PAP Test (smear)

Many sources will lista PAP as being ‘a scrape test for abnormal cervical cells’.  This is correct, though not entirely accurate.  The Boston Women’s Health Book Collective (1998) defines the PAP as a “method for distinguishing normal from abnormal cells of the vagina, uterus, and cervix” (p. 593).

The formal definition is:  Pap t., Papanicolaou t., exfoliative cytological staining procedure for the detection and diagnosis of various conditions, particularly malignant and premalignant conditions of the female genital tract (cancer of the vagina, cervix, and endometrium), in which cells which have been desquamated from the genital epithelium are obtained by smears, fixed, and stained, and examined under the microscope for evidence of pathological changes.  Each examination should have an individual histological description.  The test is also used in detecting the human papillomavirus infection, in evaluating endocrine function, and in the diagnosis of malignancies of other organs, as of the respiratory tract and lungs, gastrointestinal tract, urinary tract, and breast (Dorman’s Medical Dictionary (Tesla On-Line), 2004).

The PAP test was introduced in the United States in 1943 by Dr. George Papanicolaou, who devoted his medical research to the physiology of reproduction and exfoliative cytology (cancer).  His first paper on techniques for vaginal smears was written in 1928 describing testing for uterine cancer (Cornell University Medical College, 2004).

An annual PAP is recommended for all women for the early detection of everything from vaginitis to cervical or endometrial cancer.  Some doctors require PAP smears be done in order for birth control or hormone treatments to be prescribed. 

PAP test results are “graded” into one of the following five formal categories (Bethesda System), and one new category:

1. Normal (No evidence of malignancy).
2. A-typical (Undetermined signs which could mean Cervicitis, Vaginitis, or Dysplasia).
3. Low Grade Squamous Intraepithelial Lesion.
4. High Grade Squamous Intraepithelial Lesion.
5. Invasive Cancer.

Laparoscope(y)

Laparoscopy is performed when less invasive surgery is desired. It is also called "band-aid" surgery because only small incisions need to be made to accommodate the small surgical instruments that are used to view the abdominal contents and perform the surgery.

Diagnostic laparoscopy is a procedure that allows a health care provider to look directly at the contents of a patient's abdomen or pelvis, including the fallopian tubes, ovaries, uterus, small bowel, large bowel, appendix, liver, and gallbladder. 

The purpose of this examination is to directly assess the presence of a problem that has not been confirmed through non-invasive tests. Inflammation of the gallbladder (cholecystitis), appendix (appendicitis), or pelvic organs (pelvic inflammatory disease) or tumours of the ovaries may be diagnosed laparoscopically.

Major procedures to treat cancer, such as surgery to remove an organ, may begin with laparoscopy to exclude the presence of additional tumours (metastatic disease), which would change the course of treatment (MedLine Plus Encyclopaedia, 2004). The laparoscope was developed in 1929 by a German gastroenterologist named Heinz Kalk.  Originally a 135-degree lens was inserted into the abdomen to diagnose diseases of the gallbladder.   Kalk found he could view internal organs without exposing the patient to the “plethora of bacteria associated in large wounds” (EndoNurse, 2004).  Now, laparoscopy is used for the diagnosis and treatment of many different diseases.
With respect to reproductive cancer, laparoscopy is now used on both men and women, for both prostate and testicular cancer, as well as the female conditions and cancers discussed earlier in this essay.  It is not a common treatment yet, but it is gaining popularity amongst surgeons and patients.  For ovarian cancer, it has been found to be a very effective and humane way of dealing with the disease.

Experiments are being done to add voice activation to the camera so that less hands on will be necessary during surgical procedures.  The hope is that complete cancer treatment will eventually be a common use for laparoscopic device.

Biopsy

A biopsy procedure performed when a precancerous condition is suspected or apparent where a small tissue sample is taken after the patient is administered anesthetic (Merck Online, 2005).  There are different types of biopsy, such as endocervical curettage (see complete definition below), cone biopsy (conization), and cold-knife cone biopsy.  The loop electrosurgical excision procedure (LEEP) is a cone biopsy heated by an electric current.   There is also a variation of LEEP called large loop excision in transformation zone (LLETZ). These methods, along with conventional cone biopsy, may actually treat and prevent recurrence of precancerous conditions (Gale, 2001).

Dilation and Curettage (D & C)

D & C is considered a minor surgical procedure where the cervix is dilated (made larger) and tissue is suctioned from the uterus.  The procedure may also include scraping the walls of the uterus with a long metal device looped on the end. D & C is used in the treatment of abnormal bleeding, abnormal growths and cancer, endometrial hyperplasia, excessive menstrual bleeding, and for some infertility problems.  It is also used in abortion and miscarriage.  D & C is both a test and a procedure (ObGynCenterOnline, 2005; Merck Online, 2005).

Endo-cervical curettage

This test may be confused with a D & C, but it is very different.  It is   where a sharp instrument called a curet is used to obtain a cervical tissue sample. This test is utilized when cervical or endometrial cancer is suspected (Merck Online, 2005).

Colposcopy

A painless diagnostic procedure where a binocular style magnifying lens inspects the cervix for cancer (Merck Online, 2005).

COSEAL Surgical Sealant

Two polyethylene glycol polymers that combine to form a biocompatible, watertight seal that remains intact at the site for thirty days before reabsorbing into the body.  Used most often in vascular surgery, COSEAL is also an innovative, new way to prevent adhesions after surgery for endometriosis and polycystic ovarian syndrome. (Baxter U.S., 2005).

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This has been a “basic” listing of female reproductive conditions and diseases.  It is apparent that these illnesses have signs and symptoms which mimic each other, making it difficult to diagnose, and easy to misdiagnose. Also, it is obvious that there is a connection among these conditions even though they may be venereal diseases, endemic diseases, and diseases of unknown origin.  Combined with the diagnostic difficulties, is the fact that the female anatomy is compactly fit together, making it easy for bacteria and viruses to pass from one section to another section within the reproductive system and genital tract.  This can create multilayered conditions which play off of each other.   Tests, which became popular in the 1970s, such as the PAP and laparoscopy have greatly improved diagnostic ability in determining causes of complaints, but treatments are not always effective due to a lack of understanding of the origin of a condition or disease, or the long term maintenance of an illness or combination of illnesses.

“Passive” reproductive health requires a good relationship with your health care provider, knowledge of your body, and proper diet and exercise.  “Assertive” reproductive health means taking action if there is a problem, and being aware all of all necessary concerns and options to best treat a situation.

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