R. Wayne Whitted MD, MPH

8740 North Kendall Dr.

Suite 101

Miami, Florida 33176-2212

Phone: 305-596-3744

Fax: 305-596-3676

www.drwhitted.net

Raymond Wayne Whitted MD, MPH

...dedicated to healthy lifestyles and safe, state-of-the-art

surgery for women of all ages.

Pap Smears, Dysplasia, and Human

Papilloma Virus

What is a Pap Smear? A Pap smear is a test

your doctor does to check for signs of cancer of

the cervix. The cervix is part of your uterus

(womb). During a Pap smear, your doctor takes a

sample of cells from your cervix to be tested.

To take the sample, your doctor will put a specu-

lum into your vagina in order to visualize the cer-

vix. Your doctor will gently clean your cervix then

take a sample by passing a spatula across the

face of the cervix. The second part of the speci-

men is obtained by putting a small brush into the

opening and taking a sample from the cervical ca-

nal. Most everyone now uses the Thin Prep pap

smear which has proven to be more accurate.

What is the sample checked for? The cells in

the Thin Prep solution are checked to distinguish

normal cells and abnormal cells. A pap smear can

show if your cervical cells are becoming abnormal

long before they become cancerous. This is why

getting regular Pap smears is so important.

What do the Results mean? A negative Pap

Smear is normal. A positive Pap Smear is abnor-

mal. The Pap smears are classified now using the

Bethesda system. This is a very involved system

of grading pap smears.

Dr. Whitted is dedicated to safe, state-of-the-art,

innovative surgeries and healthy lifestyles for

women of all ages. In a nurturing environment,

the physicians and staff strive to promote a part-

nership in your healthcare and make every effort

to bridge the sterile science of diseases with your

emotional, physical, and spiritual needs. Every-

one is confronted with difficult healthcare deci-

sions at one time or another. You’ll want your

physician and staff to have the knowledge, experi-

ence, and sensitivity to guide you safely through

the decision-making process.

Dr. Whitted provides comprehensive gynecologic

office and surgical healthcare. He is certified in

laparoscopy and hysteroscopy and is an expert in

advanced gynecologic surgery. He has been a

national speaker, trainer, and researcher in ad-

vanced surgical techniques. In addition, Doctor

Whitted is a Certified Menopause Clinician who

educates, trains, and has done research in the

science of menopause. Finally, he is certified in

advanced colposcopy.

Doctor Whitted offers expert education and care in

the following areas:

If you need surgery, Dr. Whitted performs most

gynecologic surgeries with minimally invasive

techniques to reduce hospitalization, recovery,

scarring, discomfort and absence from work in

most cases.

Abnormal Paps (HPV) Loss of Urine

Abnormal Menstrual Cycles Menopause

Bladder Prolapse Ovarian cysts

Chronic Pelvic Pain Osteoporosis

Endometriosis Rectocele

Ectopic Pregnancy Uterine Prolapse

Family Planning Vaginal Prolapse

Fibroids (Leiomyoma) Well-Woman visit

***Evaluation and Diagnosis of Gynecologic Cancers

The Bethesda Grading System

This grading system is very complicated and if you

want further information for this please see

www.bethesda2001.cancer.gov

In a Nutshell

Normal Pap

ASCUS (Atypical squamous cells of undeter-

mined significance)

LGSIL (low grade squamous intraepithelial

neoplasia)

HGSIL (high grade squamous intraepithelial

neoplasia)

Cancer

When should you have Pap smears?

You should have your first pap smear when you become

sexually active or by age 18 (whichever is first). It is

generally considered safe and good healthcare to have

Pap tests once a year.

How Reliable is the test? No test is perfect, but

the Pap smear has helped drastically reduce the number

of women who die of cervical cancer. The Thin Prep

Pap Test is the most reliable Pap and is the only one

recommended routinely now.

What happens if I have an abnormal Pap

Test?

ASCUS Paps: It is recommended with this result that

a repeat pap test be performed in 3 months after treat-

ment with metrogel, cleocin, or doxycycline. 95% of AS-

CUS paps are inflammatory in nature and resolve with

therapy. 5% are, in reality, dysplastic (pre-cancerous)

and if the repeat Pap again is ASCUS then it is recom-

mended to have a Colposcopy. If the repeat Pap test is

normal then it is recommended to repeat it again in 6

months. 3 negative pap tests in a row suggest a normal

cervix.

LGSIL, HGSIL, Cancer Paps: It is recommended

that all paps that initially fall into this range should un-

dergo a more thorough evaluation of the cervix with col-

poscopy.

The Human Papilloma Virus (HPV)

Connection: HPV is now recognized as the major

cause of cervical dysplasia and cancer. It is very com-

mon, with more than 100 types known. Fewer than 20,

however, are considered high risk types that are prone to

cause higher grade dysplasias and cervical cancer. Low

risk HPV types include 6, 11 and are associated with

mild dysplasia and genital warts. High risk HPV types

include 16, 18, 31, 33, 39,45,51,52,56,59,68,69. These

types are associated with the formation of high grade

dysplasias and cancer. Most people have both types.

The HPV DNA Test checks directly for genetic HPV ma-

terial in the specimen and is used most often when re-

petitive ASCUS paps results are obtained. This helps

determine the potential of this mildly abnormal pap to

become more serious.

...

dedicated to healthy lifestyles and safe, state-of-the-art, innovative surgery for women of all ages

What is Colposcopy?

Why is Colposcopy Important?

Colposcopy helps define why the Pap test is ab-

normal, and, therefore, is a more definitive test.

Is it Painful? Most patients describe mild

cramping or pinching. This is helped by taking

ibuprofen/advil ahead of time.

Does this Procedure affect childbear-

ing? No

What happens after Colposcopy?

You may have mild cramps which advil will re-

lieve. In addition, some bleeding with brownish or

yellowish discharge may occur. You can use a

tampon after colposcopy. Call your doctor if you

have heavy bleeding and/or fever. Your results

will usually be ready in 1-2 weeks. Make sure to

schedule a follow-up appointment.

What Therapies are available?

ASCUS/LGSIL: usually 6 months pap smears

and watchful waiting. 90% resolve with healthy

living and anti-oxidants and avoidance of expo-

sures.

HGSIL: Cryosurgery, Office LEEP, Cone biopsy

with every 3-6 months follow-up. Women done

with childbearing may elect hysterectomy which is

done vaginally or laparoscopically.

The colposcope magnifies, or enlarges, the im-

age of the outer portion of the cervix. It is some-

what like looking through a pair of binoculars.

This allows the health care provider to see the

outer portion of the cervix better. Sometimes a

small sample of tissue (called a biopsy) is taken

for further study. The tissue samples help the

health care provider to figure out how to treat

any problems found. And, if cancer of the cervix

is found early, or a precancerous change of cells

is found, it can be treated and almost always

can be cured. Also, for precancers and early

cancers of the cervix, sometimes removal of part

of the cervix may be the only treatment needed.

Mild Dysplasia

CIN 1

Class 3

Atypical

Inflammatory

Class 2

Mod Dysplasia

Severe Dysplasia-

CIN 2, 3

Class 4

Cancer

Class 5