My Cervical Biopsy Results
Preface: Back in May, on our way out the door to start our nomadic journey - I had an abnormal PAP test with a positive HPV. For those newer to my journal, this is my second time around with this. I had an abnormal back in 2003, which I ended up having a LEEP procedure in 2004. I was having normal PAPs and negative HPV results until this past May. I've not been overly out about this new diagnosis like I was with my last one, as I really just didn't want to be a spokesperson against HPV again.


I had my follow-up appointment today with my gyn to discuss the cervical biopsy results that I had taken 2 weeks ago. The prognosis is not so good. My dysplasia has already progressed from mild to moderate. Which is the same thing that happened last time. My body just isn't up to snuff for handling aggressive strains of HPV.

Last time I tried every alternative therapy I could for a year - Chinese herbal medicine, homeopathic suppositories, intense vitamin supplementation to boost immune support, extra exercise, dietary improvements, etc. While that was the right choice for me then and it helped me at least feel I had some control over this virus.. this time around, I opted to not go through the agony of false hope again. I made no alterations to my lifestyle.

Same end results.



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So, what does moderate mean? Basically, there are three pre-cancereous stages of HPV-caused dysplasia.

Mild is, well.. the mildest form, and is really pre-pre-cancerous. It's when the virus is using the body's genetic reproduction programming to spread itself. Most people (like, 91%) infected with HPV will only get to this stage, the immune system will fight it over a number of months and reverse the condition within two years.

Moderate is when the virus starts to switch from focusing on reproduction, and starts 'nesting'. It starts going a little deeper into the tissue and starts changing the shape of the skin cells. Chances of reversal go down quite a bit once it gets to this stage, especially for women over 30.

Severe is well nested and going further into the tissue.

Cancer is when the infection gets past the base tissue level and starts invading the body.

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So, I'm one step closer to cancer - which is likely a several year progression (or none at all), but it could also be a rapid trip. But regardless, treatment of some sort shifts from 'you might want to consider' to 'you really should.' Sure, I could do more wait-n-see and hope that it reverses on its own, or try other alternative treatments - but I'm not stupid.


So, my treatment options through my current gyn are:

1) Have another LEEP procedure. This is an electrically charged wire that slices off the area of tissue in question. As a bonus, the heat can burn away the HPV virus too. The tissue is then sent to pathology to make sure there was none that was already cancerous, and that there is a clean margin around the edges (indicating they got it all). This is normally a pretty minor procedure that can be done in office. However, my doctor says 'I'm not in the habit of torturing patients and have found that the LEEP is too uncomfortable for most, so I don't even have the equipment here. I do it only as an outpatient surgery under general anesthesia.' I went under last time, but only because I negotiated having a tubal ligation while under too (yes, you can negotiate your health care). So, if I want a LEEP, I either have to go under (and pay out a $300 co-pay) with my current gyn, or find one in the area who has equipment in office and who is in the habit of torturing patients (I've already contacted my primary doc to see if he knows any).

2) A total abdominal hysterectomy We talked seriously with my gyn about this option, at my request. He thinks it's a reasonable course of action. Initially he said I'd have to have a LEEP first to make sure there's no cancer (because that would mean needing an oncology doc to do the procedure instead). No way I'm going under twice to deal with this, especially since the odds of me having cancer right now are very very slim. So, I negotiated with him to consider putting me under, doing a frozen section STAT biopsy (they check it for cancer while I'm under), and if it's clear - proceeding with the hysterectomy, removing my uterus and cervix. If it's cancerous, wake me up and refer me to an oncology gyn. He says after almost 5 years of dealing with this, there's plenty of indication that a hysterectomy is a justifiable solution, and should be a breeze to have approved by my insurance. In fact, he said even if a LEEP came back showing no signs of dysplasia (ie. the biopsy removed the only area of concern, or I spontaneously regressed), he'd still support doing a hysterectomy just to be done with it.

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Pros of the LEEP

- Should be a quick and easy procedure.

- Little chance of complications

- Quick recovery

- Potential to zap HPV virus particles

- We can get the HPV vaccine to help protect against future infections - my doctor even said he feels men should be getting the vaccine, and he will administer to anyone who wants it.


Cons of a LEEP

- While it worked well last time, it leaves me with a cervix that will have had two such surgeries - which increases my risks of a weakened cervix. Not such a big deal as I won't be having children to worry about needing to carry to term.. but I do wonder about how healthy my cervix will be to defend against future calamities.

- My cervix is obviously susceptible to this virus. And until I get into my 40s and 50s (when the cervical cells harden to become quite the defender of HPV), I'll remain so. Than means HPV will be a major concern for me. Both Chris and I are likely to be carriers of the virus for some time, and re-infection between us (even with condom use) is still possible. Also, in considering any new sexual partners either Chris or I take on. Basically.. the criteria for a new partner will be : is this person worth surgery for? Considering I'm intentionally polyamorous (despite my current hiatus) and in my mid-30s - this is a major quality of life issue to consider.

- Potential insurance problems. Most individual insurance plans will not take someone in current treatment for an abnormal PAP. Not being in treatment is defined as 'having 2 years of normal PAPs and your doctor having released you to go back to PAPs every year.' I'll probably likely never get there again, as having two episodes of abnormal PAPs keeps me as a high risk patient, needing PAPs every 6 months. As a self employed nomad, having my health care options cut for this silly virus is asinine. This is more an issue of our current medical system, than anything else.


Pros of a hysterectomy

- My cervix would be removed, reducing my opportunity for frustration from HPV in the future down to very little.

- My hunch is that I can't be considered in treatment for an abnormal PAP for the rest of my life if I don't have a cervix. I need to confirm this with someone knowledgeable about the insurance industry.

- Significantly reduced risk of future gyn problems. No future uterine fibroids, endrometreosis, polyps, uterine cancer, etc.

- No more periods, although since I discovered the Diva Cup (reusable menstrual cup), my periods really have become a non-issue.

- Learning how to spell hysterectomy without needing a spell checker to correct me.

Cons of a hysterectomy

- It's a major surgery done as an inpatient procedure with 3 days in the hospital afterwards.

- Significant increased risk of complications.

- 4-6 weeks of real recovery time (significant reduction of mobility, lifting, etc.)

- Besides the HPV thing, I've been greatly blessed with well functioning and problem free and pain free reproductive organs. It seems a shame to cut them out for a silly little virus.

- Possible future need to go on Hormone Replacement Therapy (HRT), although I'd likely leave my ovaries in. My mother had estrogen positive breast cancer after going on HRT, so this is a concern for sure.




So, there are my current considerations on my immediate options. I would appreciate any feedback on your thoughts, other points of consideration, references to resources you trust or personal stories folks might have around these options. Or heck, a simple message of support is appreciated too.


I have an appointment for a week from now, where I will tell my doctor my answer. So, I'll be giving this a lot of thought until then.