Research into Pap Smears During Pregnancy and Beyond

Twelve weeks: So I’m a week into researching the safety (and supposed necessity) of doing a Pap while pregnant, risks of carrying a CIN 3 while pregnant (as in my case), and about cervical cancer in general. According to the Australian Government’s Department of Health and Ageing, cervical cancer is slow-growing, taking about 10 years to develop. This tells me one important thing for my situation—I have some time.

Some professional say that doing a Pap during pregnancy can be misleading. Due to hormonal changes in pregnancy, cervical dysplasia may increase for some women. So one has to question the wisdom of doing a Pap at this time.

While many medically-based sites stress the safety, many more forums reveal the increased risk of miscarriage. Even amongst the medical community, opinions vary greatly. Some say Paps are an essential part of prenatal care, while others don’t recommend it unless there was cause for concern. However, Pap Smears are now only recommended every two years, so that ends the ‘should I have a Pap while pregnant’ question. On Gynob.com for example, Paps are recommended, however they allude to any treatment of abnormality could be addressed post birth. Even my own OBGYN did not want to perform the Pap until I was 12 weeks, saying that if I did it earlier, it could pose a risk to the pregnancy. She said that she would use the traditional ‘wooden’ stick to take the smear, rather than the more contemporary, slightly more invasive tool. OK, so this tells me that some doctors believe there could be some risk in doing Paps while pregnant. I have also learned that many doctors prefer to postpone treatment of dysplasia until after the birth. That’s my first bit of real information.

My second bit of information is around treatment of a CIN 3 while pregnant (which apparently I’m at risk of having based on my last Pap). Many doctors say that pregnancy ‘speeds up the growth of precancerous cells’ however, many others disagree. Note from an article that appeared in the European Journal of Obstetrics & Gynecology and Reproductive Biology (Volume 104 , Issue 1 , Page 67) by E . Paraskevaidis called ‘Management and evolution of cervical intraepithelial neoplasia during pregnancy and postpartum’ this conclusion:

‘There is a considerable regression rate of CIN after pregnancy possibly attributable to the loss of the dysplastic cervical epithelium [thin layer of cells] during cervical ripening and vaginal delivery.’

And if I indeed did have a Pap (and risk a miscarriage, and because I was pregnant, the chance of showing abnormal cells increased), what would the recommended treatment be? Well traditionally there are four ways to treat dysplasia:

* Cryotherapy (freezing the cells with liquid nitrogen).
* LEEP (Loop Electrosurgical Exision Procedure)
* Conization (also called cone biopsy)
* Laser (not as widely used today due to high cost, lack of availability, and not all doctors are well-trained with using it. LEEP is more commonly used)

However, again, many doctors would not attempt these procedures until post birth. If a woman has an abnormal Pap smear during or just prior to pregnancy, even if it's severely abnormal, many health care providers will not do treatment. They will just monitor the cervix closely with a colposcope during the pregnancy.

The reason that many health care providers do not want to do treatment during pregnancy is because it may accidentally cause early labour or miscarriage.

According to The American Social Health Association, the types of HPV that can cause cell changes on the cervix and genital skin have not been found to cause problems for babies.

OK – so here's my conclusion: Given that I have had a previous CIN 3 some months ago, I might be at risk of developing cervical cancer some time in the future. However, cervical cancer is slow-growing so there is time to deal with it. As well, a Pap during pregnancy could give a false reading due to hormonal changes, in addition, it could pose a risk to the pregnancy. And given the research, had I done a Pap which resulted in CIN 3 again, I am not willing to do any of the treatment procedures during the pregnancy, which could also pose a risk to the pregnancy. And in addition, many abnormalities clear up with vaginal birth. What will I do? I’ll not do the Pap. CIN 3 (if indeed that is what is happening) will have to wait.

There are those who would advise never to have a Pap, nor a mammogram. They argue that such procedures lead to over-treatment and ultimately come with their own set of risks.

Meanwhile, the sanest information I have yet to find available comes from the wonderful Susan Weed (author of Wise Woman Herbal for the Childbearing Year). Check out her wonderful article on what to do in the Pap labyrinth.