WOMENS-HEALTH Messages for April, 1997: Re: Cervical Dysplasia

Re: Cervical Dysplasia

From: Richard M. Chudacoff, MD (anonymous@obgyn.net)
Thu, 3 Apr 1997 10:56:14 -0600 (CST)

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In reply to: Michelle: "Cervical Dysplasia"

At Wed, 2 Apr 1997, Michelle wrote: >
>I am 29 yrs. old, have two children. A year ago I was diagnosed with
>moderate dysplasia and had the conization procedure done to remove the
>abnormal cells. I am now trying to get pregnant again. The doctor who
>performed the procedure said that there wouldn't be any side affects
>from the conization. Since the procedure I now have back achs,
>abdominal discomfort and sharp pains around my cervix. I just recently
>had a pap and I asked my doctor if he could see any scare tissue and he
>said no, but that that didn't mean that there couldn't be scare tissue
>further up. He said he didn't think that there was that much scaring
>because I wouldn't have a period. My questions to you are: Are the
>symptoms of pregnancy different (ie; discomfort in the abdominal and
>cervix area) after the conization? This might be a stupid question but:
>Is it easier to get pregnant with a shorter cervix? My doctor said that
>mine was considerbly shorter and off to the right. And finally, I
>noticed that my cervical muscus is alot thicker at the beginning of my
>cycle and at the end. Is it possible that my cervical muscus is to
>thick for the sperm? Sorry for all the questions but I just can't find
>any answers. Thanks!

First, since this is an email consult, it is limited by just what you have written, so understand the limits that I can be of help. Second, nothing I write is to be taken as medical advice, but rather as education. Any theraputic decision must be made with your practioner.

Now that I have that out of the way, there are certain side effects from a cervical conization. The most common, albeit less than 1 % are cervical stenosis and cervical incompetence. The former causes a narrowing and scaring of the cervical canal, the latter can decrease the integrity of the cervix, and lead to mid second trimester fetal losses. Again, these are uncommon. They also depend on the amount of tissue removed from the cervix. Since you had a cone, rather than a LEEP, is sounds as if your dysplasia was rather high into the cervical canal, not fully seen by colposcopy, or of a high enough grade that invasive carcinoma needed to be ruled out. The technique and your unique healing ability can also add to changes of the cervix.

You menstrual pain may be caused by two etiologies, or may not be related to the procedure at all. One possibility may be that there is an aspect of stenosis of the cervix, and the area that normally expanded and dilated with menstrual flow now has an increased resistance thus causing the cramping pain. The other possibility is that glandular tissue from the uterus has grown into the muscle of the cervix or uterus, and expands and contracts during the cycle, causing the pain. The pain may go away with delivery. As long as the canal is open you should be able to get pregnant, although if there is a severe reduction of the columnar mucus secreting glands of the cervical canal, there may be difficulty in allowing the sperm to pass, but remember, my hypotheses are unincumbered by data of your particular case.

There is an excellent reference in your area, and that is the UofM medical school which has assembled and retained some of the best OBGYNs in the country. If you need a second opinion you might try the UofM clinics.

Wish I could be of more help. Good luck.

--
Richard Chudacoff, MD
Baylor College of Medicine
BaylorMedCare
Houston/Richmond, TX

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