HPV found years after a hysterectomy

Hello
This is all new to me. About 10 years ago I had a total hysterectomy. At that time I was told that Pap smears were no longer needed. I went in last week for a check up and the doctor did a pap smear. It came back abnormal, with high risk HPV. The doctor has since done a scope to look at my vaginal walls. (I do not have a cervix anymore due to hysterectomy) There was some mild vaginal dysplagia. Now I need someone to help me understand this. I know the main concern with high risk HPV is cervical cancer. I don't have a cervix, so where does this leave me? Is there something I need to be doing proactively to address this? The doctor was vague and in my opinion down played this, basically telling me they will watch it and see if my immune system will resolve it. He also told me that my husband and I would need to use condoms for intercourse. We both came out of marriages where our formal spouses were unfaithful with numerous partners. The doctor said that the HPV could have been dormat in me for years. SO again I am asking where does this leave me? I can find a lot of information about HPV as it relates to women who are young and still have their cervix, but I do not find much on older women (I am almost 51) who have had total hysterectomy and no longer have their cervix.
I never dreamed at this age I would have to #1 worry about protected sex with my husband of almost 20 years and #2 worry about an STD in a committed relationship where neither of us has had any other partner since we married.
Any input or help or anythig would be so nice.
Thanks
Karen

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hello, karen. thankfully you have a doctor who knows that you DO need to have paps, even after a hysterectomy, and particularly when you've been potentially exposed to hpv via a new partner (or via your ex-husband's infidelities)

i'm not sure why your doctor is suggesting you and your husband use condoms....i would suggest you ask for an explanation.

the most common cancer that is hpv related is cervical cancer, but hpv also can cause vaginal cancer, vulvar cancer, anal cancer, and oral cancer (and penile cancer for men). vaginal dysplasia is similar to cervical dysplasia, and the pap is taking a sample of the vaginal tissues rather than the cervical tissues. i've had a hysterectomy for recurring cervical dysplasia, so i no longer have a cervix.....and i've also experienced vaginal dysplasia after the hysterectomy (i consider hpv evil!).

many women with mild dysplasia (VAIN1 would be what the biopsy said, right?) will clear the dysplasia without medical treatment. and, of course, you want that hpv infection to clear quickly too! if you are experiencing vaginal atrophy from a lack of estrogen, the atrophy provides a 'good' environment for the development of dysplasia, and the doctor may suggest vaginal estrogen to restore the vaginal tissue health.

i'm just a few years younger than you. hpv is not just in young women....it impacts all of us.

i hope this info is helpful for you. i'm sorry you're going through all of this. let us know if you have any other questions, or just want to share...or vent!

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Thanks flowershoplady,
The reason I had a hysterectomy was related to fibroid tumors, and that is why I suppose they told me no pap was needed because it was not related to cancer, who knows why they told me that!!! But now who knows how long I've had HPV, since it was 10 years since my last pap?? How long have you had vaginal dysplasia since your hysterectomy?

The doctor did put me on estrogen cream. I guess I am wondering what kind of percentages are out there as to how often this clears up and/or ends up in a form of cancer? The doctor said that we needed to use condoms because if we don't we are just going to be passing the virus back and forth to each other and therefore the virus won't clear up. Is there a test they can do to check my husband?

Not knowing the odds and outcomes of this for someone like me is making me crazy. I feel like I am in a dark room and have no light to find my way aroud. I am an information person and I cannot find much on this. The doctor did not show a high level of concern, and said something like he sees about 95 % resolution. But that is not what I am seeing/reading on the sites online.

Thank you again for your response!
Karen

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it sounds like the doctor saw vaginal atrophy which is why he prescribed the estrogen. and, i don't have VAIN any longer! :) it showed up 18 months after my TAH, and then stayed with me for a year during which my gynecologic oncologist watched it via colposcopies and biopsies to be sure it didn't progress past VAIN1. and, then, it went away, and, we 'joked' that she was removing it biopsy by biopsy, which certainly helped, but, bottomline, all is normal right now....and i hope it stays that way. and, yep, you're right that in your situation you won't really know how long you've had hpv nor when you were first exposed to it.

i don't like saying that a specific doctor is wrong, because i am certainly not a medical professional....but... based upon all the information available about hpv, your doctor is wrong.....the virus doesn't get passed back and forth like a bacteria causing a bacterial infection (such as chlamydia or gonnorhea) would get passed back and forth. you already have the virus, as most likely does your husband, and the virus will stay with you, even once the hpv infection is cleared, and even once the dysplasia is cleared.

and, there's no standard hpv test for men but his doctor, usually a urologist, may want to do an exam.

i think your doctor is right in telling you that mild dysplasia most often clears on its own. and hopefully you'll be in that majority for whom that is the case. i don't know the numbers for clearing VAIN, but they are indeed in a significant majority. i know....you'll still worry about the exceptions. so, while you wait for your next appointment, i would encourage you to eat good for you veggies, particularly cruciferous vegetables (kale, bok choy, brussel sprouts, etc.) which contain DIM which has been proven to help in clearing hpv infections. and, i would encourage you to also get plenty of sleep, reduce stress, practice yoga/meditation, and make sure there are no other vaginal inflammations or infections.

you may want to get details of your tests, including the hpv test, which will tell you if you have high risk and/or low risk hpv strains. and i think it's valuable to continue these tests when you have your paps so you can monitor the status of the hpv infection.

i'm assuming that your next step will be a follow up colposcopy and biopsies in 3 months or so.

and, if you feel any sense of concern about your doctor, don't hesitate to see someone else. you deserve to have the best medical care possible.

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I decided to do some reseach on HPV because like others in this discussion, there is no information on how HPV affects women if they have had a hysterectomy. I had a total hyster five years ago (at the age of 42)....all gone even the cervix. To me it was the greatest thing ever!!! I have had Paps every year since my hyster (the hyster was for endometriosis), and all have been great. This year my doctor did the Pap and also tested for HPV. He stated this was the first year the insurance would pay for it or it was the first time it was available, do not remember which it was. In Feb, the nurse states I am HPV positive and I would have another Pap in 6 months. She showed no concern, stated, I had no cervix, should be fine, we would decide what to do in 6 months. She also mentioned to me that there was no telling how long I had had it since this was the first HPV test. She shocked me when she said, it could have been from your ex-husband. The ex was faithful, we were married for 15 years and have been divorced for 5 years - that was shocking to think that I could have had it for that long and didn't know it. No wonder it is so wide spread. No other info given. Very frustrating. I am single, and not currently in an intimate relationship. My worries obviously is what do I do when I do become invovled? Does it clear up?

My best friend's pap also came back positive for HPV (she is also single same age). She has all her stuff, but is post-menopause.

HPV is definetely evil in that we have no defence and we don't know whether a man carries it.

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Lilac57:
I SO understand where you are coming from, at least with feeling blindsided by the HPV diagnosis, that is. My husband & I have been married (faithfully) for 29 years. We were just kids when we married (still in high school). I received my HPV diagnosis about a year ago. My doctor began the standard lecture about limiting my number of sexual partners - I burst out laughing, because I've had exactly ONE. Can't get much more limited than that.
I go for biopsy results this morning, from a LEEP I had last week which followed a colposcopy which showed dysplasia. I've NEVER had an abnormal pap, and I've had them VERY regularly.
I know there are some ladies on here who deal with other types of gynecological cancers, such as vaginal, vulval, etc. I'm sure they will be glad to talk with you about the risk factors and precautions for those. You've found a wonderful community with a wealth of knowledge - welcome.

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Hi, Karen. I'm sorry you are experiencing this situation. What a surprise it must be for you, if you didn't before know about HPV, nor about the importance of getting your vaginal vault checked periodically. I too have had abnormal readings after surgery. It probably happens more often than most folks realize. My sense is that this is a managed disease, at this stage, and that is why our doctors do not seem overly alarmed in our behalf. One can live with these issues, as long as she keeps up with her checkups and goes for treatments, as needed.

"corellin" on this site gave us all a useful run-down of some recent findings. One study that she (?) cited included evidence that condom use, even when the partners have been regular partners, can reduce the chances of reinfection. Here's the link she provided.

http://www.ncbi.nlm.nih.gov/pubmed/14566832

Her whole discussion of HPV is easy to understand and informative. The thread is this one, called HPV reinfection.

http://www.inspire.com/groups/national-cervical-cancer-coalition/discussion /hpv-reinfection/

I tend to agree with flowershoplady: once we have the HPV, we can't really get reinfected. It's a virus; it's with us. My sense is that our weakened tissues become more weakened through the contact involved in intercourse or self-stimulation, and cell breakdown continues as a result.

Yet as corellin shows in her postings, there have been studies that suggest that reinfection can occur, or retransmission of active cells, and those active cells will target the weak links in the partner's cells.

It's hard, dealing with all of this, at first. After one gets to know others who have been down this road, however, the sense of aloneness diminishes.

Please know you are not alone. Many of us live with this disease, and it's a disease that researchers are working to find better treatments for.

Best wishes to you.

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for those of us who are single, whether 20 years old, or 50 years old, i think we have a greater appreciation and understanding of the potential impact of hpv than the average woman. there's no sure way to know that we're not transmitting a potentially oncogenic strain of hpv to a new partner. and there's no sure way to know if it will impact him or impact a future partner he may have. similarly, we know that we can still get potentially oncogenic strains of hpv, and, again, there's no sure way to be sure it's not transmitted. certainly, if we're testing hpv positive, we know it will most probably be transmitted. but, we're not tested daily, so how would we know for sure. and even if we knew our cervical/vaginal hpv status, do we know our oral or anal hpv status? most likely no. there's no easy answers, that's for sure. currently we have knowledge about hpv, which is increasing all the time, and we have some abilities for testing, but it's limited. from a practical perspective, we don't yet have all the tools/technology.

justmeintexas, i hope you're able to clear that hpv infection and have no dysplasia develop. you had a normal pap with a positive hpv test? has the doctor suggested a colposcopy to take a closer look?

and, mawmaw, i'm sorry that your doctor gave you, or started to give you, a speech about limiting partners. i think that's inappropriate, because, as you know, we only need one partner to get hpv.

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I would just like to thank all of you ladies for sharing...it's evident that any women who is sexually active regardless of how few or many partners is at risk for HPV complications at any age with cervix intact or not.

I have read that there's a higher incidence of cervical cancer (that includes CIS) in women in their 40s & 50s - so now I'm wondering about the connection between VAIN showing up during this time in a woman's life as well.

Lilac, I also question condom use with a monogamous partner for a lenghty period of time. I'm curious, just as an fyi, what info your dr based his recommendation on - if you ever find out, pass it on - it may be worth looking into. My surgeon told me the opposite - not to tell my husband I was HPV+! (YIKES!!!)

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exactly, faith. i don't understand why the american cancer society and american college of ob/gyn's haven't updated their recommendations about frequency of paps. particularly with women who may be sexually active, it doesn't matter whether their previous history had no abnormal paps...or whether or not they've had a hysterectomy....they need regular yearly paps and hpv testing (in my humble opinion!).

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Absolutely!

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Are you sure your husband has been faithful? You could have had this HPV before you got married and it had layed dorment for years. Any way the Dr that told you you didn't need pap smears anymore is WRONG. I had Cervical Cancer at the early stages and I went for paps every 4 mths for years and then down to yearly paps now 7 years later. I had a TAH and left with one ovary. I sill worry about it returning or if my DR should have done more. I havd .123mm invasive CIN 3. He said no chemo or radiation was needed and now I wonder...what gets me is that people say oh you had cervical cancer did you have HPV? then kind of look down on you because it's classified as an STD

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I hear you. I am 67 now. I had a hysterectomy 30 years ago due to precancerous cervical changes seen in a PAP test. No one ever mentioned HPV. I also have only ever had one sexual partner and had no sign my husband has it either, so I never gave having HPV a thought. I do know that they always say that HPV is the main cause of cervical cancer, but I thought I was the exception. I went for 25 years without a PAP as I think I was told I did not need one any more. Within the past few years I have been recommended to start having them, and the first couple were negative. I just had one that came back abnormal, and the gynecologist said some cells by the cervix could have "hidden" for years and now they are coming out. You could knock me over with a feather to think I have HPV, a STD!! I had four biopies on Friday and will go back to the GYN next Friday for the results. She said something about possibly having to see an GYN oncologist depending on the results. Well, for today I am not going to stress about this, only if I find out I need to.

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sorry to hear you're dealing with this, slogan. and, good for those doctors who told you you still need to have a pap test (as well as a pelvic exam). and, you don't have a cervix, do you? i'm assuming if you had a hysterectomy for precancerous cervical tissue that they removed the cervix during the hysterectomy. did the gynecologist tell you what he was seeing during the colposcopy? an abnormal pap can result from many things. did they also do an hpv test? and, yes, you may want to see a gynecologic oncologist if there are vaginal tissue abnormalities....they're the experts for gyn cancers and dysplasia. if it's mild dysplasia (VIN1), they may just watch and wait. abnormal paps, as well as dysplasia, can also arise from vaginal atrophy. best wishes to you....let us know how you're doing!

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i meant to type VAIN1 (mild vaginal dysplasia)....VIN1 would be vulvar dysplasia.

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Just to clear things up, the issue with using condoms isn't related to reinfection (per se) as FSL already mentioned it doesn't ping pong back and forth like Chlamydia does for example, however since your partner also has HPV (sort of a given at this point), unprotected intercourse can have an affect by increasing YOUR viral load by his continuing to expose you to the virus. It is felt that reducing this risk can have beneficial effects in terms of preventing a mild dysplasia from progressing regardless of it is CIN, VIN, VaIN or AIN. Hope this clears things up.

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No I do not have a cervix, and the GYN said she was going to do an HPV. test. Friday I will know the story. I do not know anything about the levels, stages, or terminology , so I do not know what the initial PAP showed, except I do remember her saying "more than mild."

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You dont need a cervix to have an HPV test done. This test can be run on tissue whether received through a typical Pap test, anal Pap or from a biopsy specimen. More importantly just because you don't have a cervix doesn't mean you can't have HPV.

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