Part I—Gynecological Health Issues

Yvonne has been a student of science nearly all her life. She values her independence and loves her career in the biopharmaceutical industry. She is extremely focused, as evidenced by her three-, five-, and 10-year plans for her career. Her plans include having a child, once she has realized her career aspirations.

Yvonne’s recent promotion to senior principal scientist at the young age of 30 means she now has more responsibilities at work. She feels a deep sense of security as her dreams are coming to fruition. However, she is about to learn that the best laid plans have a way of, well, not working out as planned.

Seldom needing to see a doctor for most of her life, Yvonne has spent the past several months receiving gynecological treatment for cervicitis and cervical neoplasia, a disease for which the cause is unknown. A couple of weeks ago, Dr. James Trent, her gynecologist/obstetrician, ordered several tests and performed an in-office diagnostic procedure to try to narrow down the cause of Yvonne’s condition.

At her next scheduled appointment, Dr. Trent tells Yvonne that the tests for bacterial or viral causes (which would indicate the presence of a sexually transmitted disease, or STD) are negative. He explains that the procedure Yvonne had undergone last month, a colposcopy with cervical biopsy to evaluate the cervical topography and its epithelial character, is benign for cervical cancer.

“The results are promising,” Dr. Trent explains, “but I am afraid that at this point we have more questions then answers. I believe our best course of action is an outpatient procedure called cervical cryosurgery.”

“What is the intent of the surgery?” Yvonne asks.

“With cervical cryosurgery, we remove the superficial layers of tissue lining the cervix in hopes of permanently removing any abnormal cells, whatever their cause, thereby eliminating the precancerous condition,” Dr. Trent answers.

The following week, Yvonne has the outpatient cryosurgery procedure. At her next appointment, Yvonne listens closely as Dr. Trent says, “The cervical cryosurgery didn’t achieve the result we had hoped for; the cervical abnormality has in fact recurred.

“Our remaining option is a surgical procedure called cervical conization (or cone biopsy). We remove a cone-shaped section of tissue from the endocervix and send it to a pathologist to determine whether all abnormal tissue containing the precancerous cells is likely to have been removed.”

Dr. Trent continues, “A cone biopsy will often cure the problem. However, in a small number of cases, it may interfere with childbearing. You could choose to have the conization surgery now before a pregnancy, or after. It’s your decision.

“If you choose to have the procedure now, you will have more time to prepare for a pregnancy at a later date. However, because cervical conization involves removing endocervical tissue, the ability of the uterus to bear weight will be diminished. As the fetus’ weight increases, added strain will be placed on the muscular wall. About half way through your pregnancy, you most likely would be placed on bed rest until the baby comes,” Dr. Trent explains. “If you decide to become pregnant first, we can perform the surgery at a later date. I would recommend you start taking daily prenatal vitamins now to prepare for a pregnancy in case you decide to pursue such an option sooner rather than later.”

Yvonne’s choices are clear. She must decide between having a child in the not-too distant future with little to no risk of complications, or have a high-risk pregnancy at a more fitting time in her life. Yvonne takes some time to consider her options, turning to the people closest to her in her private life for support and advice. At age 30, although still young, Yvonne is cognizant of the medical literature concluding that a woman’s ability to conceive a child decreases with advancing age.

Questions

1. What is the anatomical relationship between the cervix and the uterus?
2. What are the current statistics on the frequency of occurrence of cervical cancer? Does a women’s race affect her chances of developing this cancer? What is the standard test for detecting cervical cancer?
3. Most cases of cervical cancer result from human papillomavirus (HPV) infection. What information can you find about transmission, contraction, and consequences of HPV from valid medical sources?
4. The success of the new HPV vaccine (approved in June 2006) will rely on parents’ willingness to vaccinate their prepubescent daughters. Discuss your own willingness to do so were you a parent of a young girl.
5. Yvonne faces a potentially life-changing decision—to have a child now or wait until after a surgical procedure. Help her weigh the pros and cons as you see them.

Date Posted: April 08, 2008.

 

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