Abnormal Pap Smear
J.M. is a 38 year old white female gravida 2 para 2002 who on routine gynecologic visit had a pap smear significant for mild dysplasia ie. CIN I. The patient's last menstrual period was three weeks ago. Her routine gyn visit occurred one week ago and a pap smear was obtained. At that time, she was without complaints, but on questioning reports that she had occasional post-coital minimal spotting in an amount that would stain her toilet tissue after voiding. She has a history of normal menarche at age 12 with subsequent regular menstrual periods. Her first coitus was at age 15. She has had six life time sexual partners and reports a monogamous relationship in the last 15 years in her marriage. She states she had a trichomonas infection as a teenager but denies any other sexually transmitted diseases. She smokes one pack of cigarettes a day and has been doing so since age 18. She currently using oral contraceptive pills. She has regular menstrual periods.
On physical exam, her height is 5'5". She is 140 pounds. HEENT is unremarkable. Lungs are clear. Breast exam (sitting and supine) negative. Abdomen soft and nontender. There is no organomegaly or lymphadenopathy. Pelvic exam: external genitalia are normal. The vaginal vault is without gross lesions. Cervix: parous. There is minimal friability of the cervix to touch with a q-tip. The uterus is anteverted, mobile, and normal in contour and size. Adnexae are negative. Recto-vaginal exam confirms the above stated findings. There are no intrinsic lesions of the rectum.You discuss the implications of an abnormal pap smear with the patient and you review her recommended work-up.