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Re: HPVFrom: D. Ashley Hill, M.D. (anonymous@obgyn.net)Sat, 28 Jun 1997 10:48:29 -0500 (CDT)
At Fri, 27 Jun 1997, MaryG wrote: >She was told she needed a panhysterectomy >with a BSO because an ultra sound showed areas suspicious >of small fibroids in uterine wall, a "history of HPV", and >class three Pap one time a year prior to the pregnancy.. >I'd like to know if there is a more difinitive dx for HPV >and does it always have to wind up a hysterectomy? Mary- This is a tough question without a lot of other information, but I'll take a stab at it. I'm unfamiliar with the term "panhysterectomy" but will assume it means the same thing as "total abdominal hysterectomy" which is removal of the uterus and cervix. None of the conditions you mention need result in hysterectomy, although large and symptomatic fibroids may often require this if other, more conservative, measures fail. For example, my partner and I did a hysterectomy recently on a woman with fibroids that continued to enlarge (to her umbilicus, or roughly the size of a 5-month pregnancy) despite non-surgical therapy. She was finished with childbearing, and was miserable. On the other hand, there are many other methods to treat fibroids that may work and we try these before resorting to a hysterectomy. I would not suggest even treating "small fibroids in the uterine wall" unless she was having symptoms or having difficulty conceiving! They are a benign condition found in about 1/2 of black women and 1/3 of white women, that do not require treatment unless symptomatic or enlarged enough to compress surrounding organs. HPV is certainly the most common cause of atypical Pap smears, but not the only one. HPV is an epidemic condition usually transmitted by sexual relations (although I have seen rare cases possibly transmitted by sharing underwear and swim suits). The overwhelming majority of women with HPV (some say up to 1/2 of all US women!) never develop an abnormal Pap, or genital warts. Like most viruses, it can remain dormant for many years before popping up to cause trouble, so we ask patients to have annual Pap smears. HPV is almost never a cause for hysterectomy, unless severe atypia keeps recurring despite less aggressive therapy (cryotherapy, burning, laser, or cold knife conization). Again, there are always exceptions, but in my opinion a doctor should try many other techniques before resorting to a hysterectomy for the sole problem of an abnormal Pap (of course, cancer is excluded from this, since it usually requires hysterectomy or radiation). HPV can be diagnosed by cervical (or vulvar) biopsy, or by taking a swab for viral typing. Your local lab can give you directions on this. Again, HPV is extremely common, but as long as the Pap smears are normal and there are no external warts, treatment is usually not necessary. I hope this helps answer your questions. I advise patients (even my own) that they may feel more comfortable with a second opinion before undergoing a major surgery. A good doctor will not begrudge a second opinion. Best of luck, Ashley
-- Ashley Hill D. Ashley Hill, M.D. Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency Orlando, FL dahmd@gate.net
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