I personally had moderate and severe cell changes on my first biopsy report. Translation: after my hellacious biopsy, the abnormal cells had to be removed via cervical ablation, which involves lasering the abnormal cells off of the cervix. Despite how scary that sounds, the procedure was a breeze—I was under anesthesia.
Why Aren’t Women Getting Painkillers?
In the days after my traumatic biopsy, I had one burning question: How is it that doctors are punching slices of a woman’s cervix from her body without anesthesia?
The answer is complex. “It is very hard to inject local [anesthesia] into the cervix because of the density of the tissue. The cervix is very tough—think injecting into the heel [of the foot],” says Heather Bartos, M.D., an ob-gyn in Texas. “Paracervical blocks (anesthesia injected around the vagina) can be done but there are four shots involved, and frankly, most women jump at those compared to a one-time pinch at the cervix.”
That’s not the only reason: “No one likes to talk about costs, but anesthesia costs money,” says Kameelah Phillips, M.D., a board-certified ob-gyn in New York City. “The cost of anesthesia is typically not covered by insurance. In an era of higher deductibles and greater out of pocket costs, most patients do not want to cover this cost for a short procedure.”
Ultimately, the doctors I spoke with say most women simply don’t need painkillers. “Cervical biopsies are not universally painful for everyone. Many patients, including myself, experience no more than cramping,” says Phillips. “Discomfort really depends on the individual and the location of the biopsy as there is not a central nerve bundle for the cervix.” The anxiety leading up to the procedure is often worse than the biopsy itself, adds Bartos. “It was uncomfortable, more so than a Pap, but not overly painful—it felt like a large, sharp pinch,” says Natasha, 33. “I think the speculum was more uncomfortable than the tissue removal.”
Then there are the women like me. “No one could have prepared me. I was gushing blood,” says Gabby, 28. “Afterward I ran into the ally and burst into tears to call my mom, raging about how I wasn’t warned. I was really traumatized.”
There is another option: a cervical biopsy can also be performed with a tool called a spirobrush, which is significantly less uncomfortable. “The brush device literally brushes off the top skin layer of the cervix, and allows evaluation of the tissue of the entire area surrounding the cervical opening,” Gersh says. It isn’t just less medieval, it’s more effective, according to Gersh. “This device makes it less likely to miss abnormal tissue, is easy to perform, and is a relatively painless procedure.” So, why the need for the potentially torturous punch biopsy? While spirobrush tissue samples are more comfortable than the alligator’s mouth, the tissue sample isn’t always as easy to read and don’t always get a big enough sample of tissue. “You need to see the thickness of the cervical sample to determine if there is dysplasia, which is a precancerous condition, or invasion (aka cancer),” says Cherie Richey, M.D., an ob-gyn in Columbus, Ohio. In cases where cervical cancer is probable, your doctor might opt for a punch biopsy to ensure the best sample. (Not all ob-gyns are trained in using the spirobrush or offer it in their practice. Ask what methods your doctor has available before going in for your biopsy.)