September 16, 2013

Colposcopy: 15 Minutes With A Flashlight And A Scalpel

Should anyone looking for more information about what a colposcopy is and what it's like, I hope this can help. Regular readers: prepare to be educated.

After 8 years of perfect Pap smears, a month ago it came up abnormal. The doctor found a small lesion, which she called LG-SIL, or low-grade squamous intraepithelial lesion. She acted like it was no big deal, and more or less explained that women get Pap smears because cervical cancers often come with no symptoms, and tends to be discovered way later than it could have. As long as you have a history of normal Paps you get them every two years. An abnormal one means you get them every year, after whatever procedure is necessary to return it to normal. 

So today I went in to get a colposcopy (medical professionals call it a colpo - I guess they deal with a lot of -oscopies). As soon as my ID and insurance were verified, they sent me to the back for a urine sample for a mandatory preggo test (negative, yay!). I didn't even get back into the waiting room because the medical assistant was waiting to take me to the exam room. She sat me down, took my vitals, told me to undress from the waist down and gave me a sheet as a cover. Usually, you sit like that for, like, 10 minutes waiting for the doctor to come in, but no sooner had I sat back down than the doctor knocked and came in.

She explained again to me what was about to happen: there was a device to my left that looked like a cross between a microscope and a hydra that she was going to use to get a better look into my cervix. It would stay on the outside of my body, so the rest of the procedure would very likely go like a regular old Pap smear: speculum, gynecologist, and some swabs. Should she see anything abnormal she'd take a biopsy to send to the lab, otherwise she'd take a scraping just to be sure there wasn't anything the Pap missed.

I had a very strong feeling throughout the procedure that this was more of a liability issue, rather than a real medical concern. If I were to develop cancer and had a recent abnormal Pap that they ignored I'd have a case against them. Plus, Paps aren't perfect, and an abnormal result could indicate something more serious, so it really is better to be 100% sure it's nothing to worry about than assume it'll just go away on its own, even though it most likely will.

Since nothing really was going on inside my uterus there was no need for any anesthesia; the doctor explained even if she has to take a biopsy it will hurt more to administer the local anesthesia than the second or two it would take to get the sample. At first, everything felt a lot like getting a Pap smear - she found a smaller speculum to make it more comfortable (God, these doctors are amazing), I could feel the Q-tip as she cleaned and collected, and we chatted about my neighborhood and this restaurant that closed and how the owners of a beer shop down the street are reopening it, all while the medical assistant stood silent in the room. Then the doctor told me she didn't see anything abnormal, so she was just going to take a scraping.

She might actually have not used a scalpel... I couldn't see over the sheet what exactly was going on and didn't try to watch, but I sure as hell could feel everything and it felt like what I imagine a scalpel in your uterus feels like. Un-fucking-pleasant. She told me I would feel cramping, and seemed to hunker down to get this part over with as quickly as possible. I'm very lucky in that I rarely experience cramps, and the ones I do get are very mild. But this felt like the worst cramps ever. I kept trying to relax my legs and not tense up, pinching myself for distraction, but I ended up making some noise anyway. Any woman who has experienced bad cramps or a Pap smear will understand what that feels like, only times 10. Ouch. But it wasn't a searing pain and it was over as soon as she was done. 

As soon as she got the scraping she removed the speculum and told me I was free to sit up if I felt OK or I could stay laying down. The doctor housed her sample, cleaned up, asked if I had any questions, and was out. The whole thing took maybe 10 minutes. Crazy fast. I was allowed to dress, the medical assistant gave me a panty liner to protect against spotting, and I headed to the check-out desk for my paperwork.

Unfortunately, that's where it got a little scary. The medical assistant left her desk for a minute to retrieve the paperwork from the printer, and immediately I started to feel hot and lightheaded. This familiar wave rushed over me - the air in the room was gone, I was sweating, and I knew I was about to pass out. I held on to the counter and tried to focus on a word on the wall... but no one was around if I did pass out, so I found a chair in an exam room, sat down and fanned myself with a paper. The medical assistant found me after a few seconds and helped me to the exam bed to lay down, then went to get the doctor. When they came back they brought some water, a cold washcloth for my forehead, and the medical assistant took my vitals again, just to be sure. Apparently this happens - I guess messing around with your cervix has some other effects on the body. After a few minutes and normal vital signs I felt well enough to leave.

Things you should know about a colposcopy:
  • They'll give you a sheet of things to prepare yourself - no sex and no putting any creams or products in or near your vagina for three days before the procedure.
  • You probably want to take an aspirin or something before getting there in case you have cramps. I didn't and the pain was only during the procedure.
  • My insurance would have charged me $100-200 to have it done in a hospital, where the original appointment was made, which a super awesome nurse informed me of and let me change my appointment to a medical facility that wouldn't charge the fee. That being said, I still have no idea how much my insurance will charge me for this whole thing (but I'm glad I didn't need a biopsy!).
  • No sex and no tampons for three days after the colposcopy. 
  • There might be spotting and cramping (I didn't have any effects after). 
  • Wear cotton panties for breathability.
  • Results come back between 7-10 days, and you should expect a call from the doctor that performed the procedure.
I hope anyone reading this who is about to have a colposcopy or knows someone who is has found useful information here. This was the fastest medical procedure ever, and all in all not as bad as I was fearing. Also, anyone sexually active (under 30, I think) should get the Gardasil vaccine - protecting yourself and/or your partner(s) against 75% of viruses that cause cancer and warts is a crazy good idea.

EDIT: My results came back normal, as expected. Now I just need to schedule my follow-up PAP for one year from now to make sure everything is still all hunky-dory.

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