Spotting, soreness and cervicitis
Dear Dr Mitchell,
I’ve been spotting in between periods for over a year. It would sometimes happen right after intercourse and last for only a day or two. But then it got worse, lasting for up to a week with a sore feeling inside. I was asked to do a pelvic ultrasound and a pap smear. The results showed that I had a 1.3cm thickening of the uterus and if it got bigger, I would be required to do a biopsy. The pap smear showed that I had a chronic case of cervicitis which was highly inflamed and needed treatment. Now I’m being told that I need to do a D&C and a B&C to get rid of both problems. Upon checking out the cost, I realise that doing such operation in a private institution is rather costly. However, I am really scared of using the public hospitals. What do you recommend I do?
The spotting in between periods that you experience is significant and definitely needs further evaluation. The excessive thickening of the lining of the uterus is also of concern and on the background of the history of abnormal vaginal bleeding, this needs further evaluation to rule out carcinoma of the lining of the uterus. In most cases, the increased thickening of the lining of the uterus (endometrium) is due to a benign problem such as endometrial hyperplasia. However, if you are over 40 years old, a malignant problem may be the cause and so sampling of the endometrial lining is definitely indicated.
I understand your concern about cervical incompetence as a result of dilatation of the cervix. However, this is usually seen after repeated and usually excessive dilatation as is sometimes done in abortions. Sampling of the lining of the uterus is a simple procedure that can be done in an in-office setting using a small plastic device called a pipelle canula.
This requires no anaesthesia or time off from work. If this is not available, then simple diagnostic curettage can be done using a small sampling device. This requires very little dilatation of the cervix and so there is no damage to the muscles. These procedures are done at both Kingston Public/Victoria Jubilee Hospital and University Hospital of the West Indies. These institutions are very safe, well equipped and have excellently trained consultants. These are the same consultants and doctors who work in the private institutions. It is extremely important that you ask your private doctor to refer you to one of these hospitals if cost is a factor, so that you will be properly investigated.
The chronic cervicitis may need further evaluation with colposcopy. This is a special investigation which allows for detailed examination of the cervix to determine if there are any underlying pre-cancerous changes or cancer of the cervix. Sometimes inflammation can mask underlying abnormal changes, and colposcopy allows for early diagnosis. Ask your doctor to refer you to colposcopic evaluation prior to the dilatation and curettage. Best Wishes.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions and comments via email to allwoman@jamaicaobserver.com or fax to 968-2025. We regret that we cannot supply personal answers.
