In this article
- endocervical curettage (ECC)
- endometrial biopsy
- genital wart removal
At Women's Health Network, we want to stress to our readers who have received an
abnormal Pap test result that the purpose of follow-up monitoring is to safeguard
their reproductive health. It can be such a source of such frustration for women
when they are unsure as to why they’re being asked to return for repeat Pap
tests or colposcopy.
We want you to consider repeat Pap smears and further screening methods as tools
for monitoring how well your immune system is protecting your reproductive health,
and to view follow-up procedures as a means of preventing any deterioration of your
cellular health into something more concerning. When you have the information you
need to reverse damaging change at a cellular level, you are better able to rally
your natural ability to heal.
Colposcopy and endocervical curettage (ECC)
Colposcopy of the cervix, which usually includes ECC, is the most common procedure
that women undergo after an abnormal Pap. Where the Pap is a screening tool, focusing
a practitioner’s attention, the colposcopy is diagnostic and more specific.
Colposcopy typically involves a second component, where the ecto-(outer)-cervix
and/or endo-(inner)-cervix are biopsied. In this procedure the clinician uses a
magnification lens (the colposcope) to view the cervix for cellular changes
and locate sites appropriate for biopsy. The biopsy procedure entails the removal
of a tiny piece of tissue that is then sent for more detailed analysis by the lab.
Sometimes more than one biopsy sample is taken, or none at all.
The colposcopy generally includes an ECC, in which the endocervical canal is scraped
more vigorously than in a Pap test. The samples are placed in jars of fixative and
sent to the lab. A diagram of the cervix is kept in the woman’s chart to document
where the samples were taken from. Some clinics also use digital photographs to
keep an accurate record.
Quite often a biopsy will show no further concerns and the woman can return to Pap
test screening — usually at shorter intervals at first. Sometimes the biopsy
shows that HPV is causing cellular changes right now that warrant further monitoring
or intervention. The changes on biopsy could be more severe than estimated on initial
Pap test. The pathology from the colposcopy is considered diagnostic, so the colposcopy
findings trump what was found on the Pap test.
If a woman has been found to have a high-risk strain of HPV, a practitioner may
also need to take a look at the outlying ruggae (folds) of her vagina, as well as
the vulva, to evaluate the need for more intensive HPV treatment on the vaginal
walls and vulva.
Endometrial biopsy can be described as somewhat of a deeper Pap smear, except in
this procedure the clinician collects cells from the inner lining of the uterus
instead of just the tip of the cervix.
There are many scenarios that indicate the need for an endometrial biopsy, such
as abnormal glandular cells (AGUS) on a Pap smear. Endometrial biopsy is also commonly
recommended for women over 35 with any unusual bleeding, spotting, changes in their
menstrual cycle patterns, or a thickened endometrium seen on pelvic ultrasound.
In this procedure a sterile straw is passed through the cervix to the inside of
the uterus to collect a sample of cells from the inner lining of the uterus (womb).
Then the straw is removed, and the collection of cells placed in jar of fixative
and sent to the lab. Further management of biopsy findings beyond normal cells is
complex and depends on the individual situation.
The results of a colposcopy/ECC or an endometrial biopsy dictate what may be needed
next and at what interval. While HPV typing results can also help guide recommendations
for follow-up, this information is less definitive than what cellular pathology
can show. Follow-up HPV testing can help track a woman’s immune response.
Even when an HPV test turns from positive to negative, however, this does not signify
that HPV is no longer present — it is more the case that her immune system
has shut down the flare-up. What this does reveal is that the immune system is doing
its job, and that is always good news.
Genital wart treatment
When it comes to genital warts, a woman’s treatment options vary both according
to location and extent of the warts. In many cases, external warts can be treated
by the patient, under the guidance of her care provider, using a regime of topical
cream application. More extensive external warts are often treated directly by the
provider with a range of topical or surgical treatments. Repeat treatments are sometimes
needed as well.
Depending on her GYN provider’s experience, a woman with internal warts may
be referred on to see a specialist for consultation and treatment. Again, treatment
is based on the location and extent of the warts, but vaginal, cervical, or urethral
warts are often treated with either cryotherapy or a number of topical choices.
Anal warts may also be treated with these options, or they may require laser vaporization
or other surgical removal. The woman may need repeat treatment in some cases.
As in all fields, technology is rapidly advancing to afford us a wider range of
choices. Topical treatment of genital warts with imiquamod (Aldara) is
now becoming the treatment of choice in many places. Aldara works as an immune system
modulator, increasing the immune response and thereby decreasing virulence of the
HPV. Trichloroacetic acid (TCA) and bichloroacetic acid (BCA) are also still widely
used, and other developments showing promise in genital wart treatment include laser
vaporization and ultrasound. According to many experts, the effect of TCA, cryofreezing,
and laser therapy is largely a “cosmetic” one — that is, the warts
are visibly gone but there is no guarantee the HPV at the site will be eliminated.
Granted, anything that improves patient comfort and convenience represents an advancement.
But it’s the immune system that holds the key.
We understand that circumstances vary widely from woman to woman, including her
personal preferences, her practitioner’s range of experience, and other resources
she may or may not have available to her. In providing this information, we hope
to guide you as you work with your practitioner in planning the ideal treatment
for your unique situation.
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