Trying to Figure out.... (pregnancy mentioned)

So I found out about 9 months ago I had HPV. I got a mild grade abnormal pap. They did a copo and did the biopsy. It came back a mild/moderate dysplesia and they did a LEEP in the few spots they found it. Well during this time before I had found out I had the HPV we had been trying to have another child for well over a yr. Afterwards I saw my doctor and he decided to put me on the fertility drugs without doing the follow up after my LEEP since most people dont get the HPV back that soon anyways. Well, I got pregnant and a different doctor decided to do the swab for HPV during my normal pregnancy pap. I got the call and was informed I had gotten a high grade abnormal pap for HPV again. They did the copo but since I am pregnant decided not to do the biopsy. She did however find that I have gotten the HPV and it is very widespread through my cervix. Which is VERY different from last time since I had only had it in a few spots. There isn't anything they can do until I have the baby in July. BUT I also know my mom had a hysterectomy when she was 27 due to cancerous cells found. And she had a lot of cysts. So problems do run in my family. BUT my question is do you think they would perform a hysterectomy in order to keep the HPV from getting so bad. Because I would love to get one done if it would make the chances of me getting cervical cancer lessen. I would really want a hysterectomy done but how likely is it that a doctor would see my situation and think it is needed?

Because of your fears, I would suggest making an appointment with an oncologist, especially a gyn/onc, and discuss your concerns and risks. An oncologist would be the one who would have the best idea as to your risk factors based on current condition, family history, etc. The oncologist may also have suggestions for helping during your pregnancy.

A hysterectomy is a major, irreversible surgery that is not without risks. When considering one, you must weigh all the pros and cons for you, knowing that not everyone has a good outcome. You will also need to consider the hormonal side of things and decide whether or not keeping your ovaries is right for you, and if you have them removed, can you use HRT or will you have to deal with surgical menopause using alternatives.

I would highly recommend keeping your GP involved in all that you are going through as your GP treats all of you and can help refer you to the specialists you may need.

Many best wishes to you and I hope you find information to help you with your decision!

Wow--you're dealing with a lot right now!

So, have you actually had another abnormal PAP, or just a positive HPV test? When you said the HPV was all over your cervix, does that mean that there is widespread dysplasia on your cervix (your doctor would not be able to see HPV--only dysplasia which is caused by HPV).

HPV is kind of tricky to deal with. It is estimated that 80% of women are exposed to or infected with HPV by the time they are age 50. Most of those women never have any signs or symptoms that they HPV. Most women find out they have HPV when their PAP comes back abnormal. It sounds as if you were treated with a LEEP, which for 90% of women is all the treatment they need. Unfortunately, though, a LEEP does not remove the HPV--only the cells that became abnormal as a result of the HPV. We continue to carry HPV with us. Most women will develop an immune response which keeps the HPV in a dormant state so that it doesn't change any more cells. This typically occurs within about a 2 year period. Some women have a little more difficulty with the virus and they will require additional treatment to continue to remove abnormal cells that develop as a result of the virus.

Now, it's possible that not all of your abnormal cells were removed during the first LEEP. Even a couple of stray cells can eventually replicate themselves until you have a full-blown problem again. It's also possible that your pregnancy was enough to bring about a re-activation of the HPV. Immune function declines during pregnancy, so it kind of opens the door for HPV to start changing cells again. It's impossible to know exactly what happened there.

At this point, it is very important that your doctor continue to monitor your cervix. It's several months until your baby is born, and your doctor will want to watch to make sure your dysplasia is not becoming more widespread or more aggressive. You might like to ask for a referral to see a gynecologic oncologist. They are the experts when it comes to female precancers and cancers, and they are highly trained in dealing with this type of situation.

It's possible that no decision will be made about treatment for you until after your baby has been born and you've had your follow-up PAP. Some women do have biopsies done during their pregnancy, and you might need to have that done as well--they like to wait until you are past a certain point though, to insure the safety of the baby.

Keep asking lots of questions. And remember, even if you have a hysterectomy, that does not guarantee you won't have ongoing problems. It is unusual, but dysplasia can recur on the vaginal wall after the cervix has been removed, so it's important that you continue to have regular follow-up PAP's--even after a hysterectomy.

Good luck during these next few months. I hope you have a smooth, healthy pregnancy and that your dysplasia remains stable or starts to resolve. Please feel free to continue asking questions about your dysplasia.

thanks so very much for your help. And yes, I did mean that it was dysplasia that they found. The first time it was very few cells and only in a couple spots on my cervix. This time the doctor said it is very widespread through my cervix. But they do plan to monitor me through my entire pregnancy, but I still worry. She said the likeliness of this reoccurring so soon after my LEEP was not very likely, so my getting it makes me worry that it may get worse. I do realize have a hysterectomy is A LOT to go through, but I think that dealing with those problems might be better than to worry about gettin cancer from the HPV. I do know that there is always going to be a possibility of problems even if I were to have a hysterectomy. BUT I can not see an onocologist because I am an Army wife and we are stationed overseas. This is a very very small base and they truely don't offer much as far as health care. BUT we leave a year after the baby is born so I plan to follow up with this as soon as we are back in the states. My question is how likely do you think they would even offer it as an option? I know my age will have a factor since I am only 21. But I do know that this is something I would want.

jeanine explained really well about hpv and dypslasia, and such, so i won't repeat any of that information (!), and i just wanted to add that your being 21, a young age in the grand scheme of things, is a definite advantage in fighting off the hpv as well as the dysplasia since your immune system is stronger when you're younger vs. older. i hope you don't need to have a hysterectomy and that the dysplasia is eliminated via less major surgeries such as additional leeps or cone biopsies, or even goes away with your own immune system kicking up a notch. having a hysterectomy is a major surgery with risks, and still doesn't guarantee that dysplasia/cancer won't develop since the virus will remain in your body regardless of treatments and surgeries.

best wishes for a healthy and happy pregnancy.