It is quite amazing how many patients I see are unfamiliar with their own resproductive and sexual organs. The cervix, especially, which is such a vital part of female reproductive health. So let us begin with the basics, shall we?
The lower part of the uterus that connects it to the vagina is called the cervix. It is a long tubular hollow structure that is responsible for keeping the baby safe during pregnancy by being closed up and is the one that dilates and opens up to let the baby into the world during vaginal birth. It is also the organ responsible for the regular white discharge you see every day. Think of the cervix like the gatekeeper and regular maintenance guy of your vagina. The pap smear, which has probably been advised to you on your routine health check-up, was to take cells from your cervix for examining for any abnormalities. This routine screening for cervical health is important because the cervix can be infected with a very common virus called HPV or the Human Papilloma Virus. This virus has no symptoms and the infected person is often a silent carrier. But certain strains of the virus cause cervical cancer and this viral infection is pretty much the predominant cause of this cancer.
The risk factors for cervical cancer include HIV infection, having multiple sexual partners, smoking, and cervical infections. A healthy diet rich in antioxidants and vitamins, particularly Vitamin E, is important for maintaining cervical health. Safe sex by using condoms also provides protection to the cervix by preventing the spread of the virus from one silent carrier to his partner. Cervical cancer is most often seen in the age group of 35 and above. But you can protect your cervix from any abnormality from the age of as low as 10 years.
The Gardasil vaccination is the vaccine for cervical cancer prevention and recommended for both males and females before attaining sexual maturity. Even if the person gets sexually active in his/her teens, the protection against the virus will be conferred. From 10-15 years of age, the vaccine schedule is only two doses of vaccine spaced 6 months apart. For unvaccinated individuals over the age of 15, three doses of the vaccine will be required. The first one, followed by the second one a month later and the third one at 6 months.
This vaccine not only protects against the commonly occurring cervical cancer but also the less common vaginal and vulvar cancer. Another infection that can be caused by HPV is the genital wart. While the genital wart can affect the genitalia of both men and women, it is more dangerous in women. Usually, genital warts can be easily treated but will recur if the underlying infection is not treated. A wart can present with abnormal vaginal discharge, itching, bleeding and burning. A simple examination is usually followed by chemical treatment by the doctor.
The HPV vaccine prevents the person from new HPV infections but cannot be used to treat a pre-existing infection. This is why individuals older than 26 years of age are not routinely recommended to take the vaccine because by then usually the person is infected if they have been sexually active. A word of caution here. The HPV vaccine is not a sure-shot prevention for cervical cancer. So be sure to undergo screening and testing as advised by your gynaecologist every few years.
In fact, cervical cancer is one of the few cancers that can be completely cured if caught early. The most important thing you can do to help prevent this cancer is to get vaccinated early and see your gynaecologist for regular screening tests. There are two kinds of tests that can help with early detection of any miscreant cells, The pap smear and the HPV test. As the name suggests, the HPV test detects the virus. The pap smear, on the other hand, looks for cells in the pre-cancer stage, when the cells have still not transformed into cancer cells which are capable of spreading through the body. Early treatment and removal of pre-cancer can prevent cervical cancer.
A normal or negative test result means that no cell changes were found on the test. But one normal test does not guarantee that an abnormal result will not occur in the future. So it is imperative that you go for follow-ups every 3 years if you are over the age of 21. A negative result on the pap smear test mandates visits every 3 years while a negative HPV test along with pap smear requires follow-ups every 5 years. So while you are at it, get yourself checked for both.
A positive HPV infection means that you do have an HPV infection. There are two important strains of HPV, HPV 16 and 18, which are responsible for cervical cancer mostly. So in case you test positive for either, the next important test is to find out the kind of HPV virus infecting you, which is usually done by a DNA test. So get screened and stay safe!
Dr Farah Adam Mukadam is a family physician based in Bengaluru and the author of Newborns and New Moms. She is also a women's health educator working through her Instagram channel @dr.farah_momstein.