R. Wayne Whitted MD, MPH
8740 North Kendall Dr.
Suite 101
Miami, Florida 33176-2212
Phone: 305-596-3744
Fax: 305-596-3676
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
In a Nutshell
Normal Pap
ASCUS (Atypical squamous cells of undeter-
mined significance)
LGSIL (low grade squamous intraepithelial
HGSIL (high grade squamous intraepithelial
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
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
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-
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-
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
Class 3
Class 2
Mod Dysplasia
Severe Dysplasia-
CIN 2, 3
Class 4
Class 5