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Forum Name: Gynecology

Question: No cervix but LSIL pap result


 Twig Hamilton - Fri Dec 30, 2005 1:04 am

Hello,

I've recently been informed that my last pap smear came back LSIL. Had a referral to a ObGyn today but she was called away from her office for an emergency thus no colposcopy or information.

Due to complications from my first bowel resection for Crohn's Disease, I suffered from a severe abdominal and pelvic infection which ended in a total abdominal hysterectomy when I was 20 years old. All of the cervix was removed. Because of that, I've been informed (or perhaps mis-informed) that I didn't need regular pap smears though my current GP suggested that I did.

This is the second smear that came back abnormal, the first being 2 years ago and, after GP discussed it with ObGyn, they decided to not further investigate due to the fact that I had no cervix and had a yeast infection at the time of the smear. Thus, HPV was mentioned but then never addressed again by my physician. I, perhaps foolishly, thought that all was well and there was no need for concern.

I understand that most LSIL results are due to underlying high-risk type HPV infection...

Q: Are such results possible (with or without underlying HPV) with a sample taken from a vault smear?

Q: Perhaps there are cervical cells remaining?

Q: Can high-risk HPV cause LSIL in vaginal tissue?

I have been in a monogamous relationship for nearly two years now and as we've both tested negative for all types of STD's including HIV, we've chosen to have unprotected sex. High-risk type HPV was not a cause for concern as neither of us knew much about it and there was not part of my testing.

Although I'm aware that he would have already been exposed and contracted HPV if I have it, I'm concerned that continuing to have unprotected sex will put him (or his future partners) at higher risk.

Q: Would it be wise to abstain until I see my ObGyn in or to start using protection (i.e. condoms)?

Due to bowel disease, I'm currently taking the immunosuppressant drug Imuran (5th year into it), and am taking the oral steroid Budesonide (Entocort). I am also on HRT.

Any advice would be greatly appreciated.

Thank you.
 Rhonda P, CEP - Sun Jan 01, 2006 12:38 am

User avatar Dear Twig Hamilton,

It isn’t usually necessary for a woman that has had a hysterectomy for benign reasons to get pap smears on a routine basis unless it has been advised by a physician (It is generally recommended to get them every few years). When one is done, tissue is taken from around the area where the cervix use to be and the tissue is tested for the development of any carcinoma or dysplastic lesions.

Infections and medications can alter the results of a pap smear, results will need to be confirmed with follow-up exams. Chronic steroid use or other immunosuppressive drugs can also cause a change in the pap smear results. Make sure your doctor is aware of the medications you take. To ensure your pap is not tainted in any other way, don’t have intercourse, douche, use vaginal creams or anything you would insert vaginally for at least 24 hours prior to the exam.

LSIL - Low-grade squamous intraepithelial neoplasia lesion = mild cellular changes, a small number may progress to cancer but the majority of the cells can return to normal if left alone.

HSIL – High-grade squamous intraepithelial neoplasia lesion = moderate to severe changes in the cells and are considered precancerous

Any time you have an abnormal pap smear it is recommended that you have a colposcopy and biopsy for identification purposes and treatment decisions.

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