Abnormal Pap Smear Research Articles

Comparison of Three Methods, “Pap Smear, Conization and LEEP” in Women with Abnormal Pap Smear: A Ten-Year Retrospective Analytical Study

Aim: Considering that many cases of abnormal pap smears are reported, which lead to more aggressive procedures such as colposcopy and cervical Loop Electrosurgical Excision Procedure conization, therefore, we tried to investigate the results of conization and compare them with the results of pap smears, so that perhaps more aggressive procedures can be avoided. Methods: This cross-sectional retrospective analytical study was conducted on women who underwent pap smear and cervical conization in Mortaz and Shahid Sadoughi hospitals from 2011 to 2020. All data including age, Pap smear, and conization pathology results were extracted from medical records. P-value Results: Totally 1306 patients were included in this study. The mean age was 40.74±9.73 years old. The most commonly reported pap smear tests and loop electrosurgical excision procedure conization were atypical squamous cells of undetermined significance with 912 (69.8%) patients for a pap smear and chronic cervicitis with 860 (65.8%) patients for loop electrosurgical excision procedure, respectively. A significant difference was seen between the distribution of conization findings and the pap smear test. In addition, no significant difference was observed between the distribution of findings of pap smear tests and cervical conization in terms of age. Conclusion: According to the results, it can be said that there was no significant difference between different age groups, but there is a significant difference between the results of pap smear and cervical conization, it seems that pap smears should be reported more accurately to avoid unnecessary conization. Keywords: uterine cervical neoplasms, papanicolaou test, conization, cervix uteri

A Retrospective Case Control Study to Evaluate the Frequency of Pap Smear Abnormalities among HIV-seropositive and HIV-seronegative Women

A Retrospective Case Control Study to Evaluate the Frequency of Pap Smear Abnormalities among HIV-seropositive and HIV-seronegative Women

A rare case of poorly-differentiated endometrial carcinoma in a female-to-male transgender man on testosterone therapy

Abstract Introduction/Objective Testosterone is commonly used as gender-affirming therapy for transmasculine individuals. The effects of testosterone therapy on endometrial tissue are complex, with some experiencing atrophy, and others with abnormal uterine bleeding (AUB). Endometrial carcinomas in transgender men are rarely reported in the literature. Here we present a case of poorly-differentiated endometrial carcinoma in a transgender man on testosterone. Methods/Case Report A 56 year-old female-to-male transgender man who had been on testosterone and finasteride therapy since 2015 developed vaginal discharge in 2022. No history of abnormal pap smears was noted. The patient’s pelvic ultrasound that was subsequently obtained after presenting with the vaginal discharge showed a thickened endometrium of 4 cm thickness. PET-CT revealed hypermetabolic activity corresponding to the endometrial lining of the uterus. Endometrial biopsy was notable for poorly differentiated carcinoma with retained expression of the mismatch repair proteins by immunohistochemical stains. The patient underwent hysterectomy with bilateral salpingo-oophorectomy. Grossly, there was a 9.5 cm necrotic mass occupying the entire endometrial cavity, extending >50% into myometrium thickness and extending into the lower uterine segment, without cervical involvement. Background endometrium was inactive/atrophic. Microscopic examination of the tumor showed sheets of epithelioid tumor cells with extensive necrosis, without any glandular pattern. On immunohistochemical stains, the tumor cells were positive for pankeratin and patchy staining for keratin 7 and keratin 20, without expression of PAX8, estrogen receptor, progesterone receptor or androgen receptor. Results (if a Case Study enter NA) N/A Conclusion Gender-affirming testosterone is a common long-term treatment for transgender men. There is limited understanding of the long-term effects of testosterone therapy on endometrial pathology, particularly regarding the potential for developing malignancy. Positive staining for androgen receptor has been previously reported in endometrial malignancies, and therefore, studies on the potential effects of testosterone therapy on endometrial malignancies is warranted. This case demonstrates the importance of continued gynecologic care in female-to-male transgender individuals who have not undergone previous gender affirming gynecologic surgery.

Colposcopy-A Valuable Diagnostic Tool for Pregnant Women With Unexplained Vaginal Bleeding.

We aimed to examine the diagnostic value of colposcopy in a large cohort of pregnant women with unexplained vaginal bleeding during the second or third trimester. This retrospective study included women who underwent colposcopy due to vaginal bleeding in the second and third trimesters during 2012-2022 at a tertiary care hospital. Demographics, obstetric data, bleeding characteristics, colposcopy results, cervical cytology testing, a sonogram directed at the placenta, and birth details were collected. In total, 364 women were included. The mean maternal age was 29.7 years and the mean gestational age at examination was 30.7 weeks. Vaginal bleeding was mild in 80.8%, moderate in 14.6%, and severe in 4.7%. Only 3.3% had been vaccinated against human papilloma virus and 25.5% underwent a Pap smear study before pregnancy. Colposcopy diagnosed the bleeding source in 83 women (22.8%). The colposcopic examination revealed vaginal bleeding due to contact bleeding from ectropion in 46 (12.6%), a decidual/cervical polyp in 37 (10.2%), acetowhite epithelium in 12 (3.3%), herpes genetalis in 2 (0.5%), and bleeding from vaginal varices in 2 (0.5%). Of those who were recommended a follow-up examination after the postpartum period, only 49.1% completed such.Among women with compared to without postcoital bleeding ( N = 72), the risk of abnormal colposcopic findings was higher (24 [33.3%] vs 54 [19.7%], p = .017) and the rate of abnormal Pap smear was higher (7 [13.2%] vs 7 [3.2%], p = .008). Colposcopy can be a valuable diagnostic tool for women with unexplained vaginal bleeding in the second or third trimester.

The analysis of Lactobacillus spp. distribution in the vaginal microbiota of Polish women with abnormal Pap smear result.

A healthy vaginal microbiota is represented mainly by Lactobacillus spp. and plays a vital role in maintaining the functional balance in the vaginal environment. Scientists have drawn attention to possible correlations between the vaginal microbiome and gynecological neoplasms. Several recent studies have shown a potential link between the vaginal microbiome and the risk of developing cervical cancer from human papillomavirus (HPV) infection. This study aimed to compare the prevalence and abundance of various lactic acid bacteria species (LABs) in vaginal swabs from healthy controls and patients with abnormal Pap smear results. The study included 100 women (79 patients with abnormal cervical Pap smear results and 21 controls) from whom vaginal swabs were collected. Real-time quantitative PCR was used to determine seven lactic acid bacteria (LAB) species and their quantities. Most patients were colonized by two Lactobacillus species, primarily Lactobacillus gasseri (93%) and L. crispatus (83%). Patient age and place of residence were associated with the diversity of LAB in the vaginal microbiota. The abundance of L. delbrueckii in the vaginal microbiota increased, whereas the abundance of L. gasseri abundance decreased, with patient age. Lactobacillus acidophilus and Limosilactobacillus fermentum were significantly more often detected in patients living in rural versus urban areas. Statistical analysis did not show any significant differences in LAB between groups of patients with various changes on smear tests. The degree of dysplastic changes in the endothelium or the presence of a group of atypical cervical stratified epithelial cells was not associated with significant changes in the studied vaginal bacteria.

Factors Affecting Non-Histologically Proven Invasive Cancer of the Uterine Cervix that Had an Abnormal Pap Smear: Results of the CCS Program.

Cervical cancer (CC) ranks fourth among cancers diagnosed around the world, but early detection and treatment can reduce invasive cervical cancer and mortality. Screening programs (CCSP), such as the one covering Thailand's 75 provinces, use histology to confirm cases. The study determined the incidence rate (IR) and investigated the factors associated with non-histologically proven invasive cancer of the uterine cervix (non-HPICUC) with an abnormal pap smear from the CCSP at Mahasarakham Hospital, Thailand. The CCSP was used to analyse a retrospective cohort of 288 women between 30 and 60 years of age. All abnormal pap smears were followed up until April 30, 2022. We estimated the IR and assessed the relationship between various independent variables and non-HPICUC using the generalised linear model (GLM) for testing association data. We reported the adjusted RR and 95% confidence intervals (95%CI). 260 non-HPICUC cases had abnormal CCSP pap smears for an overall IR of 90.0 (95% CI: 86.3 - 93.2). After adjusting the model for all variables, age at recruitment and pregnancy had a statistically significant association with non-HPICUC (p-value < 0.05). We found that the risk of non-HPICUC increased 1.02 times for every 20-year increment in age compared to below that age (adjusted RR=1.02, 95% CI: 1.01 - 1.04). Pregnancy at risk for non-HPICUC was 0.89 times compared to non-pregnancy (adjusted RR=0.89, 95% CI: 0.80 - 0.99). Pathological vaginal discharge (PVD) did not have a statistically significant association with non-HPICUC (p-value = 0.094); notwithstanding, women with PVD had 1.08 times the risk of non-HPICUC compared to women without PVD (adjusted RR=1.08, 95% CI: 0.97 - 1.20). Based on an abnormal pap smear from the CCS Program at Mahasarakham Hospital Thailand, age and pregnancy are associated with an increased risk of non-HPICUC. High-risk groups with abnormal pap smears should be targeted for CC campaigns.

Prognostic Impact of a Negative Central Pelvic Biopsy after Definitive Chemoradiotherapy (CRT) for Locally Advanced Cervical Cancer (LACC)

Central pelvic biopsies are occasionally performed during post-treatment surveillance of locally advanced cervical cancer (LACC) after a change in symptoms, abnormal pelvic exam, pap smear or imaging. Although it is established that a positive result is considered disease recurrence, it is unclear the prognostic impact of a negative biopsy. Here, we investigated the characteristics and the clinical course of patients with negative biopsy, focusing on central pelvic recurrence. Our institutional database of female patients with diagnosis of cervical cancer treated with definitive CRT was retrospectively reviewed (2013-2022). The central pelvic region was subdivided in: I) cervix, II) endocervix/endometrium, III) vagina, IV) vulva, V) bladder and VI) rectum. Each subsite sampled was considered a distinct biopsy event, but multiple samples from one subsite at the same procedure were considered one biopsy event. We calculated the rate of initial negative and positive biopsies. The central pelvic control (local recurrence rate [LCRR]) for patients with negative biopsy was estimated with Kaplan Meier method. Two hundred and twenty-five consecutive patients were included (initial FIGO 2018 staging: 30% I/II and 70% III-IVA). Of these, 66 (29.3%) underwent 112 central pelvic biopsies (average 1.7 per patient) during a median follow up time of 27.1 months [range: 0.2-94.0], with median time from treatment to first biopsy of 7.0 months [range: 1.0-41.7]. Biopsies were triggered by: symptoms/physical exam in 83 (73.4%), imaging abnormalities in 21 (18.6%), and abnormal pap smear in 9 (8%). The most common structures biopsied were: cervix (53.6%, n = 60), vagina (17.9%, n = 20), endocervix/endometrium (11.6%, n = 13), rectum/sigmoid (11.6%, n = 13), bladder (4.5%, n = 5) and vulva (0.9%, n = 1). Overall, 13.6% cases (9/66) had an initial positive biopsy, while 86.4% (57/66) had an initial negative biopsy. Of these patients with negative biopsies, 84.2% (48/57) remained without evidence of local recurrence and 15.8% (9/57) were subsequently diagnosed with local disease recurrence (1y post-biopsy LCRR 15.0% [95% CI 4.8-24.0]). Although most (>85%) post-treatment central pelvic biopsies are negative, these patients are still at considerable risk of early local recurrence thereafter (post-biopsy 1y-LCRR 15%). Strategies to intensify surveillance may be beneficial in the first year after a negative biopsy.

Correlation Between Colposcopic Patterns and Histological Grade of Vaginal Intraepithelial Neoplasia: A Retrospective Cohort Study.

Vaginal intraepithelial neoplasia (VaIN) is a rare human papillomavirus (HPV)- related premalignant condition. VaIN lesions are diagnosed histologically through colposcopy-guided biopsies of suspicious areas, conduced by gynecologists with expertise in lower genital tract diseases. The present study aimed to evaluate the accuracy of colposcopy in the diagnosis of VaIN of any grade. We conducted a retrospective analysis on a cohort of 149 women diagnosed with low grade (LG)-VaIN (VaIN1) and high grade (HG)-VaIN (VaIN2-3) between 2010 and 2022 at the "Regional Referral Center for Prevention, Diagnosis and Treatment of HPV-related Genital Disorders", Ospedale Maggiore Policlinico, Milan, Italy. All women had been referred to our center for an abnormal Pap smear or as part of routine follow-up of other HPV-related diseases and had undergone a vaginal biopsy under colposcopic guidance. The distribution of the histological grades of VaIN lesions was the following: 62 women (41.6%) were diagnosed with VaIN1, 51 (34.2%) with VaIN2, and 36 (24.2%) with VaIN3. Grade II (major) abnormal colposcopic patterns were recorded in 71 cases (47.7%) and were more commonly observed in women with VaIN3 (80.6%). However, we found a poor and not statistically significant association between colposcopic and histological grade of VaIN. The sensitivity, specificity, positive predictive value, and negative predictive value of colposcopy for histologically confirmed VaIN were 56.3%, 64.5%, 69% and 51.2%, respectively. The overall diagnostic accuracy of colposcopy was 59.7%. Colposcopy-guided biopsy plays an important role in the diagnosis of VaIN and in the distinction between low and high-grade lesions. Our data show that major colposcopic abnormalities moderately correlate with HG-VaIN and that grade I colposcopic findings do not exclude HG-VaIN, especially VaIN2. Targeted biopsies of suspicious vaginal areas must be performed in all women with an abnormal Pap smear.

A retrospective cohort study of human papillomavirus (HPV) genotypes in women with abnormal Pap smear cytology in Turkey

Background/Aim: The most common genotypes of human papillomavirus (HPV) in patients with cervical cancer worldwide are HPV16 and HPV18. The persistence of these genotypes is associated with cervical cancer and detection, and HPV genotyping, particularly in women with abnormal Pap smears, has become a crucial tool for cervical cancer screening, diagnosis and management. We evaluated the overall prevalence of HPV in women with abnormal Pap smear cytology and also investigated age-specific HPV prevalence and HPV genotype distribution. Methods: We analyzed 716 cervical smear specimens in this retrospective cohort study. Cytological diagnoses of typical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesions (LSILs), and high-grade squamous intraepithelial lesions (HSILs) were made utilizing the Bethesda System. The Papanicolaou method was used for the staining of the Pap smears. The specimens were pre-screened for HPV DNA positivity using an HC2 assay (Qiagen, USA). After the pre-screening, a Cobas 4800 HPV test system (Roche Diagnostics GmBH, Germany) was used to genotype the HPV-positive samples. Results: Of the 716 cervical smear samples, 520 (72.6%) were found to be HPV-negative. Among the HPV-positive samples, 106 (23.2%), 57 (28.8%) and 33 (53.2%) were identified from 456 ASCUS, 198 LSIL and 62 HSIL cases, respectively. These findings revealed a gradual decrease in HPV prevalence with increased cytological grade (P&lt;0.05). For high-risk, low-risk and high-risk/low-risk HPV types, 76 (38.8%), 78 (39.8%) and 42 (21.4) were positive according to the HC2 assay, respectively (P&lt;0.05) Only 117 of the 196 HPV-positive samples were found to be HPV-positive with the Cobas 4800 HPV test system. HPV16 was the most prevalent type detected by the Cobas 4800 HPV test: 55 out of 117 HPV-positive smear samples across all age groups (47%). HPV16 was significantly more frequently detected in the HSIL samples than HPV18 (P&lt;0.05). The prevalence of HPV was the highest in women with ages between 29 and 38 (71/196, 36.22%) and declined with age. Conclusion: We found that HPV16 and HPV18 were the most prevalent genotypes of HPV in a cohort of Turkish women; HPV16 was most frequently detected in HSIL samples from women with ages between 29 and 38. We conclude that investigating the incidence of HPV16 and HPV18 genotypes will be important for implementing new programs and protocols to reduce the incidence of cervical cancer. These data may contribute to the development of preventive strategies to reduce the cervical cancer burden in Turkey.

Is phased implementation of HPV testing and triage with dual staining the way to transform organized cytology screening?

The substantial material and legislative investments in establishing and maintaining cytological screening in the Czech Republic represent barriers to a direct transition to primary HPV screening. Therefore, the LIBUSE project was implemented to test the efficacy of phasing in HPV DNA testing as a co-test to cytology in routine screening of women >30 years of age. Women aged 30 to 60 years who underwent regular annual Pap smears were co-tested for HPV DNA with selective 16/18 genotyping at 3-year intervals. All HPV 16/18-positive cases and/or cases with a severe abnormality in cytology were sent for colposcopy; HPV non-16/18-positive cases and LSILs were graded using p16/Ki67 dual-stain cytology, and positive cases were sent for colposcopy. Overall, 2409 patients were included. After the first combined screening (year 'zero') visit, 7.4% of women were HPV-positive and 2.0% were HPV16/18-positive; only 8 women had severe Pap smear abnormalities. Triage by dual staining was positive in 21.9% of cases (28/128). Biopsy confirmed 34 high-grade precancer lesions. At the second combined visit (year 'three'), the frequency of HPV infection (5.3% vs. 7.4%) frequency of HPV16/18 (1.1% vs. 2.0%), referrals for colposcopy (35 vs. 83), and biopsy verified high-grade lesions (5 vs. 34) were significantly lower (all P ≤ 0.001). The addition of HPV DNA testing with selective genotyping of HPV16/18 to existing cytology screening significantly increased the safety of the program. The gradual introduction of HPV testing was well received by healthcare professionals and patients, and can facilitate transformation of the cytology-based screening. ClinicalTrials.gov Identifier: NCT05578833.

Prevalence and impact of human papillomavirus (HPV) in adults with cystic fibrosis: A self-reported cross-sectional Canadian survey

BackgroundIn persons with cystic fibrosis (pwCF), little is known about the prevalence or impact of HPV on quality of life and attitudes towards vaccination. MethodsWe conducted a national online survey of adult pwCF. We sought to determine the prevalence of self-reported HPV infection, disease-associated complications and effects on quality of life. Additionally, we investigated factors associated with vaccination status. ResultsA total of 235 adult pwCF across Canada (≥18 years, 68% female) completed the survey. Forty-eight percent of female pwCF had a history of abnormal Pap smear, with 62% self-reporting a ‘no’ or ‘low’ chance of risk of HPV-associated disease. Across participants, 12% reported at least one HPV-associated complication including anogenital warts (58%), HPV-associated malignancies (34%) and cervical dysplasia requiring colposcopy (69%). Only 19% reported discussions with their CF care provider around HPV complications. Across both sexes, pwCF experienced high psychosocial burden in the domains of ‘worries and concerns’, ‘sexual impact’ and ‘self-image’. Sixty percent of adult pwCF were unvaccinated for HPV. Eighty-one percent reported never having discussed HPV vaccination with their CF care provider, with similar rates in vaccinated and unvaccinated groups. Barriers to vaccination included: lack of discussions with healthcare providers (31%), insured coverage (based on age) (19%) and perceived side effects/risk (10%). ConclusionsAcross adult pwCF, we found high prevalence of HPV disease and associated HPV-psychosocial burden and low vaccination uptake. Given the limited medical discussions reported, incorporation of HPV prevention and management should be prioritized by CF care providers as part of comprehensive multimodal care.

Abnormal Pap smear among pregnant women - Feasibility of opportunistic cervical screening.

The uptake of cervical cancer screening is poor, especially in developing countries. Thus, pregnancy represents a good opportunity to have the test done. The aim of this study is to determine the prevalence of abnormal Pap smear among pregnant women during their antenatal check-ups. A prospective study involving five hundred and ninety-six women was recruited over a 1-year duration from 15th January 2018 until 14th January 2019 in a tertiary referral center, in Malaysia. Pap smears were performed on all consented pregnant women using liquid-based cytology and the results were obtained to evaluate the prevalence of abnormal Pap smear during pregnancy. Maternal risk factors associated with abnormal Pap smear were identified and the outcomes of abnormal Pap smear were followed up. A total of 670 participants were approached and 596 participants agreed to participate, giving a response rate of 89.0 %. Therefore, 587 participants were available for analysis. There were nine unsatisfactory smears (1.5 %). The prevalence of premalignant lesions reported on p % ap smear was 0.8 %. Three respondents had atypical squamous cells of undetermined significance (ASCUS) (0.5 %) and two respondents had low-grade squamous intraepithelial lesions (LSIL) (0.3 %). Almost one-third (30.3 %) of respondents had an infection and 24 (4.1 %) smears were reported as reactive changes associated with inflammation. Respondents between the age of 20-30 years old had a significant association with an abnormal pre-cancerous smear (p=0.000) as well as nulliparity (p=0.0.40). There was no significant association between height, weight, BMI, sexual partner, age of first intercourse, smoking habit, history of sexually transmitted disease and history of abnormal Pap smear. The prevalence of abnormal pre-cancerous smears during pregnancy is low. However, it is desirable to perform cervical screening as it provides an opportunity to no screening at all.

Can HPV Test on Random Urine Replace Self-HPV Test on Vaginal Self-Samples or Clinician-Collected Cervical Samples?

This study investigated whether random urine (RU) samples can be used to accurately identify human papillomavirus (HPV) and whether these samples can replace self-collected vaginal samples in HPV tests. A total of 167 patients with abnormal Pap smears were recruited. The patients provided self-collected vaginal and RU samples for HPV testing. Clinicians obtained cervical samples from the patients. Colposcopy examination and cervical biopsy were performed. Hybrid Capture II (HC II) and Cervista tests were used to detect HPV in the RU samples. The results of tests on clinician-collected cervical samples were used as the benchmark. The sensitivities of the Cervista tests on vaginal samples and the HC II and Cervista tests on RU samples were 75.00%, 49.07%, and 44.44%, respectively. After we adjusted the HPV detection cutoff value for urine samples based on values in the receiver operating characteristic curve, the sensitivities of the HC II and Cervista tests increased to 63.89% and 58.33%, respectively. In 167 patients, 59 had cervix biopsies showing CIN2 or worse (CIN2+). For CIN2+, the sensitivity was 47.5% and 50.8% in the HC II and Cervista tests on RU samples, respectively. HPV tests on RU samples had approximately 60% sensitivity to HPV tests on clinician-collected cervical samples after the cutoff values were adjusted. For CIN2+, the sensitivity was only approximately 50%. Further studies and improvements in urine-based HPV testing are needed to establish it as a more convenient and accessible method for detecting HPV and cervical dysplasia in patients.

Baseline anxiety and knowledge level of abnormal pap smear results and colposcopy procedure in patients presenting to colposcopy clinic (2146)

Baseline anxiety and knowledge level of abnormal pap smear results and colposcopy procedure in patients presenting to colposcopy clinic (2146)

Prevalence of human papillomavirus infection in abnormal pap smears.

This study was undertaken to study the prevalence of human papillomavirus (HPV) infection using the polymerase chain reaction (PCR) technique in abnormal cervical pap smears and to correlate the different cytological results with HPV infection. A total of 1788 cervical pap smears of women more than 30 years of age conducted over a period of 1 year 3 months (June 2015-August 2016) were screened by liquid-based cytology. High-risk (HR)-HPV testing was performed by PCR in abnormal lesions. Inflammatory smears and some atypical squamous cells of undetermined significance (ASCUS)-reactive cases were excluded from HPV testing. Histopathological correlation was done wherever possible. The overall prevalence of the intraepithelial lesions/malignancy was ASCUS. (ASCUS) - 79 (4.42%), atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H) - 10 (0.56%), low-grade squamous intraepithelial lesion (LSIL) - 26 (1.45%), high-grade squamous intraepithelial lesion (HSIL) - 15 (0.84%), squamous cell carcinoma - 5 (0.28%), and adenocarcinoma - 1 case (0.06%). Overall, 136 (7.60%) samples were classified as abnormal. Seventy-seven samples were included for HR-HPV testing - 20 ASCUS, 10 ASC-H, 26 LSIL, 15 HSIL, and 6 malignant cases. A control group of ten samples with normal cervical cytology within the normal limit (Control) (WNLc) was tested for HR-HPV. HR-HPV was detected in 20% of samples of the WNLc group, 45% of the ASCUS group, 70% of the ASC-H group, 73.07% of the LSIL group, 86.67% of the HSIL, and 83.34% of the samples in the malignant group. Overall, HR-HPV was detected in 68.83% of abnormal cervical pap smears. Our study shows that the percentage of HR-HPV-positive case increases with the severity of cytologic morphology. HPV had 4 times higher positivity in squamous intraepithelial lesion as compared to ASCUS.

Psychological Distress in Women With Abnormal Pap Smear Results Attending Cervical Cancer Screening.

Women often experience psychological distress upon receipt of an abnormal Pap test result. This study aimed to evaluate psychological distress and its correlates among women who received an abnormal Pap screening test result. A cross-sectional study was performed in a cohort of 172 consecutive women who had attended screening for cervical cancer and who received abnormal Pap smear results and underwent additional diagnostic procedures (colposcopy/biopsy/endocervical curettage). The participants filled out a questionnaire on sociodemographic variables and the Cervical Dysplasia Distress Questionnaire. Multivariate linear regression was used for the analysis of the data. For multiple comparisons, the Bonferroni correction was applied to adjust the level of significance. In women who received an abnormal Pap smear result, the independent correlate of higher psychological distress (by Cervical Dysplasia Distress Questionnaire score) before diagnostic procedures was lower satisfaction with information/support received from other people ( p = .002). Correlates of psychological distress in women older than 40 years with abnormal Pap smear were anxiety ( p = .042) and worry about having cervical cancer, general health and having sex ( p = .044). The authors' findings could enable control of factors predictive of psychological distress in women who received a positive Pap smear screening test before undergoing diagnostic procedures, primarily via active provision of targeted information.

High-grade cervical squamous intraepithelial lesions in female partners of men with high-grade penile squamous intraepithelial lesions: a monocentric retrospective study.

We have conducted the first study to focus on the presence of cervical human papillomavirus (HPV) lesions in the female partners of males with high-grade penile squamous intraepithelial lesions (PHSILs). A histologically confirmed cervical squamous intraepithelial lesion (SIL) in female partners was observed in 81% of cases, with high-grade SIL seen in more than two-thirds of cases and low-grade SIL in a third. It is important to screen females whose male partners have PHSIL, in order to detect a clinical HPV lesion early and treat it, if necessary. Our results indicate that a HPV test and reflex cytology (if the HPV test is positive) are necessary for the female partners of males with PHSIL. If there is an abnormal Pap smear, colposcopy should be performed.

(055) Effect of Loop Electrosurgical Excision Procedure (LEEP) on Female Sexual Function

Abstract Introduction Cancer of the uterine cervix is the third most common gynecologic cancer and accounts for approximately 528,000 new cancer cancers globally, on an annual basis. Cervical cancer continues to be the second leading cause of cancer death for women aged 20 to 39. Human papillomavirus (HPV) infection is responsible for the majority of cervical cancer cases. Screening with cervical cell cytology in conjunction with HPV testing is an effective screening technique that enables providers to risk-stratify women with cervical dysplasia for subsequent development of invasive cervical cancer. Colposcopy is a diagnostic technique utilized as a follow-up for abnormal cervical screening test results. Depending on the adequacy of the colposcopy procedure and the patient’s histology, an excisional procedure may be required. Loop electrosurgical excision (LEEP) is one of three common techniques employed to remove the pre- cancerous transformation zone. Theoretically this “minimally invasive” approach reduces thermal injury to surrounding structures, causes less intraoperative bleeding, and creates smaller excised specimens. The aim of this technique is to minimize cervical trauma compared to other excisional techniques. However, to date, there have been no prospective studies to examine the effect of excisional biopsy on patient-centered outcomes, such as sexual satisfaction post-procedure and subsequent development of subsequent sexual dysfunction. A 2015 review article found only 6 studies examining the effect of excisional biopsy on sexual dysfunction. There have only been four published prospective studies examining the effect of LEEP on sexual function, and only two of them utilized validated research questionnaires. Our university-based clinic performs approximately 1000 colposcopies and 100 LEEP procedures annually. The Medical Faculty Associates practice providers care to both a racially and socioeconomically diverse patient population. Objectives We plan to conduct a prospective cohort study in 736 women comparing FSFI and FSDS-R scores, and the prevalence of sexual dysfunction (defined as FSFI &amp;lt; 26 points) among patients who undergo colposcopy versus patients who undergo both colposcopy and LEEP. Methods The FSFI and FSDS-R questionnaires will be completed at their initial encounter after having an abnormal pap smear. This initial questionnaire will serve as our baseline measurement. If the patient did not need any additional procedures, they will complete the FSFI and FSDS-R questionnaires at 6 and 12 weeks after colposcopy. If further excision is required, patients will complete the questionnaires at 6 and at 12 weeks after their LEEP procedure. Results Results are pending completion of study enrollment. Analyses will be controlled for parity, age, menopausal status, psychotropic medication use, anxiety or depression diagnosis. Conclusions We anticipate our study to find no difference in FSFI score or FSDS-R score among women who have undergone colposcopy versus colposcopy versus LEEP. We plan to have interim results to present at the upcoming conference. Disclosure No.

Cervical Dysplasia Distress Questionnaire: Turkish validity and reliability study

ABSTRACT The aim of this study was to determine the validity and reliability of the Turkish adaptation of the Cervical Dysplasia Distress Questionnaire (CDDQ) in women with abnormal Pap smear results. This validation study was conducted using a cross-sectional research design. A total of 115 patients who were being followed up in the obstetrics and gynecology outpatient clinic of a university hospital due to an abnormal Pap smear test were included. In the study, the results of language and content validity, item analysis, exploratory, and confirmatory factor analyses, internal consistency coefficients, and concurrent and convergent validity were assessed in order to adapt the CDDQ to the Turkish language and culture and to determine its reliability and validity. It was determined that all factor loads of the scale ranged from 0.13 to 0.85. The exploratory variance was found to be 29.986 for the first subscale, 19.734 for the second subscale, 16.551 for the third subscale, and 66.271 for the overall scale. Cronbach’s alpha values for the tension during the examination, concerns about health consequences, and concerns about sexual consequences were 0.92, 0.91, and 0.87, respectively. The desired level of correlation was achieved between the CDDQ and the Hospital Anxiety and Depression Scale (HADS). In the study, the Turkish adaptation of the CDDQ was found to be a valid and reliable instrument to assess psychological distress in women with abnormal Pap smear results.

(073) The New, Undescribed, and Lethal Components of The Genitourinary Syndrome of Menopause

Abstract Introduction Genitourinary syndrome of menopause (GSM) has been well described within medical literature and its effects have been well managed by physicians with an extensive understanding of the condition. However, the progression of medicine in each area continues to evolve. We propose new findings that are extremely important to have in consideration of GSM. Objective To describe new findings that are not traditionally associated with GSM, some with lethal consequences: * False abnormal pap smears * Total vulvovaginal obliteration and secondary renal damage * Undiagnosed recurrent urinary tract infections (UTI) in the geriatric population without hormone replacement therapy with secondary sepsis, pneumonia, and death. Methods Large review of recent literature, diagnosis, treatment and follow up of patients within our facility and nursing homes including geriatric females with and without hormone replacement therapy. Results `- Resolution of the abnormal pap smear with the use of local estrogens in more than 1500 cases. - Management of 6 cases of vulvovaginal obliteration with surgery, dilators, increasing penetrative sex, and local estrogens with great results. - Description of some dozens of patients seen and evaluated in home care facilities with undiagnosed UTI by the primary care, showed subsequent findings of sepsis, pneumonia, and even death. Conclusions Emphasize the need to inform and educate healthcare providers, especially primary care, internal medicine, OB/GYN physicians, and urologists the ample growing and potentially lethal spectrum of GSM. Disclosure No