Gynecology


Human Papillomavirus (HPV)

What is HPV?

HPV (human papillomavirus) is a common virus that affects both females and males. Most types of HPV are harmless, do not cause any symptoms, and go away on their own. About 30 types of HPV are known as genital HPV since they affect the genital area. Some types are high risk and can cause cervical cancer or abnormal cells in the lining of the cervix that sometimes turn into cancer. Others are low risk and can cause genital warts and changes in the cervix that are benign (abnormal but noncancerous).

Who gets genital HPV?

Anyone who has any kind of sexual activity involving genital contact could get genital HPV. Because many people who have HPV may not show any signs or symptoms, they can transmit the virus without even knowing it. HPV is more common than you might think. In 2005, approximately 20 million Americans had genital HPV. More than 6 million new cases of genital HPV are diagnosed in the United States every year.

How do I know if I have HPV?

Because HPV may not show any signs or symptoms, you probably won't know you have it. Most women are diagnosed with HPV as a result of abnormal Pap tests. A Pap test (also known as a Pap smear) is part of a gynecological exam and helps detect abnormal cells in the lining of the cervix before they have the chance to become precancers or cervical cancer. Many cervical precancers (changes that could lead to cancer) are related to HPV and can be treated successfully if detected early. That's why early detection is so important.

What happens if I get HPV?

In most people, the body's defenses are enough to clear HPV. If not cleared by the body, some HPV types cause genital warts. Other types cause abnormal changes in the cells lining the cervix that can lead to precancers and even turn into cervical cancer later in life.


Abnormal Cervical Cells

What are abnormal cervical cells?

Abnormal cervical cells (also called cervical dysplasia) are cells in the lining of the cervix that have changed in appearance. The more severe the cervical abnormality, the more likely it is that cervical cancer could develop in the future. Most often this can take a number of years, although in rare cases it can happen within a year.

What causes abnormal cervical cells?

Abnormal cervical cells may have a number of different causes, such as an infection or inflammation, but are commonly caused by certain types of HPV (human papillomavirus).

How do I know if I have abnormal cervical cells?

The usual way to detect abnormal cervical cells is through a Pap test. You may have additional testing, such as repeat Pap testing, HPV DNA testing, colposcopy, and possible biopsy. An abnormal biopsy result may be reported as CIN (cervical intraepithelial neoplasia). The term CIN, along with a number (1 to 3), describes how much of the thickness of the lining of the cervix contains abnormal cells. A diagnosis of CIN 3 means there are severely abnormal cervical cells through the entire thickness of the lining of the cervix.

How are abnormal cervical cells treated?

Most abnormal cells in the lining of the cervix will eventually go away on their own. If the abnormalities are mild, the healthcare professional may choose to closely monitor them. If the abnormalities are more severe, removing these cells can almost always prevent cervical cancer from developing in the future. Methods commonly used to treat abnormal cervical cells include freezing, removing them using an electrical instrument, and conventional surgery. The treatment may have to be repeated if the abnormal cells reappear.


Cervical Cancer

What is cervical cancer?

Cervical cancer is cancer of the cervix. The cervix is the part of the uterus that connects the upper part of the uterus (the womb) and the vagina. Cervical cancer is a serious condition that can be life threatening. When a woman becomes infected with certain high-risk types of HPV and does not clear the infection, abnormal cells can develop in the lining of the cervix. If not discovered early and treated, these abnormal cells can become cervical precancers and then possibly cancer. Most often this can take a number of years, although in rare cases it can happen within a year.

Who gets cervical cancer?

About half of all females diagnosed with cervical cancer are between 35 and 55 years old. What many of these women may not realize is that they were most likely exposed to one of the high-risk types of HPV during their teens and 20s. The American Cancer Society estimated that in 2005 there were 10,370 new cases of cervical cancer diagnosed in the United States, and 3,710 women died from the disease.

How do I know if I have cervical cancer?

The usual way to detect cervical cancer is through a Pap test. If the results of a Pap test indicate that you have abnormal cervical cells, it's important to follow your healthcare professional's recommendations for more testing, such as repeat Pap testing, HPV DNA testing, colposcopy (examination of the cervix through a magnifying device), and possible biopsy (obtaining a tissue sample of analysis in the lab).

How is cervical cancer treated?

The three main methods are surgery (an operation to remove the cancer), radiation therapy (using high energy beams to destroy cancer cells), and chemotherapy (using medications to disrupt the growth of cancer cells). Sometimes treatment includes two or more of these methods. Before choosing a treatment, a healthcare professional will consider the size of the cancer, whether it has spread, the woman's age and overall health, and patient preferences. The treatment that is right for one person may not be right for someone else.


Genital Warts

What are genital warts?

Genital warts are flesh-colored growths that are most often caused by certain types of HPV. Genital warts most often appear on the external genitals or near the anus of females and males. Less commonly, genital warts can appear inside the vagina and on the cervix.

Who gets genital warts?

Anyone who has any kind of sexual activity involving genital contact could get genital HPV, and certain types of HPV can develop into genital warts. Because many people who have HPV may not show any signs or symptoms, they can transmit the virus without even knowing it. After sexual contact with an infected person, genital warts may appear within weeks, months, years, or not at all. Genital warts are very common. Each year in the United States, there are approximately 1 million new cases of genital warts.

How do I know if I have genital warts?

A healthcare professional can usually recognize genital warts just by seeing them. Genital warts often do not cause symptoms. In some cases, however, they may cause burning, itching or pain.

How are genital warts treated?

Genital warts sometimes disappear on their own without treatment. However, there is no way to tell if they will disappear or grow larger. A healthcare professional may choose to apply a special cream or solution to the warts. Alternatively, some genital warts can be removed by freezing, burning, or using a laser treatment. If these treatments don't work, they may be removed by surgery. There is a chance that genital warts can reappear after treatment, since the HPV that caused them may still be present.

This fact sheet does not cover everything there is to know about HPV, abnormal cervical cells, cervical cancer or genital warts. Talk to your healthcare professional or visit HPV.com for more information.


Kegel Exercises

In the mid 1900's, Dr. Kegel developed a series of exercises to help women who suffered from urinary incontinence, i.e., they would inadvertently expel small amounts of urine if they coughed, sneezed or had an orgasm. The exercises consisted of strengthening the pubococcygeal (PC) muscle, the muscle that stops the flow of urine. The PC muscle turns out to be the same muscle that forms the orgasmic platform, and along with other pelvic muscles, contracts with orgasm. When Kegel questioned women about their response to his exercises, they replied that not only was their ability to retain urine better after practicing the exercises, but they were experiencing more sexual sensations during intercourse as well. Kegel exercises are also recommended both before and after childbirth as a way of toning and strengthening the vagina. Post menopausal women who use Kegel exercises find that they help to maintain lubrication (by increasing blood flow in the vaginal area) and reduce the need for estrogen creams.

After practicing the following exercises for about six weeks, see if you notice any difference in the strength of your PC muscle when you put your finger in your vagina and squeeze.

The Squeeze-Release Exercise

The first Kegel exercise consists of squeezing the PC muscle for three seconds, relaxing the muscle for three seconds, and squeezing it again. It may be difficult at first to contract the muscle for a full three seconds. If this is the case, contract for one or two seconds at first and build up the time as the muscles get stronger. Carry out a series of ten squeezes and releases three times during the day.

The Flutter Exercise

This is much like the first exercise except that instead of holding the squeeze for three seconds, the objective is to squeeze the muscle, relax it, squeeze again, and release as quickly as possible. Again, complete a series of ten squeeze and releases at three different times during the day.

When you first start doing this exercise, it may feel like a tongue twister; you may not be able to tell if you are contracting or releasing and for a while it may feel all muddled together. However, begin slowly and with practice you will gradually be able to do the flutter more rapidly.

The Elevator Exercise

This exercise consists of exercising the entire length of the vagina. Imagine that your vagina is an elevator shaft and the elevator is at the opening to the vagina. Rather than squeezing, contract the muscles as you imagine yourself slowly pulling the elevator upward along the vaginal canal, beginning at the opening and ending at the uterus. After the three or four seconds it takes to go the entire length of the vagina, slowly relax the muscles as if you were lowering the elevator to the ground floor, and then begin again at the vaginal opening. This is good for strengthening the uterine muscles as well as the PC muscles.

The advantage of these first three Kegel exercises is that you can do them anywhere and at any time and no one can tell you're doing them. Practice when you stop the car for a red light or in the morning when you wake up. Or do them when you answer the telephone at home or at work, or when you are lying down to rest. The muscles surrounding your anus may move during these exercises, but if you find you are moving your thigh muscles, your stomach muscles or your buttocks, you are probably squeezing the wrong muscles.

The Bearing Down Exercise

This exercise is more apparent to the observer, so you might want to practice it in privacy. It consists of bearing down as during a bowel movement, but with the emphasis more on the vagina than the anal area. Imagine there is a tampon deep inside your vagina and bear down as if you were pushing it out. The bearing down should be held for three or four seconds, and with the elevator exercise.

All four exercises should be practiced ten times each at three different times during the day. As you progress with the Kegel exercises, slowly increase the number of repetitions in each series until you are able to do twenty of each exercise in succession. You can do them as frequently during the day as you can find time but consider three times daily a minimum.

Some women hesitate to practice the Kegel exercises because they feel sexually aroused by contracting the PC muscle. While this can be disconcerting, it is a perfectly normal reaction. The muscle tension created by the exercises causes blood to flow to the pelvic region, which is the same physiological process that occurs with sexual stimulation. So, if this happened to you, don't worry about it, just enjoy it.

If you are carrying out these exercises correctly, but you initially notice some discomfort or tightness in the pelvic region, reduce the number of daily contractions but do not abandon the exercises. Like any muscle that is being exercised for the first time, it may feel a little stiff initially. However it is quite important to keep this muscle, like others in your body, in tone.