How To Handle A Problem Pap

The best treatment may be less invasive than you think.

You had your Pap two weeks ago, but this time your doctor called you for a follow-up instead of sending the usual "No worries" postcard. The Pap revealed precancerous cells on your cervix. Your first response? "Get them out now!" But you may want to hold off: Nearly 60 percent of the 1 million women diagnosed each year with this condition, called cervical intraepithelial neoplasia (CIN), have such mild cases that treatment isn't necessary. In fact, having the cells excised may lead to other problems later. A study recently found that women who had the loop electro excision procedure (LEEP)—a popular treatment—were three times more likely to have preterm babies than women who didn't undergo it, possibly due to resulting scar tissue on the cervix, according to a report in Obstetrics & Gynecology.

Taking a watch-and-wait approach is actually what experts recommend in mild cases. That doesn't mean doing nothing: Your doctor will monitor you with a strict schedule of Paps, colposcopies (magnified cervical exams) and tests for human papillomavirus, the sexually transmitted disease linked to cervical cancer. And most likely, your immune system will knock out the abnormal cells. Women with moderate or severe CIN, however, should have the cells removed. Use our guide, then talk to your M.D. about your options.

Solution #1. Your doctor can perform LEEP, using an electrically charged loop-shaped wire to remove the tissue. The almost painless procedure lasts 5 to 10 minutes, and in moderate to severe cases of CIN the lifesaving benefit far outweighs the possible risk for a compromised future pregnancy, study author Sheri-Lee Samson, M.D., says. Maximize your chances of a healthy pregnancy post-LEEP by eating well, exercising regularly and not smoking.

Solution #2. Your M.D. vaporizes the problem spot with a laser in the office. Laser ablation doesn't seem to impact pregnancy, but it can cause significant cramping, and you can't have sex or use tampons for three weeks.

Solution #3. Your physician can freeze the abnormal cells. During cryotherapy, you may feel pressure in the lower abdomen; after the procedure, watery discharge may persist for up to a month as your body expels the tissue.

Solution #4. For the most severe cases, a doctor removes a piece of the cervix with a scalpel while you're under general anesthesia, in a procedure called cone biopsy. Some women may experience bleeding and, in rare instances, fertility problems later. The good news: If you stay up-to-date on your Paps at the ob/gyn, there is little chance you'll ever need a biopsy this invasive.

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