If Your Doctor Wants to do a Colposcopy

“Hi! We need to you come in for some tests.”

No women wants to get that call from your OBGYN, However it is not always as scary as you might think. It you do get a call from your doctor after your pap smear and they suggest a Colposcopy don’t be afraid.

What is a Colposcopy?

A colposcopy is a test where you OBGYN uses a special magnifying glass and light, a colposcope, to look directly at the vulva, vagina and cervix. This allows the doctor to see cellular changes which may be causing the pap smear test to come back abnormal.

Many abnormal Pap tests are caused by viral infections, such as HPV infection, or other types of infection like bacteria, fungi (yeast), or protozoa (Trichomonas). Abnormal pap test can also be the result of natural cervical cell changes (atrophic vaginitis) related to menopause. In some cases, untreated cervical cell changes that cause abnormal Pap tests may progress to precancerous or cancerous changes. The colposcopy will help determine if you need treatment and if so what kind of treatment will be most affective.

Abortions

How is it done?

Step One: Pre-Colposcopy instructions.  You will be told by the doctor or nurse that for the few days before the exam to avoid vaginal intercourse. This is because seamen which stay in the body for up to 72 hours can interfere with the doctor’s ability to visualize the cervical cells. Also, if you start your period right before you are supposed to have a colposcopy it is important to call you doctor and reschedule. Menstrual bleeding will also have the same effect.

Step Two: The appointment. The day of your appointment you will sign in and get ready in the exam room just like you are having another pap smear. You will disrobe from the waist down and put on a drape.

Once you have your feet in the stirrups and are in position the doctor will insert a speculum – the curved instrument that holds the vaginal walls apart so that they doctor can see you cervix.  This is exactly the same as a regular pelvic exam. Then the doctor will use a vinegar (acetic acid) or iodine (Lugol’s Solution) to make any areas of abnormal cells more visible to the eye and for the camera if the doctor has attached the camera to the colposcope.

Step Three: Abnormal Cell Biopsy. In some cases the doctor will look through the colposcope and see that there is really no problem. This means that the abnormality on the pap smear was not serious but they may recommend that you have your pap smears at more frequent intervals like every 6 months rather then a year. This will be determined by you doctor based on what is seen and your medical history.

However, if visible abnormalities look significant then your doctor may take small tissue samples directly from the abnormal areas they see. This is called a Biopsy. This can pinch and cause some discomfort – but it is important for proper diagnosis. If a biopsy is done there may be a little bleeding. A special solution (Monsel’s Liquid) or a nitrate swab may be used to stop the bleeding. If a sample is needed from inside the cervical opening then an endocervical curette will be used to take a sample of tissue from this area. Again this may cause cramping or discomfort – but it only lasts a minute.

Usually this procedure lasts about 15 minutes. 

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Step Four: Aftercare

After the colposcopy you will probably feel fine. However if you had a biopsy, you may have some vaginal soreness for a day or two. A little bleeding or discharge is normal for up to a week after a biopsy. It also may be dark in color because of the solutions used during the biopsy. Use a sanitary pads for the bleeding. Do not douche, have sex, or use tampons for one week, to allow time for your cervix to heal and avoid exercise for one day after your colposcopy.

Follow any extra instructions your doctor gives you and  Call your doctor if you have:

Heavy vaginal bleeding (more than a normal menstrual period).

A fever.

Belly pain.

Bad-smelling vaginal discharge.

Although colposcopy and cervical biopsy are very safe, there are always small risks of infection or bleeding so be aware of how you feel and any symptoms.

The Results – In the best case the doctor will not see any areas of abnormal cells during you test and you will not have to receive treatment.

The abnormalities seen during the test sores, genital warts or an infection, may be found in or around the vagina or cervix. If this is the case your doctor may prescribe medicine for you or other course of treatment.

If precancerous or cancerous cells are detected then you may need further procedures to remove these cells so that they do not spread causing more serious health issues.

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abortionpillnyc and Parkmed

Parkmed Physicians is a leader in women’s health care offering free pregnancy test, abortions, and full OBGYN services. This Blog is sponsored by Parkmed Physicians however it does not seek to give medical advice – for medical services you should consult your medical professional or call our office and make an appointment to meet with one of our doctors.

I am Heather MacGibbon, Ph.D. in Cinema Studies from NYC and author of Screening Choice: The Abortion Issue in American Film 1900-2000 (VDM Verlang 2009). I have been a counselor for women’s health clinics in the New York area for the past 12 years and a critic and scholar on the abortion issue in the US media for even longer. In this blog I will be keeping you updated on the current state of reproductive rights and advances in women’s health care.

As I am sure you are well aware – reproductive rights in the United States has come under heavy attack in recent months. It is hard to know where to start in looking at how things have gotten more contentious and complicated over the last year. What I can say definitively is that we are seeing as continuation of a three prong assault on the abortion rights: The Cultural War, The Legal Battle and Control of Access.

The hottest place in this battle currently is the control over access to safe and legal abortion care – which has spilled over into an attack on general reproductive health care for women. This includes both legal limitations on when a woman and her partner can choose to have abortion as well as limiting access through cutting funding.

Recent attacks on the legal front have come based on the argument that abortions beyond 20 weeks should be banned do to possible pain of the fetus. The most recent of these came last week in Iowa where a bill was passed by the largely republican senate to limit abortions in that state to less then 20 weeks into the pregnancy. This bill modeled after similar bills being considered in 15 states, one of which passed into law in Nebraska last year. A similar bill recently passed the Kansas legislature and is expected to be signed into law by Gov. Sam Brownback. Supporters state that these laws are based on research which notes that a fetus of 20 weeks or more has nerves and presumably could feel pain during the procedure.

These laws contradicts current scientific knowledge – as pointed out by Mark Rosen of the University of California, San Francisco, and co-author of a seminal 2005 review on fetal pain:

“The first brain pathways associated with pain perception "are not complete before approximately 29 weeks of gestation", so although fetuses develop brain wiring from about 23 weeks onwards, the connections are not there to enable them to experience pain. As pointed out there are very few instances when this comes up – and is part of a larger attack on all abortions bring allowed.” (Coghlan, Andy “Breifing: New Law Claims …” New Scientist April 16, 2010)

Despite the contradictions with accepted science lawmakers have forged ahead with these restrictions. This nullifies the complex issues facing women and their families. It also takes away from other – more pressing prenatal issues according to opponents.

 “Rep. Anesa Kajtazovic, a Waterloo Democrat, questioned why the body is debating an issue that has affected so few families compared to other maternity issues. Kajtazovic said just six abortions were performed in the state last year after 20 weeks of pregnancy, compared to 700 Iowa families that have experienced a miscarriage or stillbirth in the past year. "What's sad is that we have members in this body politicizing what is such a personal and difficult decision," Kajtazovic said.(Henderson, Kay Reuters on line Fri April 1, 2011 6:32 EDT)
Similar bills are also being passed in Oklahoma.
“The 94-28 vote Tuesday ( March 29, 2011)  by which the Kansas House approved a bill imposing tighter restrictions on abortions after the 21st week of pregnancy based on disputed claims that fetuses can feel pain. The House's vote was to accept the Senate's version of the bill and sent the measure to Gov. Sam Brownback .(Associated Press 03/29/11 1:58 PM)
These legal skirmishes  come on the heels of several bills being passed and signed, or expected to be signed by Arizona Gov. Jan Brewer which limit both which medical providers can perform abortion, but also the reasons that abortions can be provided.

“The law makes it a felony to knowingly perform or provide financing for an abortion sought because of the race or sex of the fetus or a parent’s race. The maximum punishment if convicted is 3.5 years in prison. Supporters said they wanted Arizona to prevent discrimination-based abortions, and they disagreed with opponents over whether there was evidence that race and sex selection-based agendas were actually occurring in Arizona. Critics said there was no evidence that selective abortions occur in Arizona, and doctors could face jail time if they lose a newly required affidavit that an abortion is not for selection purposes. “This law creates a highly unusual requirement that women state publicly their reason for choosing to terminate a pregnancy — a private decision they already made with their physician, partner and family,” Bryan Howard, chief executive officer of Planned Parenthood of Arizona, said in a statement.” (AP in New York Times March 31, 2011, on page A14 of the New York edition.)

These few legal attacks on abortion rights need to be seen in the larger context of the de funding of Planned Parenthood by the federal government which will severely limit not just abortion access – but access to cancer screening and general OB / GYN care provided by this organization. This and the other local and national legal limitations of different kinds are popping up encouraged by current anti choice environment of our current political scene.

In the coming weeks I will endeavor to highlight other legal and cultural attacks on reproductive rights as they happen.

An Informed Opinion Re The Neuhaus Hearings – How Much Suffering Is Enough?

As a long time patient advocate at several New York City Abortion Clinics I wanted to chime in with an opinion about these hearings. Over the years I have referred many patient to Dr Tiller’s clinic – while he was still alive – and never feared for the quality of care both medical and psychological that our patients received. The complaints being brought against Dr Neuhaus are just another attempt to defame the brave medical providers that perform abortions as a necessary and important part of women’s health care. These accusations are part of the ongoing battle by anti-choice groups to take away women’s rights to determine when and if they will have children.

My question to these groups is the following: How much suffering is enough? What you are trying to claim by attacking Dr Neuhaus is that her record keeping was not adequate – however standardized notes are common practice when it comes to psychiatric evaluation because the issues of patient confidentiality. Often when people are evaluated or in counseling notes are taken to provide basic information to professionals that need it –but the details remain between the patient and the doctor or psychologist doing the evaluation. Claiming that this is not appropriate standard of care is a questionable ploy.
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What is really being attacked here is whether a woman or girl in these cases – as suffered enough to be allowed to decide their reproductive fate. If it fair to ask a 10 year old girl, below the age of consent, to go through child birth which will change her life forever? Or does she only have rights if she is a victim of server trauma? I think that even anti-choice groups would have a hard time denying that these cases need to be examined carefully and the psychological harm to the woman or girl should be considered. Doctors, psychologists, social workers and counselors who make these assessments should be respected and commended for the difficult job they are performing. They should not be publically attacked and threatened with losing their licenses.

Aspiration: What to Expect the Day of Your Visit

When you schedule an appointment at Parkmed Physicians for an Aspiration Procedure you probably will have questions.

Our friendly and knowledgeable staff will try to answer your questions before you come in but hopefully the following summary will help ease your mind as well.

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When You Arrive:

 Our Office, located on the 6^th floor of  800 Second Ave, is a very secure building shared by medical offices and diplomatic embassies. When you enter the building you will be asked to produce a Photo ID in order to enter the premises. Any form of official Photo ID is fine: School ID, Work ID, DMV ID, Drivers License, and Pass Port.

When you arrive on the 6^th floor come to the lobby area and sign in at the front desk. We will ask you to fill out a set of registration forms including a detailed medical history, a demographics form and a HIPPA Privacy statement. These documents are used to ensure that you receive the highest quality medical treatment and are aware of your rights as a patient.

When you finish your forms you will be signed in by one of our Patient Facilitators. They will create a confidential chart for you in the electronic medical records system. They will review your medical history and information as well as answer questions regarding the consent forms and procedure information. You will be asked to read and sign the consent form at this time. You will also have the opportunity to discuss this form with the Nurse or Doctor before the procedure as well.

Once you are signed in, you will begin the testing phase of your visit. This phase lasted 45 – 60 minutes. We will do a urine pregnancy test to confirm the pregnancy. Then we will draw a small amount of blood to do a CBC and blood typing test before the procedure. These tests are important because they help is make sure that you are in good health and that it is safe to do the procedure. You blood type is important because if you have a negative RH factor you will need an additional medication. You will be informed if this is the case.

Once your test results and sonogram is complete the chart will be cleared for the procedure. If there are any concerns regarding your health that may affect the procedure a Patient Facilitator, Nurse, or Doctor will discuss these factors with you.

Once all your questions are answered your chart will be set up to go in for the procedure.

The Aspiration Procedure:

A nurse or medical assistant will call you and have you change into a sterile hospital gown and place your personal items in a bag that you can keep with you in the room at all times. Then you will be shown to the exam room and asked to have a seat on the exam table.

You will be introduced to your physician, nurses and the anesthesiologist. You will be given the choice to be awake or asleep during the Aspiration Procedure. Most people choose the aspiration procedure because it does not require anesthesia – however at Parkmed Physicians you comfort is very important to us. With this in mind we do provide general anesthesia for the Aspiration Procedure if you desire. Please let us know when you are scheduling your appointment if you would like to be asleep during the procedure because this effects the instructions you will be given to prepare for your visit.

The Doctor will ask you to lie back on the table with your feet in the stirrups just like you are having a regular pap smear performed. Once you are in position the doctor will perform a pelvic exam to check you vagina. They will then insert a speculum – the duck bill shaped device used to hold the vagina open during GYN examinations. The doctor will then swab you cervix with iodine to clean the area and give a series of injections, called a cervical block, to numb your uterus. Although your uterus will be number you will experience some cramping during the procedure.

The doctor will gently dilate your cervix. Once this is done they will insert a tub called a canulette through the cervix into the uterus. Once this is in place they will attach the canulette to a syringe like device which will be used to manually provide gentile suction and remove the pregnancy tissue. You will want to breathe slowly and deeply through your nose and mouth to help you relax during this procedure. The doctor and nurses will talk you through the steps so that you are as comfortable as possible. The Aspiration Procedure will take approximately 2-5 minutes.

Once the procedure is complete the doctor will remove the canulette and then the speculum from your vagina. They will place a sanitary pad on for you so that if you have post-operative bleeding you do not need to worry. Once they are certain you are ok you will be allowed to rest in the exam room or in the recovery area after the procedure for 30 – 45 minutes or longer depending on how you are feeling. The nurses will monitor your bleeding, blood pressure and temperature until they feel you are ok to leave. If you are asleep for the procedure you will need someone to escort you home at the end of your visit.

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Post Aspiration Instructions:

The instructions for care after an aspiration procedure are the similar to those for a m procedure. You will be given written and verbal instructions by the nursing staff before you leave our facility.

You will be given a prescription for antibiotics to help protect you from getting an infection while you cervix closes back down. You will also be asked not to insert anything into your vagina for 2 to 3 weeks after the procedure. This will keep extra bacteria from getting into your vagina which could infect your uterus. If you run fevers over 100 degrees during this time you should contact the office so that the doctor can evaluate the situation and possible have you come in for further treatment. You also want to avoid heavy exercise for two to three weeks after having an aspiration. While bleeding is normal after the procedure – and the amount is different for every woman – exercise like heavy lifting, running or working out at the gym can cause increased bleeding. If at any time in the two to three week period after the procedure you begin bleeding enough that you need to change maxi pads more then twice an hour you should contact the office immediately.

You may have some cramping as your uterus goes back to normal. You can take Ibuprofen, Tylenol or other over the counter pain relievers as long as they do not contain aspirin. Aspirin acts as a blood thinner and will cause extra bleeding. If you are on blood thinning medications please let the doctors know before your procedure so precautions can be taken to protect your health.

You Follow Up Visit:

You should have a check up 3 weeks after your procedure. You can book this appointment when you are signed in for the procedure to ensure that you get a good time and date that will be convenient for you. If you wish to return to your own OBGYN you can do so, but they may request that the tests from the visit are sent over. We will need a signed medical records release to send this information.