Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
A Pap smear (also known as the Pap test) is a medical procedure in which a
sample of cells from a woman's cervix (the end of the uterus that extends into
the vagina) is collected
and spread (smeared) on a microscope slide. The cells
are examined under a microscope in order to look for pre-malignant
(before-cancer) or malignant (cancer) changes.
A Pap smear is a simple, quick, and relatively painless screening test. Its
specificity - which means its ability to avoid classifying a normal smear as
abnormal (a "false positive" result) - while very good, is not
perfect. The sensitivity of a Pap smear - which means its ability to detect
every single abnormality -- while good, is also not perfect, and some "false
negative" results (in which abnormalities are present but not detected by the
test) will occur. Thus, a few women develop cervical cancer despite having regular Pap screening.
In the vast majority of cases, a Pap test does identify minor cellular
abnormalities before they have had a chance to become malignant and at a point
when the condition is most easily treatable. The Pap smear is not intended to
detect other forms of cancer such as those of the ovary, vagina, or uterus.
Cancer of these organs may be discovered during the course of the gynecologic
(pelvic) exam, which usually is done at the same time as the Pap smear.
Who should have a Pap smear?
Pregnancy does not prevent a woman from having a Pap smear. Pap smears can be
safely done during pregnancy.
Pap smear testing is not indicated for women who have
had a hysterectomy (with removal
of the cervix) for benign conditions. Women who have had a hysterectomy in which
the cervix is not removed, called subtotal hysterectomy, should continue
screening following the same guidelines as women who have not had a
hysterectomy.
The screening guidelines of several key medical organizations are summarized in
the table below.
3 years after vaginal intercourse, no later than age 21
Yearly with exceptions:
every 2 years if liquid-based kit
every 2-3 years if three normal tests in a row in women >30
years old
Total hysterectomy for benign disease
> 70 years old with at least three normal Pap smear
results and no abnormal Pap results in the last 10 years
United States Preventative Services Task Force 2003
Within 3 years of onset of sexual activity or age 21, whichever
comes first
At least every 3 years (no evidence that every year is better than
every 3 years)
Recommend against doing Pap smears in women
older than 65 years of age, if adequate screening with normal results
and otherwise not at risk for cervical cancer.
Recommend against doing Pap smears in women who have had a total
hysterectomy for benign disease.
Yeast vaginitis is a yeast infection of the vagina. Symptoms include itching, burning, soreness, pain during intercourse and urination, and vaginal discharge. Yeast infections can be treated with over-the-counter and prescription medications.
There are many types of ovarian cancer, epithelial carcinoma is the most common. Women with a family history of ovarian cancer have an increased risk of developing the disease. Some ovarian cancer symptoms include abdominal pain, nausea, diarrhea, constipation, and abnormal vaginal bleeding, however, they usually do not present until the disease has progressed. Early diagnosis is important for successful treatment.
Chlamydia, a type of bacteria that causes an infection, is spread through sexual contact. Most of the time, women with chlamydia have no symptoms. Antibiotics are an effective treatment for chlamydia.
Sexually transmitted diseases, or STDs,
are infections that are transmitted during any type of sexual exposure,
including intercourse (vaginal or anal), oral sex, and the sharing of sexual
devices, such as vibrators. Women can contract all of the STDs, but may have no symptoms, or have different symptoms than men do.
Cervical cancer is cancer of the entrance to the womb (uterus). Regular pelvic exams and Pap testing can detect precancerous changes in the cervix. Precancerous changes in the cervix may be treated with cryosurgery, cauterization, or laser surgery. The most common symptom of cancer of the cervix is abnormal bleeding.
Menopause is the time in a woman's life when menstrual periods permanently stop, also called the “change of life." Menopause symptoms include hot flashes, night sweats, irregular vaginal bleeding, vaginal dryness, painful intercourse, urinary incontinence, weight gain, and emotional symptoms such as mood swings. Treatment of menopausal symptoms varies, and should be discussed with your physician.
Cervical dysplasia is a condition in which the cells of the inner lining of the cervix have precancerous changes. There are two types of cervical dysplasia; 1) squamous intraepithelial lesion, and 2) cervical intraepithelial neoplasia. Cervical dysplasia is caused by infection of the cervix with HPV (human papillomavirus). There are various diagnostic measures for cervical dysplasia. Treatment generally depends upon the progression of the dysplasia, mild, moderate, or severe.
Human papillomavirus (HPV) infection is the most common sexually transmitted infection in the U.S. HPV is primarily transmitted by sexual contact. While some people develop warts in the genital region after infection, others experience no symptoms. Though genital warts can be removed, there is no cure for HPV infection. There is a vaccine to prevent infection from four common HPV types.
Benign uterine growths are tissue enlargements of the female womb (uterus). Three types of benign uterine growths are uterine fibroids, adenomyosis, and uterine polyps. Symptoms include: abdominal pressure, pelvic pain, and pain during intercourse. Diagnosis and treatment of benign uterine growths depends upon the type of growth.
Vaginal cancer is fairly uncommon. There are two types of vaginal cancer: squamous cell carcinoma and adenocarcinoma. Risk factors include being 60 or older, exposure to DES while in the womb, HPV infection, and having a history of abnormal cervical cells. Painful intercourse, pelvic pain, vaginal lumps, and abnormal vaginal bleeding or discharge are all symptoms of vaginal cancer. Treatment depends upon the stage of the vaginal cancer and may involve surgery, radiation therapy, chemotherapy, and the use of radiosensitizers.
Syphilis, a sexually transmitted disease, is caused by a microscopic, wormlike bacterial organism called a spirochete. There are three stages of syphilis. The first involves the formation of the chancre. The second stage often includes hair loss, a sore throat, white patches in the nose, mouth, and vagina, fever, headaches, and a skin rash. The third stage can cause extensive damage to the internal organs and the brain, and can lead to death. Though early infection often resolves on its own, treatment usually varies based on the stage of the infection at the time of diagnosis.
Sexual dysfunction refers to a problem that arises during any phase of the sexual response cycle, preventing an individual or couple from experiencing sexual satisfaction. Physical, medical, and psychological conditions may affect sexual functioning, resulting in inhibited sexual desire, inability to become aroused, lack of orgasm, and painful intercourse. Treating the underlying physical and psychological problems usually resolves most female sexual problems.
Sexual health information including birth control, impotence, herpes, sexually transmitted diseases, staying healthy, women's sexual health concerns, and men's sexual health concerns. Learn about the most common sexual conditions affecting men and women.
When you are pregnant, many sexually transmitted diseases (STDs) can be especially harmful to you and your baby. These STDs include herpes, HIV/AIDS, genital warts (HPV), hepatitis B, chlamydia, syphilis, gonorrhea, and trichomoniasis. Symptoms include bumps, sores, warts, swelling, itching, or redness in the genital region. Treatment of STDs while pregnant depends on how far along you are in the pregnancy and the progression of the infection.
Disease prevention in women includes screening tests that are a basic part of prevention medicine. All screening tests
are commonly available through your general doctor. Some specialized tests may be available elsewhere.
Cervical dysplasia refers to the presence of precancerous changes of the
cells that make up the inner lining of the cervix, the opening to the womb (uterus). The term
dysplasia refers to the abnormal appearance of the cells when viewed under the
microscope. The degree and extent of abnormality seen on a tissue sample (such
as a Pap smear) was formerly referred to as mild, moderate,
or severe dysplasia. In recent years, this nomenclature has been replaced by two
newer systems. These systems are based upon changes in the appearance of cells
visualized when smears of individual cells (cytological changes) or tissue
biopsies (histological changes) are reviewed under a microscope.
Squamous intraepithelial lesion is the
pathology terminology for
cervical dysplasia observed in smears of cells taken from the cervix.
Squamous refers to the type of cell that lines the cervix.
intraepithelial refers to the f...