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Cancer: Cervical & Ovarian Message Board


Cancer: Cervical & Ovarian Board Index


Hello,

Three days ago I found out that my most recent pap result came back with atypical glandular cells (AGUS or AGC). This is my first abnormal pap result (I'm 36), and I'm still in a bit of shock. I definitely wasn't expecting this to happen, but who does?

I've been doing a lot of reading since I got the results, and I realize that the AGUS result needs to be taken seriously and tested thoroughly. I really appreciate the members here who have provided such great information and support to others in the same position. Thank you!

My colposcopy is scheduled for 3 weeks from now (May 6), and I assume I'll need to have an ECC and endometrial biopsy (and HPV test) done at that time. I'm also guessing that if they don't find anything at first, I'll need to continue having these tests done for a while, considering the possibility of glandular involvement. I also plan to request a pelvic ultrasound if things come back normal the first time.

Unfortunately, I've read some of the horror stories here about the ECC and endometrial biopsies, so I'm pretty nervous about the pain involved with these procedures, especially if I have to get them done on a regular basis. I'd like to ask a few questions of those who have had one or both of these procedures done, or of anyone who has knowledge about these procedures.

* What is the most painful part about the procedures -- the actual biopsies, or when the doctor inserts the instruments into the cervix?

* Is there anything I can do to relax my cervical muscles during the procedure, hopefully to make it easier to pass the instruments through the canal?

* How long does the pain last? How would you describe it -- pinching, cramping, stabbing, sharp? On a scale from 1 to 10? Please be honest! I want to know what to expect.

* I've called a couple of OB/GYN offices (one was actually a gyn/onc) and asked if they would use a local anesthetic before these procedures, and neither of them will. Is this common? Why won't they do it? Does the local anesthetic not help?

* Has anyone been prescribed pain killers (stronger than Advil or Tylenol) before these procedures, and did it help relieve the pain?

* Do you think that these procedures are just "uncomfortable" for most women, but that a few women have severe pain? I can't understand why the medical establishment would subject women to such painful procedures if the majority of women have severe pain.

Thanks in advance for sharing your experiences. I really appreciate it!

Angel4747
Hi Angel --

Welcome, but sorry for the circumstances that bring you here.

Regarding the procedures, I've had a colpo, ECC and endometrial biopsy, and for me, the endo biopsy was the worst, although definitely bearable. I did not have any pain killers for any of these procedures, except a couple of motrin before the endo biopsy (which was performed a few months before the colpo and ECC, which were done at the same time.

My colpo involved a few biopsies, which were for me really just a minor, extremely quick pinch that I wouldn't even say was painful. The colposcope is really just a magnifying instrument so they doc can better see the cells, and see if there's area that he/she feels need to be biopsied, so there is really no pain associated with that as it's just a visual exam. If they take a biopsy, for me that was a quick pinch, and lasted less than a second. They only usually take about a 1mm by 1mm piece of tissue, if that. It's very small.

The ECC takes a small piece of tissue (but larger than the other biposies) from inside the cervical canal. For me, that pinched and was painful (not terribly, but it was noticeable), although by the time I was able to say ow, it was over with. In my case, the ECC sample was 1cm by 1cm by less than 1mm deep.

I had no residual pain from either of those procedures. While the ECC does go into the cervical canal, the doc doesn't really go that far up (usually about 1cm or so). The instrument is very narrow and doesn't go all the way up the canal.

During the endo biopsy, I believe the doc will dilate you if they can't pass the swab through the cervical canal. I didn't have to be dilated. My doc had told me to take 800mg of motrin an hour before I came in for the exam. What bothered me was the swishing around they do with the swab in order to get the sample. THAT sucked, in my opinion. At least the one I had was done with what looked like a fat tipped, long-handled Q-tip. After passing through the cervix (which did not hurt), she kind of swished it around for ten seconds. I was like um, this is not comfortable, and she counted out loud to let me know when it would end. I had some very uncomfortable (not unbearable, but definitely uncomfortable) cramping within about ten minutes, and it lasted probably about an hour or so. By the next day I think I was fine.

Aside from taking the motrin, I don't believe there's anything you can take to make yourself more relaxed, except maybe some Xanax or other anti-anxiety medication, so perhaps you won't tense up in anticipation. Some ladies on here have had horror stories, I agree, but there are also a bunch of us, myself included, that didn't really have a problem with these tests.

With an AGUS pap, you definitely want to make sure that they do an ECC. Assuming this testing finds nothing of concern, they will tell you to come back in six months, maybe three, depending on how cautious your doctor is. Personally, I'd insist on three months, even if I had to pay for the visit myself. Glandular stuff is nothing you want to mess with, and definitely moves faster than the squamous stuff. There are a few of us on this board, myself included, whose cases moved rather quickly. I don't want to scare you with my story, because a large part of what happened to me is because I had a really crappy doc who couldn't do a proper pap, but I went from a clean pap and clean endo biopsy in May, to being diagnosed with invasive adenocarcinoma (glandular) in November. My problem was probably there in May as well and my old doc missed it, but I was diagnosed at 39, and had never had even one bad pap my entire life, and I faithfully went every year. So my point is, keep a close eye on this!!

Unless you have a rather large tumor, a pelvic ultrasound isn't going to show you anything of use regarding your cervical condition.

Good luck with your tests, and keep us posted on how you are doing.
I agree with everything Zoe says. I'll add my answers to your questions for a second opinion but I've never had an endometrial biopsy.

[I]* What is the most painful part about the procedures -- the actual biopsies, or when the doctor inserts the instruments into the cervix?[/I]

The ECC for sure. I didn't find the biopsies painful at all, so of course that is the winner.

[I]* Is there anything I can do to relax my cervical muscles during the procedure, hopefully to make it easier to pass the instruments through the canal?[/I]

Definitely take some pain killers before. I do a whole bunch of Midol before each procedure.

[I]* How long does the pain last? How would you describe it -- pinching, cramping, stabbing, sharp? On a scale from 1 to 10? Please be honest! I want to know what to expect.[/I]

The pain of the ECC last only as long as they are doing it. For my doctor, that's usally around 5 seconds. It is NOT stabbing or sharp pain at all. It's dull but intense. Sort of like bad cramps. I'd put the pain at about a 7, but again, it's only for 5 seconds. I am SURE you can handle it. But some women don't even feel the ECC at all. Maybe you will be one of them!

[I]* I've called a couple of OB/GYN offices (one was actually a gyn/onc) and asked if they would use a local anesthetic before these procedures, and neither of them will. Is this common? Why won't they do it? Does the local anesthetic not help?[/I]

I had a LEEP and I received the local anesthetic for that. They injected it into my cervix using several injections. Getting injections in my cervix hurts me MORE than the ECC, so getting a local anesthetic is really pointless for that. Though it might help with the pain involved with the opening of the cervix for the endo biopsy, I think it might not be that helpful with the swishing stuff Zoe is talking about. After all, they inject your cervix, so most of your uterus will probably not be numb. I'm not sure if there is anything they can do to prevent that short of putting you under or a spinal block.

[I]* Has anyone been prescribed pain killers (stronger than Advil or Tylenol) before these procedures, and did it help relieve the pain?[/I]

No I haven't and I really don't think they are necessary for biopsy and ECC. I can't say about the endometrial biopsy though. Also, I think Zoe's recommendation for Xanax of some anti-anxiety meds would be a good idea.

After my CKC, I awoke from surgery and I was in pain. I told the nurse and she gave me a 5 mg Percocet orally (even though I had an IV). It did NOTHING. I told her I was still in pain and she said, "Unfortunately, we can't make all your pain go away. We just reduce it." That is such crap. They can stop the pain. If I could do anything over again in my treatment, I would yell at that nurse and tell her to get me some real drugs. But I was stilly groggy from the anesthesia and I just didn't say anything.

I think doctors don't like to prescribe pain meds, possibly because of the risk of abuse, but seriously there is no reason for you to be in unnecessary pain. Tell your doctor that you want some pain killers. You don't have to use them if it isn't so bad, but at least you will have them. Not wanting to be in pain doesn't make you a baby, it makes you smart. You shouldn't have to suffer when there is stuff out there that could easily help you.

(That's my pain rant. Every time I think of that nusre I get really pissed off!!!)

[I]* Do you think that these procedures are just "uncomfortable" for most women, but that a few women have severe pain? I can't understand why the medical establishment would subject women to such painful procedures if the majority of women have severe pain. [/I]

I think you're right about it. Most of it is just uncomfortable. And like I said above, the procedures to numb you are way worse than the pain it causes, so they just aren't used.





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