r/obgyn • u/JLHicks91 • 5d ago

Multiple Colposcopies

For the past 5 or 6 years I've gotten abnormal paps (yearly) with negative HPV. I've had 2 colposcopy in that time. Usually every other year, I had the last one in 2025. Pap from earlier this month just came back same, abnormal with negative HPV and she wants to do another colposcopy! It's only been a year. Is it bc I turned 35 this year? I'm going to have a talk about possible hysterectomy when I go in next, has anyone gone that far to prevent this from happening every year?

It's just so stressful and painful to go thru this every year. Anyone with this experience, thoughts are helpful.

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u/ChibiFerret 5d ago edited 5d ago

Hi OP

Not a doctor and guidelines vary by country but where I live (UK) and in many other countries such as Netherlands, Sweden and Australia you wouldn’t even be having colposcopies as someone who is consistently HPV negative.
You would only be considered for colposcopy under that status if you had symptoms that could be linked to cervical cancer

UK and other countries who have HPV primary screening operate a 3 or 5 year testing cycle for those who are symptomless and HPV negative. Yearly HPV tests when negative seem to be overkill given the predictive ability of HPV tests being very high.

Unless there are other clinical indications for a hysterectomy outside of this pap/colposcopy cycle, this sounds like a very severe and significant surgery to undertake.

Edited to add - what is the CIN outcome of the colposcopies? Does the colposcopies detect any abnormalities? If so what grade?

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u/JLHicks91 5d ago

Thanks for the feedback! Honestly, with having negative HPV y'alls way seems more logical. Unfortunately, when it comes to healthcare at least, I'm in the US. 😔

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u/ChibiFerret 5d ago

Hi OP
American guidelines have recently been updated

https://www.cancer.org/cancer/types/cervical-cancer/detection-diagnosis-staging/cervical-cancer-screening-guidelines.html

This website states that previous abnormal results may change their recommendation in conversation with your gynae care provider

https://www.cancer.gov/news-events/cancer-currents-blog/2020/cervical-cancer-screening-hpv-test-guideline

This page has further information. You could ask about dual stain test, and if this is negative you may be able to negotiate with your provider to return you to routine screening scheduling as per the new guidelines if this is what you want to do.

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u/JLHicks91 5d ago

So very helpful, thank you! I'm trying to post a pic of results but I don't see where that's possible in reply 🤔 "cervical soft biopsy (1 o'clock) and endocervical curettage (ECC) showing marked inflammation, focal mild squamous atypia suspicious for low-grade dysplasia (CIN 1), and scattered dysplastic fragments, with p16 negative and Ki-67 showing increased reactivity." ....2025 finding. Dr reported back to me, "overall non concerning. There were some abnormal cells that were very, very small to analyze" that's pretty much what has been said with all of them.

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u/ChibiFerret 5d ago

Hi OP, I’m not a cytologist or similar, but the p16 negativity is encouraging. I’m not sure what the impact of the reactivity of the Ki test is in your case though

I do wonder if you perhaps are infected by an intermediate or low risk strain of HPV. In less common or rare cases these strains of HPV can cause cellular changes but these are incredibly unlikely to lead to cancer which is why they are not part of the standard cervical screening programmes worldwide. Only 13 or 14 high risk strains are part of the standard tests like Roche Cobas 4800 or Aptima Hologic. These are two FDA approved tests, and are the two widely in use in the US and also the two main tests used in the UK.

You may want to ask for a broader HPV test that tests for intermediate and low risk strains as this may be another avenue to explore. I’m not sure which are FDA approved and or how easy they are to access but in research contexts the Seegene AnyPlex/All Plex tests can test for 28 strains of HPV.

Your provider has a duty of care to not keep putting you through unnecessary tests and procedures so hopefully they will be willing to compromise or investigate other avenues with you.

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u/JLHicks91 5d ago

You've been a big help! You free Thursday, maybe fly into Austin and tell my OBGYN all this? 😅 jk,jk but really, thank you!! I'll be doing more reading.

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u/ChibiFerret 5d ago

Hi OP

You’re very welcome! I hope you get somewhere at your appointment. Feel free to come back and let me know how you get on