What It's Like to Be Diagnosed with HPV—and Cervical Cancer—When You're Pregnant
In an effort to fight the stigma associated with HPV, Lindsay McClelland shares her experience with the sexually transmitted infection.
When 31-year-old content marketing strategist and fitness enthusiast, Lindsay McClelland found out she was pregnant with her first child, she says she was beyond excited to start planning for this major life change. She had just run her 18th marathon in June 2019 before finding out the big news. To confirm her pregnancy, she scheduled an appointment with her ob-gyn in Sarasota, Florida, where she was living at the time.
The following week, McClelland's appointment was about as routine as she expected, she says. She confirmed her pregnancy, discovering she was eight weeks along, she says. And, since she'd had a busy few years that involved a change in jobs and a move from Texas to Florida, she hadn't seen a gynecologist for her annual wellness exam, nor had she gotten a Pap test, since she was 29 (nearly three years earlier), she explains. So, McClelland received a Pap and human papillomavirus (HPV) test. (FYI: You should see your gyno at least once a year, but you don't need a pap or HPV test every year.)
A few days after this visit, McClelland's doctor's office called her with the results: She'd tested positive for HPV, and her Pap showed abnormal glandular cells, which can potentially indicate precancerous or even cancerous lesions, shares McClelland. (Reminder: While nearly all cervical cancers are caused by HPV, not every strain of HPV causes cancer.)
Her doctor recommended she return for more tests—specifically, a colposcopy, a procedure (which can be moderately painful) in which a solution is applied to the cervix to help detect abnormalities while the doctor closely examines the area with a magnifying instrument. While some colposcopies end there, your doctor may take a tissue sample if they feel a biopsy is necessary.
Thirteen weeks into her pregnancy, McClelland underwent her colposcopy. During the procedure, her doctor told her that he felt it was best to perform a cervical biopsy to remove some tissue and test for precancerous cells—a more invasive, sometimes painful procedure that, McClelland later found out, isn't typically done for a pregnant patient, as it can increase the risk of bleeding when done after the first trimester, according to the University of Michigan Medicine.
"I initially thought I was going [to the colposcopy] for another routine procedure that might be slightly painful, but I ended up having a vasovagal response [a sudden drop in heart rate and blood pressure, often in response to a stressful event] that made me feel lightheaded, and I ended up dealing with more bleeding than I expected [because of my pregnancy]," says McClelland.
But, unfortunately, that wouldn't be the most alarming development that came from her abnormal Pap results. When McClelland's doctor called her a few weeks later with the biopsy results, he confirmed her diagnosis of adenocarcinoma in situ (AIS), a rare, precancerous lesion that can later become cancer. Generally speaking, the risk that abnormal glandular cells are precancerous (as in McClelland's case) can be up to 11 percent, while just 1 percent of all cases of abnormal glandular cells become cervical cancer, says Courtney Bailey, D.O., a gynecologic oncology fellow at the Medical College of Georgia at Augusta University.
Although McClelland says her doctor later referred her to a gynecologic oncologist, he initially told her that her "only" option was to have a Cesarean section when she was 30 weeks into her pregnancy and have surgery to remove the precancerous lesions at the same time as the birth. (Related: C-Section Births Have Almost Doubled In Recent Years—Here's Why That Matters)
"I was really freaked out to hear the early C-section recommendation, which I later learned is not what would typically be recommended by gynecologic oncology specialists for this type of diagnosis," says McClelland. "My husband and I began worrying about several things, from the prospect of having a premature baby, to my potential cancer diagnosis, as well as the possibility of not making our planned move to Charlotte, North Carolina, where he was interviewing for a new job."
Searching for Other Solutions
After receiving her biopsy results, McClelland says she immediately called her father, a grant writer at The University of Texas MD Anderson Cancer Center in Houston, for advice on how to proceed in seeking a second opinion from a gynecologic oncologist. He connected her with a specialist at his research hospital, who not only helped answer many of McClelland's initial questions but also referred her to gynecologic oncology specialists in both Florida (where she and her husband lived at the time) and Charlotte (where they were about to move).
"In hindsight, I wish my original ob-gyn had referred me to an oncologist from the start [before doing a cervical biopsy], as the specialists I've spoken to since then said they likely would not have recommended the biopsy while I was pregnant, instead opting to closely monitor me with regular colposcopies until after I delivered," says McClelland. "But the specialists I later met with ultimately put my mind at ease with their recommendations to be able to continue on with an otherwise healthy pregnancy and vaginal delivery."
"If you get a diagnosis of dysplasia (aka precancerous lesions) during pregnancy, the biggest thing we're worried about is that you actually have cancer," explains Bailey (who, to be clear, did not treat McClelland specifically), also noting that it's unlikely for these lesions to cause any harm to the baby. That said, if you opt for a biopsy to treat or further examine these lesions, that procedure can impact labor and delivery. While McClelland's cervical biopsy only caused bleeding during the procedure, another kind of procedure called a cone biopsy (which specifically involves cutting a cone-shaped wedge out of the cervix to remove abnormal cells) if performed during pregnancy could increase the risk of going into labor early or rupturing membranes and breaking your water during the procedure, which is why doctors tend to avoid these types of biopsies as much as possible during pregnancy, notes Bailey. "Typically, if it's pre-cancer, we will do regular colposcopies at different time periods during pregnancy, depending on how pregnant the patient is, among other factors, and do our best to wait to do biopsies and other treatment after the patient delivers," she explains.
With her new specialists' guidance, McClelland was able to continue her pregnancy with regular colposcopies every six weeks. She also didn't have any complications related to her diagnosis; in fact, she was able to stay active through the end of her pregnancy (she even ran a half marathon) and made it all the way to her due date with a standard vaginal birth. On January 20, 2020, she and Kyle welcomed a healthy baby boy named Parker. (Related: How Much Exercise Is *Actually* Safe to Do While Pregnant?)
"Obviously the end result of pregnancy is great, but the journey to get there is hard enough," she shares. McClelland was given an additional IV during labor and delivery in case the abnormal cervical cells caused any additional bleeding—another source of stress in an already-tense situation, she explains. "The additional stress of the HPV and a pre-cancer diagnosis made it really hard, and it was really scary to see myself categorized as high-risk. I felt more stress and anxiety than I expected to, and I didn't have a baby shower or do other fun things that I might have otherwise done with a normal pregnancy."
How She Navigated the Diagnosis Postpartum
After McClelland successfully delivered baby Parker, she was cleared to undergo another biopsy to learn more about her precancerous lesions. At seven weeks postpartum, her doctors scheduled her to come in for a cone biopsy (aka conization).
McClelland was admittedly nervous about what the procedure would entail, as it involved being put under general anesthesia, which she'd never experienced before. She also initially thought that her loved ones would be able to accompany her to the hospital, but by this point, it was early March of 2020. As COVID-19 spread across the U.S., widespread stay-at-home orders had started to go into effect. McClelland ended up being dropped off alone at the hospital and picked up after the procedure, she says. (See: Some Hospitals Aren't Allowing Partners and Supporters In Childbirth Delivery Rooms Due to COVID-19 Concerns)
"The biggest thing I was concerned about was being able to breastfeed Parker before and after the procedure, and the discomfort I'd face if I wasn't able to. But luckily, the medical team helped me to be able to pump beforehand," says McClelland. "The surgery itself was pretty simple, and recovery really wasn't bad, especially after having already experienced childbirth."
Shortly after the procedure, McClelland's gynecologic oncologist called her to confirm that they did indeed find signs of cancer in the cervical tissue they'd removed. However, there was also good news: The cold-knife cone biopsy had successfully removed all of the margins with abnormal cells.
From there, McClelland took three weeks to recover, during which time she refrained from exercise to let her body heal, despite her desire to get moving again, she shares. "While I was eager to get back to a regular routine and ramp up my running again, in retrospect, I'm grateful that the surgery forced me to give my body time to heal after childbirth instead of doing too much too soon," she says. "I also feel fortunate that I was able to get it done in the nick of time, as it surely would have been one of the many surgeries that ended up being canceled or postponed because of the pandemic (as my post-op visit was)." (Related: 6 Women Share What Getting Virtual Prenatal and Postpartum Care Has Been Like)
The Importance of Sharing Experiences with HPV
Even though HPV is the most common sexually transmitted infection (STI) in the U.S., many people choose not to talk about their experiences with it, largely because of the stigma associated with the infection.
McClelland chose not to publicly talk about her diagnosis until after her pregnancy, saying she wanted to focus on having a healthy delivery and baby. However, once she began to share more, she was surprised by how many friends reached out to talk about their own experiences with HPV and other STIs, she explains. (Related: Your Guide to Dealing with a Positive STI Diagnosis)
"I'm pretty open and I never felt ashamed about my diagnosis, but I was still amazed by how many women in my network had gone through something similar, and I hope my sharing my experience encourages more women to be more open about this if they ever go through it," she says. "My other general message would be to get your regular Pap tests, and if you can't remember when you last had one, schedule it ASAP. It's not the most fun exam in the world, but after everything I've now been through, my next Pap will surely be no big deal."