Last September, I was trying to drink on my lunch hour when the doctor's office called. I hate when the doctor's office calls when I am trying to drink on my lunch hour. But the phone call wasn't a surprise. I'd had my first abnormal pap smear results in 2009, and I didn't have much faith in my cervix to have gotten its shit together over the course of the year.
The nurse told me that this time, I was looking at (or rather, carrying around) "atypical squamous cells" from which the test "cannot exclude high grade squamous intraepithelial lesion." Most abnormal paps come back with the "atypical squamous cells" part but not the high-grade squamous bit (also called HSIL). In English, this means that the changes to cervical cells are more defined and significant than just your garden-variety abnormality. All most women with atypical results really need to do is hope the next pap isn't worse, because most changes in cervical tissue fix themselves over time. Well, mine was worse. The high-grade squamous bit indicated that I had moderate to severe dysplasia, which is the medical term for "abnormality." After I hung up with the nurse, I said two words: "Ugh, fuck."
All of this was happening because, at some point in the last few years, I contracted human papillomavirus, or HPV, which you are almost guaranteed to do if you engage in sexual activity. There are more than 100 different strains of HPV, and most are relatively harmless. A few "high-risk" strains can cause cancer and warts. I had the cancer-causing kind. Many, many people do, in fact — Dr. Lois Ramondetta, a gynecologic oncologist at the M.D. Anderson Cancer Center in Houston told me, "Unless you are a really, really good Catholic nun, you will have been exposed," in your lifetime.
Unpleasant as that may be, it's a reality for sexually active people. To get more expert perspective, I called Dr. Hunter Handsfield , an STD specialist at the University of Washington. He estimates that probably 80 percent of sexually active people will contract an HPV infection in their lives. Most of the time, infections resolve themselves. Many are never even detected. Even for those HPV infections that are detected, "most infections just appear and go away," he said. An abnormal pap one year is naught but a memory come the next.
But because I had some high-risk strains of HPV, I found myself facing the possibility of cervical cancer. The virus is a nasty little shit, in that for those of us who do contract cancer-causing strains, it can be hellishly stressful while we wait for test results. Dr. Handsfield estimated that someone with my degree of dysplasia might only have a 30 percent chance of contracting cervical cancer if I never did a damn thing about it — but a 30 percent chance of cancer is not something to be fucked with.
In October, I scheduled a colposcopy, which is like a pap smear but originating in a deeper level of hell. With a pap smear, you can kind of lay back and make small talk about upcoming holidays or the weather or your cat. You can kind of imagine a delicate little fuzzy Q-Tip dancing its happy way into the shallowest part of your ladybits, taking a quick blink around, and dancing its happy way back out again and maybe giving you a thumbs up on the way out.
With a colposcopy, you take some Ibuprofen beforehand to combat cramping and get all stirruped up while the doctor uses a big electronic microscope to peer into the depths of your vaginal cavity. The colposcope allows your doctor to get a closer look at your cervix, and if necessary, to locate and measure the depth of abnormality and remove tissue for a biopsy. That part feels a little bit like if someone sharpened kitten claws, scratched them across a chalkboard and pinched away tiny, inflamed bits of your cervical tissue. Twinkyank! go the biopsy-kitten-claws. And then there's the stuff that fell out of my vagina for a day after the procedure, which looked like used coffee grounds. It's just the stuff they used to stop up bleeding, but apparently, I was a real bleeder and therefore a real crotch barista.
My pathology report from the colposcopy showed, again, moderate to severe dysplasia and HSIL — the high-risk lesion that pap couldn't rule out. I was on the cancer track with what's called CIN III level of abnormality. Still, cancer was unlikely, and it was all very slow-going, but there were two groupings of uncooperative, assbaggy cells that needed to be removed.
Before pap smears, women died all the time of cervical cancer. "It was terrible," said Dr. Ramondetta in Houston. After the advent of the pap, "you see this huge drop off" in instances of cervical cancer. Today, the doctor told me, "it is pathetic that we see anybody die of this" because the tests, prevention and treatment are known and widely available.
I was scheduled for a cone biopsy at my earliest convenience. Of course, "convenience" is a funny word for a procedure that requires anesthesia and also that you abstain from all sexual contact for four weeks, not that you'd want to have sex while you bleed, cramp and expel wads of gauze for days at a time. That's right, I said expel wads of gauze. But we'll get to that later.
The day of the cone biopsy came, and I was given the lovely, happy gas and wheeled in for a procedure that takes, total, about a half hour or forty-five minutes. I woke up with a scratchy throat — I'd had to be intubated — and a pad shoved between my legs to catch the bleeding. In no time, I was back on the couch at home, surrounded by balloons and get-well posters that my best friend Susan and boyfriend had made during my procedure. I wasn't supposed to move — or even walk — if I could help it, for 24 hours. You don't want the scabs or gauze coming loose from incision sites. Everything was peachy for a week or so. I didn't bleed all that much, nothing a light pad couldn't handle.
About ten days after my procedure, I finally expelled that gauze. I could feel it creeping down my body for several hours, kind of doing this ambivalent dangle thing. And then it gave up hanging on and just oozed its way out. It was black and scarlet and chunky and afterward, I felt like I should have called Sigourney Weaver and given her an alien-birth high-five.
As for my boyfriend, he made an excellent point in his extemporaneous oral presentation about not having sex for a month: "It sucked." We made a Google Doc outlining the many and various things we could keep ourselves occupied with that weren't sex. We went camping. We cooked. We finished The Wire.
As I look forward to my follow-up pap smear this spring, what weighs most on my mind is the fact that I did not get the HPV vaccine — neither Gardasil nor Cervarix — as soon as it became available to me. I was 25 when I first talked to a nurse practitioner about the vaccine; 26 is the unofficial cut-off age for receiving the shot, which ran about $500. She kind of threw up her hands at the possibility: I was sexually active, I didn't have a steady boyfriend, I was probably already a high-risk HPV'er. She discouraged me from the vaccine. Today, I wish I'd gone ahead and gotten it anyway. Five hundred bucks seems, in retrospect, quite small in comparison to $5,000 (obviously), and also a worthy price to pay to spare my family, my friends, and myself from worrying about cancer. Not to mention spare myself of a having a doctor yank little pieces of my cervix out.
Here's my takeaway, if you're facing high-risk HPV and cervical abnormalities: yes, this shit is scary. But remember that it happens to many, many women. With early detection — and almost all detection is early for this slow-growing cancer — it is almost never deadly. It is highly treatable, even if it is a hassle. But it doesn't mean you're a slut, or irresponsible, or freakish. It simply means you're unlucky. Which is why now, when I'm drinking on my lunch breaks, I drink to good fortune — and then, of course, good health.