What happens after a positive Pap test?
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Getting an abnormal result from your regular Pap test can leave a woman feeling the dread of the unknown. Prepare yourself for what happens next with this put-your-mind-at-ease primer by the Mommy Docs.
First of all, try not to be afraid. You will be okay.

I've known patients to panic, rush to the Internet and Google anything and everything that could possibly be wrong with them. The truth is, the unknown is far scarier than what will probably happen next.

If you do have some sort of an abnormal result from your Pap test, your next step will probably be a minor procedure called colposcopy with cervical biopsies. This is a quick and minor procedure, so there is rarely any need for anesthetic.

When you enter the exam room for your procedure, you'll probably see a lot of equipment that will look unfamiliar. What is all that stuff? The largest instrument that looks like a microscope on wheels is called a colposcope—essentially a microscope on wheels that allows your doctor to visualize your cervix and vagina magnified.

There also may be some metal instruments and small brushes on the table nearby. Your doctor will use these to take the biopsy. When we do it, we literally pinch and cut off a small piece of a patient's cervix or take a sampling of her cervix with a brush that we rotate back and forth over the area of concern. There's also an instrument that we use to do something called an EEC, or endocervical curettage. This is often the very last part of the procedure, where we scrape some cells from a cervical canal. We always want to be sure a patient does not have abnormal cells hiding in a canal that is not immediately visible.

Why does the room suddenly smell of vinegar? That is acetic acid—essentially, vinegar—which we apply to the cervix with a large cotton swab. The acetic acid makes the abnormal areas really stand out under a green filtered light that helps guide us right to the abnormal areas. Often a patient feels slight burning when the acetic acid is applied to her cervix.

In the room, there will also be several small bottles containing clear liquids and one with something that looks like mustard. The clear solutions are the bottles in which we put cervical biopsy specimens to be sent off to be scrutinized under a microscope by a pathologist. The mustard-like solution is called Monsel's solution.

Once we do the biopsies, there will be small areas of bleeding at the biopsy sites. We apply the solution with a large cotton swab to make the bleeding stop. This solution turns black and grainy, so do not be alarmed if you pass brownish/blackish discharge along with some blood after the procedure. On occasion, the solution forms almost like a scab over the cervix, and it may fall out of your vagina as a large chunk. Again, don't be afraid. This is normal.

The procedure itself is very quick and straightforward, much like a regular gynecological examination. The speculum we always use to do a Pap will be used in a patient's vagina so we can see her cervix. The lights will be turned off in the exam room so we can use a green light to visualize her cervix. Often the doctor will be silent at this time, studying the patient's cervix for abnormal areas. I tell my patients that my silence does not mean I'm seeing something terrible—it just means I'm concentrating.

After the procedure, patients may have some minor cramping. We recommend taking over-the-counter ibuprofen for this as needed. Patients may also take over-the-counter pain meds an hour before the procedure. As mentioned previously, a couple of days of light bloody/brownish/blackish/grainy discharge is normal.

So that's what is normal. But what's not normal? Vaginal bleeding like a period, persistent or increasing lower abdominal pain, fever or malodorous vaginal discharge. Please call your gynecologist if you experience any of these symptoms.

There's always art to medicine, so your own gynecologist may have her own way of doing things. Be sure to ask her if you have any questions or concerns. More often than not, these biopsies show nothing of immediate concern, although you'll probably be asked to follow up with your ob/gyn more frequently in the next year to keep an eye on things.

Above all, do not be afraid to go into your ob/gyn's office to follow up on an abnormal Pap result. You don't want to postpone and end up dealing with the potential of cancer down the road.

Dr. Yvonne Bohn, Dr. Allison Hill and Dr. Alane Park are the Mommy Docs. While they are doctors, they're also moms with six kids among them. They've welcomed more than 15,000 babies into the world. The Mommy Docs are featured in the TV series Deliver Me on the Discovery Health Channel. For more information on the Mommy Docs, visit mommydocs.com.

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