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21st-Jan-2009 07:28 pm [cramps, pap smear, preterm labor]
christina // covering face
Okay, I had a cervical biopsy today. They were just supposed to take a look at my cervix because of an abnormal pap, but there was some type of lesion or something on there that they needed to take a biopsy of. I'm kind of freaking out thinking I might have HPV or something. Has anyone had one of these done? And does it usually mean HPV or is it quite commonly something else?

I also wanted to ask... They told me to come back if I had heavy bleeding or severe cramping. I've had some cramping but not severe, but I'm trying to decide if my stomach starts feeling tighter than normal when they happen. Can a biopsy cause preterm labor? What exactly are the signs? Does preterm labor always come quickly or can you stay in early labor for a long time still if you're coming preterm? Maybe I'm just freaking myself out about this... I'm 29 weeks.

Thanks.

Edit: Also, I believe what was done was a "punch biopsy" from what I've read but I'm not sure. I keep reading that cone biopsies are a cause for preterm labor but I don't think that's what my doctor did. She didn't tell me what type of biopsy it was though, and unfortunately I wasn't educated enough about biopsies to ask which type she was performing. I figured a biopsy is a biopsy...
Comments 
22nd-Jan-2009 12:42 am (UTC)
I had HPV, cervical displaysia level 2 or something like that, basically is left untreated it likely would have turned to cancer within a year, the biopsy itself wasnt bad, the leep proceedure they did to remove it they would probably post-pone for you, they told me not to get pregnant for X amount of time (it was a while ago, dont remember how long the time was), because the leep proceedure can weaken your cervix.

Them warning you to watch for cramps was probably just precautionary, if you're nervous to go the Doctor though, always trust your body
22nd-Jan-2009 12:44 am (UTC)
I've read that when they remove the HPV lesion that you normally gain an immunity to the strain and after the lesion has cleared and you gain the immunity you're no longer considered infectious unless another lesion appears, is that correct? The information I keep reading about HPV seems very conflicting.
22nd-Jan-2009 12:48 am (UTC)
I wasn't told anything like that, and in fact seems off, since I had to be tested every 3 months for HPV for a year, then every six months for another two years, so it took 3 years to go back to my regular yearly pap. Seems to me if you became immune you wouldnt have to be tested constantly, and it doesnt take anywhere near 3 years for the leep crap to heal, more like a week or two
22nd-Jan-2009 12:56 am (UTC)
I've read a lot of things like this that make it seem like you don't have HPV forever, it goes away on its own usually... so now I'm kind of confused as to whether you have it and are contagious for life or if it commonly clears up and you're no longer contagious.
22nd-Jan-2009 12:57 am (UTC)
It varies. If you have "level 1" or whatever they called it, it typically goes away on its own, "level2" typically turns into cancer, "level 3" is cancer

Once they do the leep proceedure and burn off a chunk of your cervix you are clear, I no longer carry HPV
22nd-Jan-2009 01:02 am (UTC)
That's good! Well, not that they have to burn off a chunk of the cervix, but that it's possible to be HPV free again. My real concern is that if you DON'T develop the immunity, since there is no cure/treatment for males, it would theoretically be possible to reinfect yourself with HPV if you're still with the same partner you contracted it from.

"In some cases your body may have developed antibodies that suppress HPV to the point that it is undetectable on tests, or may have at least suppressed any symptoms of HPV, however the virus may still technically be present." is from AskAlice.com.

I'd think maybe the antibodies would be what the immunity is that keeps you from getting the same strain from the same partner over and over again is? I'll have to ask my doctor. :) But here's hoping it's just a random hormonal change from pregnancy and there's no HPV in me to worry about anyway! Always good to be educated though.
22nd-Jan-2009 01:05 am (UTC)
Well that's very possible (the hormonal thing) 'cuz I know they told me not to have my pap if I had recently been sick, or was the day or so after my period, 'cuz it could cause abnormal paps without it actually being hpv
22nd-Jan-2009 01:07 am (UTC)
Well, I know SOMETHING was there for them to biopsy, but I really do hope it was just a random cell change in my body from the pregnancy and not something serious. There was something there that definitely threw the pap off though.
22nd-Jan-2009 01:08 am (UTC)
Well I'll keep you in my thoughts and hope it's just a cold or something unimportant :)
22nd-Jan-2009 01:13 am (UTC)
Thanks! I'd like to hope so
22nd-Jan-2009 04:25 am (UTC)
if you get the DNA Pap then another illness or anything else would not cause a false positive as far as the HPV part goes. The DNA Pap looks for the actual DNA of the HPV for a positive test.
22nd-Jan-2009 02:15 am (UTC)
it is not uncommon for HPV to be come active in women when pregnant even when they never had symptoms before. But a biopsy - even a punch biopsy - should not be done while pregnant esp considering that once you deliver your immune system most likely get the HPV back into check. i really would question your doctors care if s/he would put you at risk like this. the reason it is not done on pregnant women is 1. higher risk of infection 2. possible pre-term labor.
22nd-Jan-2009 02:22 am (UTC)
I keep looking for a medical site that tells me preterm labor can be caused by a punch biopsy, but they all say just cone biopsies. I do know there's a higher risk of infection and prolonged bleeding (and the subsequent issues from prolonged bleeding) during a biopsy. I was a little weirded out by my doctor doing a biopsy as well, but she's been great about everything else and she said she only does a biopsy if she finds it to be absolutely necessary during pregnancy, which is kind of what scared me in the first place. I'd hate to get rid of this doctor because I'm so close and I really like her, but this did kind of freak me out a little bit. She seemed to think I really needed to get the biopsy though.
22nd-Jan-2009 02:33 am (UTC)
It's also very odd to me in general because PAPs are so often abnormal in pregnant and newly PP women. The idea that she would consider more action after that is odd (assuming a merely "abnormal" result and not something clear that needed to be acted upon obviously and immediately).
22nd-Jan-2009 02:36 am (UTC)
She was originally just going to do the colposcopy (forgive me if the spelling was wrong) to LOOK at the cervix, and then when she did it she saw some sort of lesion that worried her that she said she was going to biopsy.

It weirded me out a little bit when she started looking up there and asked me if I smoked/used to smoke.
22nd-Jan-2009 04:20 am (UTC)
there are studies that link smoking with HPV infections but honestly she should totally know about the pregnancy/HPV link. not smoking and increasing B complex has been linked with helping suppress the infection but there is not a whole lot that can be done while pregnant. but i am guessing that you are not smoking right now and taking your prenatal so the most likely cause the HPV flair up is the pregnancy.
It is one thing to get the colop while pregnant so that they can map out where the infection is for later if needed. for the colop they "paint" the cervix with acetic acid (basically a white vinegar solution) and HPV infected cells turn white - that is most likely your "lesion" that she biopsied.
honestly the whole situation has me weirded out out and personally i would consider getting a new doctor/at least a second look on the situation...
22nd-Jan-2009 04:44 am (UTC)
I've cut down smoking but quitting entirely has been extremely difficult for me, but I'm about to try quitting cold turkey again. (Better late than never, right?) I also haven't been the best about my prenatals lately. I was diligent about them during the first trimester but the past few months I'd say I'd been slacking. (The whole I-can't-remember-a-pill-every-day thing is part of the reason birth control wouldn't have done a thing for me...)

If I understood her correctly, she actually removed the lesion today when she did the biopsy. I don't know. I wish I really knew which questions to ask when it comes to these things but I tend to trust my doctors too much and not be well informed enough unless I have time to get to a computer before the procedure. I'd looked up a colop before and knew what it was but hadn't done any research on the biopsy before today.
22nd-Jan-2009 06:23 pm (UTC)
okay - so you are working on the smoking thing - good for you.
as far as the prenatal if you have a really well balanced diet then they are not as important but they are good thing to take. put them in a place where you'll see them so that it can help you remember to take them.
if she was able to remove the lesion with just a punch biopsy then it was not large at all!
as far as being pushed around by your doctor if you don't start getting more informed than this will just con't.
22nd-Jan-2009 03:02 am (UTC)
iron shots are rare to say the least. unless you have an actual medical condition such as cancer most doctor will not give them.
there are many different ways to get iron into your diet and making sure that you get enough b complex as well as vit c are just as impt when it comes to iron absorption. many (pregnant) women like taking liquid iron supplements as they are just over all easier to deal with - so that is something to look into
22nd-Jan-2009 03:04 am (UTC)
i have no idea how this ended up here and not somewhere else - sorry!
24th-Jan-2009 04:51 pm (UTC)
OK, I know this is a late comment but I just want to clear up some misinformation in some of the above comments.

They're not looking for HPV on a cervical biopsy. HPV is the virus (actually a group of viruses) that causes genital warts. HPV is *associated* with cervical cancer and, by extension, precancerous changes of the cervix. You can have genital warts removed but there is no treatment to cure HPV. It can go away on its own.

If you have an abnormal pap smear, it does not mean that HPV was detected. It means that it's likely that the outer layer of cells on your cervix are showing changes in size or shape. These changes are generally called some form of "squamous intraepithelial lesion" (SIL) or neoplasia--meaning abnormalities of the squamous cells on your cervix. They can be low grade or high grade--less or more severe changes--and they are the kinds of cell changes that can turn into outright cervical cancer if left alone. The fact is that these lesions are often associated with HPV, but you are not being tested or treated for HPV by having a biopsy of these lesions.

Smoking cigarettes is associated with a higher risk of cervical cancer which is probably why your doctor asked you about it.

The terms for these precancerous cervical lesions can include LGSIL, HSIL, CIN I, CIN II and CIN III. Google them for more info.

If your doctor did a colposcopy, she probably stained your cervix with acetowhite, and if she saw a lesion that looked like cancer or pre-cancer she took a little chunk of tissue (yeah, probably a punch biopsy, almost definitely not a cone biopsy) to see exactly how malformed those cells are. She'll be giving you your diagnosis shortly.

Almost all of these lesions are precancerous and are treated easily with a cone biopsy, laser, LEEP excision, or some other form of scraping off or removing the top layer of cells from the cervix. This is generally not done during pregnancy.

If the lesion is actually invasive cancer, that is a very serious thing and warrants much more aggressive treatment. But that's relatively rare.

Hope this helps.
24th-Jan-2009 09:50 pm (UTC)
i think that it would be safe to say that the science has shown that most cases of cervical cancer are in fact caused by high risk HPV - there is no quasi association between the two.
Genital warts are caused by low risk strains of HPV.
acetowhite (aka acetic acid) will only change the colour of cells from normal to white when they are infected with HPV. The punch biopsy allows a pathologist to determine how deep in to the underlaying cells the virus as been able to infect - thus how invasive the infection is.
25th-Jan-2009 01:13 am (UTC)
I agree with everything you said, except that most but not all neoplasia is caused to HPV. The pathologist will most likely look for depth of invasion of neoplastic cells. Acetowhite may show precancerous lesions and/or HPV lesions, and yes, the biopsy tissue may also be tested for HPV but the precancerous cells are the main concern regardless of the cause. Many, many, many people have high risk strains of HPV without ever developing precancerous changes.
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