Pap Smears

Pap smear/cervical cytology is offered routinely at annual examinations as well as based on risk and previous history.  ThinPrep, which is a trademark liquid based cytology, has been proven for over a decade to be the superior method of analyzing Pap smears with lowest false negative rates and the highest sensitivities of all methodologies combined.  Dr. Wheeler has been using ThinPrep for over ten years since it was first FDA approved in the United States with great success.  In addition, human papilloma virus (HPV) screening (Hybird II) will be included based on a risk analysis of the patient’s history or upon request.  Hybrid II capture analysis will be included with the Pap smear or performed separately based on the outlined indications. 

It is widely understood that most cervical cancers are associated with certain high-risk HPV viruses which are screened for with the hybrid capture technique.  It is felt that all women 21 and over should be routinely screened with Pap smear and/or HPV screening.  Over the age of 30, women who are monogamous may chose to have hybrid screening performed on an every two to three year basis based on recent data available.  These will be discussed with you at the time of your visit.  In the event that there are abnormalities which include the high-risk viruses for cervical cancer, a colposcopy will be recommended and performed in the office.

Colposcopy

Colposcopy is a microscopic evaluation of the cervix and endocervix for signs of abnormalities associated within the papilloma virus and dysplasia.  The procedure takes 10 to 15 minutes in the office and the cervix is cleaned with acetic acid (vinegar).  Biopsies may be obtained at the time of the procedure which usually result in no more than a small pinch or cramp.  The patient will be asked to return one week later to review the results of colposcopy to assess if there is need for further treatment.  In most cases, younger women with mild abnormalities will require no treatment and will be asked to return every six months for repeat cervical cytology (Pap).  In the event that more significant abnormalities including moderate or severe dysplasia (CIN II & III) or precancerous changes such as carcinoma insitu, the patient will be asked to return for treatments which include, LEEP or LLETZ procedures. 

LEEP

Loop Electrical Excision Procedure (LEEP) and a similar procedure LLETZ (Large Loop Excision of the Transformation Zone) are procedures performed in the office under local anesthesia.  In rare cases, these will be performed in the operating room, but more than 95% of patients find that the mild discomfort of this procedure is very tolerable in the office setting.  These will be performed when colposcopy reveals that more severe cell changes are seen such as moderate to severe dysplasia or changes not regressing after 12 to 24 months of observation.  The cervix is anesltetized with local anesthetic and the patients find the procedure very tolerable.  Patients are asked to follow-up in two weeks to check for proper healing and to review their results and will be seen on a regular basis of for the next one to two years to assure that the treatments are successful.