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It used to be that only the starkest of cell changes would be reported back as an abnormal. As a result, cases of cervical cancer went undetected and became fatal. Now, paps are reported as abnormal if the cells appear inflamed or precancerous. Almost anything in the vagina, from tampons to penises to sex toys, can irritate the cervix. This irritation can then be detected by the pap. Douching and menopausal changes can also inflame. Or cervical cells may be undergoing architectural changes called "dysplasia". Dysplasia does not mean one has cancer, but it could lead to cancer if ignored.

When a pap test does come back as abnormal, it's up to the doctor to investigate further. The next step is usually a colposcopy. The colposcope is like a microscope with its own light. It allows the doctor to get a closer look at the vagina and cervix. After the vaginal walls are opened with the speculum and the vagina and cervix are swabbed with vinegar, the doctor examines the magnified cells.

If she sees a problem, she scrapes a cell sample for the lab. The scrape usually feels a little more pronounced than the pap scrape. If she thinks it's warranted, she'll snip a larger lab sample for a biopsy.

Cervical cancer is rare in women who have regular pap tests, because it can be treated and cured if it's found early. And, if the pap does detect precancerous cells, treatments can be administered right in the doctor's office. These include freezing the affected areas of the cervix, called "cryosurgery." In other options, called "LEEP" or "LEETZ," the doctor uses a tiny electric wire to remove the offending cells. Lasers can also be effective. (Of course, the cervix would be appropriately numbed.) If a woman is diagnosed with a more-advanced cancer, her doctor might refer her to an oncologist to discuss further options.

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"Eleanor Parker?" the nurse asked.

I wanted to say, "No, I go by Stacy," but I was sure the nurse just didn't care. I kept my mouth shut, as if every word swallowed would bring this to a quicker close.

"You can go in here to empty your bladder," she said.

I did. Then I followed her into room No. 5. The nurse put down her vials and left. I was alone with an exam table, complete with cotton-footed stirrups and a big white sheet. If she gave me instructions I didn't hear them, so out of habit I took off all my clothes, got wrapped in my toga and sat on the table. I tried to block out the braying of the morning DJs on the piped-in radio program so I could pray. I told God that I knew I was often a rotten agnostic, but he had to know that deep down inside I truly loved him, and that I understood that life-saving strength was divinely bestowed. (So please, please bestow some on me!)

The nurse came back in. "You know, she's only going to look down below ..."

"Oh, I'm sorry, I'll put my shirt back on." I felt like such an idiot! God, did she think I wanted to get naked? She walked back out and I put my bra and blouse back on, turned my toga into a sarong and got back on the table. Then a song came on -- "Sexual Healing." I just laughed, thinking someone above had a sense of humor.

The doctor and nurse team finally came in and explained everything again. She said my pap had come back with mild dysplasia. Now they would look at my cervix with the high-powered microscope. I could see the machine in the corner; it looked like it was made for vision exams, but it had enough oiled joints that all I would have to do was lie there while she adjusted it to cervix level. If she still saw anything abnormal, they'd proceed with a biopsy. She reassured me that I shouldn't feel much with the first test, and if they did do a biopsy, then it would only be a slight pinch.

So my doctor did her stuff (pressure, pressure) under the sheet, and then said she was going to do a biopsy. I was in free-fall. Somehow I had convinced myself that if they just didn't do a biopsy, everything would be OK (pressure, pressure).

When they pinched my cervix, it hurt! I'm sure it was the smallest sample but oh, God, it ached, a truly cramping ache; it made me want to contract into myself and roll over, but I just kept going with my slammed-shut eyes. She then applied a solution that scabbed it over. The initial pain was gone, but the dull cramping remained. (It's recommended that you take ibuprofen before the procedure to preempt the cramps; I didn't.) My doctor, with her warm-honey voice, told me again that this could still mean nothing, that I'd just have to get more frequent paps, and if I did need treatment there were several options, including the "freezing" one.

One word she never used was "surgery." For that I gave quick thanks. But as they walked out, I could feel my eyes grow hotter. As soon as the door closed I wept and wept; I just lay there on the white-papered table with a sheet wrapped around me and my knees pressed tightly together. I thought I was crying because I didn't want to hurt my mother and be badgered by her panicky questions, but I knew I was really crying because I was a 25-year-old and I was having my first biopsy.

I got it together long enough to get dressed and go to the counter and settle my bill. "We're going to bill insurance," the receptionist said, as if to say, "You've had enough for one morning, keep the change." As soon as I left the office, tears rolled down from behind my sunglasses. When I pulled up to the parking-lot attendant and handed her my dollar, she just smiled kindly. No doubt she'd seen them all before, the devastated faces of women who'd miscarried, of women with inoperable malignant growths, of women afraid they'd orphan their children. I wondered what she thought was my sentence. I'm sure she didn't think "first biopsy," and I felt ashamed for being so weak. I arrived home still red-eyed and pink-nosed.

My dad's first reaction: "Did you get into another car accident?"

"No, I did not get into car another accident! I had my first biopsy and it upset me." I splashed my face at the kitchen sink.

"Oh, I thought something bad had happened to you."

I wanted to scream and say, "Yes, something very bad did happen to me."

But deep down, I knew I was wrong. I'd lost perspective. I'd let all my anxieties incubate within me until they were out of control. Whether I had any physical cancers growing or not, I knew that if I didn't get a grip on my runaway imagination, those negative energies would knot my flesh on their own.

Six days later I learned the results. My biopsy was negative. No precancerous cells. No dysplasia. Nothing. I just had to get another pap in six months to make sure everything was still OK. And next time I have another health "emergency" I'll be on the lookout for the true enemy within: the ulcer-maker called fear.
salon.com | Aug. 19, 1999

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