HPV immunisation

April 23: If I sneeze, I will flood Auckland. In a radiologist's waiting room, I am discovering new definitions of water torture.

Last night, I couldn't sleep. I phoned a friend. "What if this is the last day I think I'm normal?" He just snorted. But I knew my smear test was overdue. Months of bleeding, periods so painful I vomited, intense cramps and lectures from friends and family finally forced the doctor's appointment. It's probably hormonal, said the doctor. But go for a scan anyway.

So here I am, waiting for someone to inspect my insides. Five glasses of water gone, as per medical instruction, and pretty sure I will wet myself. "Don't slouch," said the receptionist imperiously, too loudly. "It will just put pressure on your bladder." She must have noticed I looked like I was going to pass out because, eventually, in a room full of strangers, she relented. "You can go to the bathroom," she said. "But just let out a little bit."

I felt like I'd just won Lotto.

The radiologist smeared gel on my stomach and explained that a distended bladder created a window for the ultrasound. Then she slipped a condom over something that looked like a giant marker pen and started an internal exam. On the television screen beside the bed, I could see, in grainy black and white, the parts of me I don't usually think about. It didn't hurt, but when she pointed out the cyst, I wanted to cry. About six centimetres, she said. And there, another one. I got dressed in a daze.

April 24: A little bit of Google is a dangerous thing. Ovarian cysts, I read, are extremely common. About 30% of "normal" pre-menopausal women get them, and about half of those with irregular periods. They are not usually cancerous. In most cases, the experts simply adopt a "wait and see" approach. The radiologist told me that, sometimes, they affect hormones. I'm not a bitch, I thought, it's just my cyst.

A friend read out loud from a website: cysts are prone to bursting, especially after exercise, pelvic examinations or sexual intercourse. Christ. Imagine that as a first-date scenario.

Honestly? I was terrified. I went out and got so drunk that when a friend who was even drunker fell over and brought down four glasses, two bottles, and me, I didn't feel a thing.

April 28: I go back to my GP. I assume this is routine, that she will refer me to a gynaecologist, that they will either aspirate (draw out the fluid from the cyst) or operate. Cysts can be removed laparoscopically. I was sort of OK about this, until I discovered they would go in through my belly button. I have an irrational phobia about belly buttons. I try to pretend mine doesn't exist. I feel the same way about my ovaries. I never wanted children. At first I thought it was because I was too emotional, too up-and-down, too selfish to become a mother. As I grew older, I couldn't even tell people why. I didn't really know. I love other people's kids. I think I'd make an OK mum, now. But no one has ever really been able to give me a good reason for having a child. Sometimes, secretly, I have hoped this possibility will be removed from my life. Be careful what you wish for, I suppose. I tell my doctor I have read that some cysts have teeth and hair. She smiles and tells me she once saw a 19-year-old with a cyst so large, she looked like she was nine months pregnant. She tells me that for now, the experts will simply monitor my situation. That, in two months, I'll go back for another scan, because sometimes these things disappear on their own. I relax. Then she tells me my smear test results are back: the cells she scraped from my cervix are abnormal.

I go home and lose myself loudly, play Patti Smith on high repeat, shattered and exhausted, wondering how to wait out the month before I see the gynaecologist who will train a pair of binoculars up my vagina and snip out match-head sized bits of skin and tell me whether I have cervical cancer. My mother required a full hysterectomy at 44. I am 38, single, childless, with a fabulous job and a social life that can involve every night of the week if I want it to. All things considered, I have never been happier. All I want to do is go to sleep forever.

May 26: The pain is intense. My legs are resting on raised plastic footholds. The examination room smells sharp, like disinfectant, and there is a box containing a jumble of metal instruments that looks like my kitchen utensil drawer but is not. My gynaecologist takes a cervical biopsy and asks me to cough as she moves up into my uterus. There is no reason for the cough, she says, except to take my mind off what she is doing, because this part can be painful for women who have not yet had children. It hurts. I yell, more loudly than I intended to.

I can't see what's going on down there. It feels like extremely bad sex. I try to breathe through it. She asks if there is any risk I could be pregnant and I feel sicker still. She ticks boxes for blood tests and writes a note for another scan and I just can't face it. I want to be left alone to reclaim that part of me.

Afterwards, old blood leaches from me. I buy groceries and bright yellow daisies, read a book, try to do the crossword, think about quitting smoking and wish I wasn't dealing with this on my own.

And I'm not. A friend has waited in the car park for the duration of the colposcopy (the official word for what just happened). I am not religious, but the text from the person who tells me they are praying for me is not unwelcome. Constant tears are just below the surface. Today, there was a successful landing on Mars. The world keeps turning.

May 28: My insides are being clawed by a meat hook. It's like a hot wire in my uterus. Nothing prepared me for this (although later, my specialist says this pain does, sometimes, happen). At 3am, alone in the dark, I wonder if I am pregnant and these are contractions and whether I should call someone. They stop. I tidy the house. Scrub, vacuum, mop, dust, vow to clean up my life, wonder if all this is a punishment for months of staying up too late, drinking too much, living for the right now and not taking care of myself for tomorrow.

June 1: The high-grade cervical cell changes have been downgraded. I don't want to sound like a drama queen, but it's really good to wake up and worry about work, not dying. Last weekend, a friend brought his eight-year-old daughter over for the day and we made candles and tie-dyed pillow cases and played charades. She told me that every cigarette I smoked would take a minute off my life. She gave me a spontaneous hug and I nearly cried.

August 11: In my neat work skirt, in a neat office in Remuera, my gynaecologist is presenting surgical options in a neat, black inked drawing. I have been in denial for weeks. Ignoring requests for the follow-up, to thoroughly talk through the biopsy results. She tells me there are three separate problems: cell changes in my uterus and cervix that, despite the downgraded diagnosis, could still turn into cancer, plus the ovarian cyst, which must be removed before she can confirm it is benign. Given my age and the abnormalities presenting themselves throughout my body, she suggests I consider a full hysterectomy. If I were five years older, she says, she would absolutely recommend this. For the first time, I understand the concept of a biological clock. Five more years to be a useful representative of my gender? I work on "being strong". What a ridiculous, inadequate sentence. I am angry.

August 14: I will let them cut out the cyst, scrape more cells from cervix for more detailed analysis, check for endometriosis and insert a mirena a stingray-shaped intrauterine device that will release hormones into my uterus and control cellular changes. My workplace health insurance will pay for 80% of the operation. I wonder if I can raise a bank loan for the other $2000, a friend offers me money, my sister says she will fly to Auckland to be with me for the surgery and every night it gets harder and harder to sleep. In three weeks' time I will know if I have cancer.

August 29: Unexpected, out of the blue, how bad is the timing - a man who takes my breath away, even as I try to find the words to tell him he is amazing, to warn him what he might be getting into. We talk and talk, telling each other in a week the things that, in your 20s, take years to share. Clocks ticking, baggage to lay at each other's feet for brutal inspection.

September 16: Three days without drinking or smoking. My little sister is in my Auckland house for the first time. We go out for Chinese, and I try to be normal. In the morning, I will be fitted for white surgical stockings, I will take a pregnancy test (negative), I will sign forms and feel more terrified than I have ever felt in my life. I go to sleep as the anaesthetist asks me about Winston Peters' chances in the upcoming election and, when I wake, the recovery room nurses are talking about the woman in reception who knew someone who babysat a child who stole a penguin from Kelly Tarlton's. "It's not true," I mutter. "It's an urban legend that's been circulating internationally for a decade. I wrote a newspaper article about it last year." They look at me kindly and administer painkillers. My sister, my friends and the unexpected new man in my life are waiting for me back in my room. I can't focus on anything, I am incredibly tired, I can't move and I don't need to, because a catheter takes away my urine and another tube takes away my blood and the drugs take away the pain.

September 18: So my cyst had hair, but not teeth. When they pulled the drain out of my stomach, I heard the skin suckering against the tube like a horror movie. I go home and wait to feel better; I am sick of facing my own mortality. Friends bring chocolate-chip ice cream, magazines, and arms to fall into.

September 24: My cyst also had "advanced neural matter". My friends want me to name it. Officially, it is called a dermoid which, from what I can figure out from the internet, developed from a piece of genetic material caught inside my body at birth. It was, as they usually are, benign. My gynaecologist is thrilled she didn't remove my uterus, because the latest smear tests have also come back normal, and the uterine changes can be controlled with the mirena, which must stay inside me for a minimum of six months. Bottom line: I don't have cancer, I can still have children and Everything Is Going To Be All Right.

Sort of. I'm still trying to quit smoking. I have reduced the number of nights a week I drink. And I have a new crusading cause: it takes a long, long time for cervical cancer to fully develop. If a woman has a smear test every three years, as recommended, there is almost no chance she could die of this disease. And yet, every year, according to latest statistics, 60 New Zealand women do.

Pick up the phone, call a health centre and book a smear test. It doesn't hurt. It doesn't take that long. It could save your life. 

 

Cervical cancer facts

Annually, 160 women are diagnosed with cervical cancer and 60 women die of it.

It is the 10th most common cancer for women (breast cancer is most common).

More than 99% of cases are linked to human papillomavirus (HPV) infection.

HPV contributes to about 30,000 abnormal smears and 27,000 colposcopy visits annually.

 

Gardasil vaccination

Protects against four HPV types responsible for approximately 70% of cervical cancer and 90% of genital warts.

It is approved for use in more than 100 countries 26 million doses have been distributed worldwide. It is available for 12-year-olds at participating schools. For those born in 1990 and 1991, it is available from their immunising health care provider. Catch-up programmes for 13 to 16-year-olds will be provided through schools. It is free for girls aged 12-18.

 

Smear tests

Sexually active women should have smear tests every three years, even if they have been vaccinated.

Tests screen for abnormal changes in the cells of the cervix (neck of the womb) before they develop into cancer.

Tests are available from a local doctor or nurse, family planning clinic, local community health clinic, marae-based clinic or Pacific health centre.

It costs the same as a regular doctor or nurse visit.

An abnormal result means some cell changes have occurred and further tests will be needed. 

- © Fairfax NZ News