with vaginismus also have trouble inserting tampons. If this is the cause for the pain, and your gynecologist is willing, he/she might be able to use a little topical anesthetic on the finger used for the exam, which could make matters less painful for you. Just a thought.

Good luck.