HPV and Treatment for CIN cells

[Froggie]

My sister and sister-in-law are both going through similar situations with HPV. My SIL (28) has followed a traditional treatment plan following abnormal paps and has ended up with repeat LEEP treatments and now a cone biopsy. She just had another abnormal pap and I'm afraid to ask her what the're going to do next!

My sister(25) has also had two abnormal paps and has been told she has CIN2 cells - the treatment is LEEP but she hasn't had it yet...

Is this an epidemic? Why are so many young women having these procedures? Is there any alternative or more conservative approach that respects the cervix more? It seems like they are very ready to get in there and scrape away :-(

I just don't want to see her go through something so invasive when there might be an alternative. I was kinda hoping that if she saw a midwife that also did routine care, that she'd get a more informed viewpoint. Is there any hope of this?

[kate3]

Is this an epidemic?

Yes, HPV is a huge epidemic and currently the most common STD. The situation you describe with your SIL is concerning because her disease appears to be persistent. One LEEP should be sufficient. A few things to think about: is this the same infection (ie same strain of HPV causing a lot of damage) or is she infected with multiple strains? During the time this has been going on has she had different/multiple sex partners (picking up different strains with different guys)? Does she smoke? Is her immune system normal? I am assuming her ecc biopsy was abnormal for her to end with a cone, and after all the procedures to her cervix she would definitely be high risk for an incompetent cervix, premature delivery, PTL, and PROM with a pregnancy.

Yes, the recommended treatment for CIN II is LEEP, although in my practice we might sit on if for 6 months if the patient really wanted to avoid a LEEP. But it is hard to justify doing nothing with that level of abnormality.

The problem with HPV is that although it is the cause of almost all cervical cancer, many people are taking a "no big deal" attitude because cervical cancer rates are low among women who seek care, and because many times the infection does clear on it's own or with treatment. So in a way it is becoming "normalized". Almost everyone knows someone with an abnormal pap. Usually everything turns out OK. The biggest problem I am seeing is that the treatment is causing problems down the road with pregnancy, and I am seeing more patients with moderate dysplasia at younger and younger ages.

Sorry for the mini rant. I work in a STD/family planning clinic and the amount of HPV we deal with on a daily basis is overwhelming. Some days 75% of my schedule can be wart treatments or management of abnormal paps. If your sister hasn't been getting answers to her questions a second opinion (with either a doc or midwife) is always a good idea. But it's doubtful she'll find anyone who will advise her not to treat a CIN II.

[mwherbs]

yes it is an "epidemic" in any case there is some adjunctive/complementary therapy that can be done- read Tori Hudson's book - Women's Encyclopedia of Natural Medicine

there is also an article by her --available on line

http://www.liebertonline.com/doi/abs...ournalCode=act

[Froggie]

Wow, I was really hoping to hear that the LEEP treatments were overkill and that she could fix it all with Evening primrose oil or something. Yes, they are both "social" smokers <!> What is that?? They are both on birth control pills. And they both seem to have NOT A CLUE about HPV or any other STD that they could contract. And neither do their friends and co-workers. According to them, Everyone they know has HPV.

Thanks for the book reference. I will get three copies: one for each of them and one for myself.

Jenni

[ZoeyZoo]

There are several treatments to try to HPV/adnormal paps. LEEP is one of the more invasive ones and has a higher risk of causing pregnancy problems like a PP described. There are several other procedures like cyro surgery and laser surgery that can work and that are far less evasive to the cervix. For some reason, I see a lot of doctors recommending LEEP over the others for young women who will want to get pregnant. I would encourage your friends to see if they are a candidate for some of the alternative surgeries like cyro that will be less likely to cause issues down the road.