Because problems with the female organs may go unnoticed until they become serious, regular gynecological exams are important.

Pap smears are necessary so that the cervix can be examined for abnormal cell growth. Pap smears have helped dramatically reduced the rate of death from cervical cancer, and can find cervical abnormalities before they become life-threatening.

Yearly Pap smears are generally recommended. Since HIV-positive women are more vulnerable to infections, however, they should have Pap smears twice a year.

High risk for HIV-positive women

In the largest study of its kind, Joel Palefsky, M.D., of the University of California at San Francisco, has found strong new evidence that HIV-positive women run a high risk of infection with human papillomavirus (HPV), a major cause of cervical cancer. He reports that the study shows that both a higher HIV viral load and lower CD4 count were predictive of HPV infection. Among women with CD4 counts under 200/ml, the risk was high regardless of the HIV viral load.

During sexual intercourse, viruses may get into the cells of the cervix (the opening of the uterus). These viruses may cause abnormal tissue growth which is known as "dysplasia."

Dysplasia is easy to treat. If left untreated, dysplasia can become severe, and it has been called carcinoma in situ (CIS) or high-grade dysplasia. If this condition is left untreated over a number of years, the cells may eventually break through the skin layer and invade the layer beneath, which means cervical cancer is present.

The most common cause of cervical cancer is a group of viruses called human papallomavirus (HPV). These viruses are very common and have been found in 6 percent of all women. HPV is a group of about 70 similar viruses of which about 20 can infect the genital skin. A noticeable overgrowth of the skin called condyloma or genital warts may result, which are usually painless.

If the virus is only present on the cervix, the only way to detect it is with a Pap smear.

Although cervical cancer does not appear to be inheritable, certain behavior may increase your risk. For example, multiple sexual partners increases the risk. Smoking, which makes the immune system less effective, also increases the risk for cervical cancer.

Treatment options

Treatment for cervical cancer usually requires surgery, radiation or both.

While HPV does not always need to be treated, some treatment may be necessary. Most treatments are relatively painless. If the Pap smear is abnormal, repeat Pap smears every three months can be done to look for any further abnormal cell growth.

A colposcope can be used to see a magnified view of the cervix. If abnormal patterns are found, then a cervical biopsy will be needed. A biopsy is the removal of a small area of the cervix which is then sent to a pathologist for an accurate diagnosis.

Cryotherapy can be used to treat HPV. Freezing the outer cervical area or the skin area destroys the cells and new cells grow back.

Loop electrosurgical excision procedure (LEEP) is another painless method of treatment which takes only a few minutes using an electrical current and a small wire loop to cut through the cervix. The cells are removed as treatment but are also sent to a lab for further diagnosis.

Condom use recommended

If you have HPV, there is a 60 percent chance that a male sexual partner may have the virus as well. Treatment is available for men using a liquid chemical, an electrical instrument or freezing instrument.

Due to increased vulnerability to infections, women with HIV/AIDS should use condoms to prevent further spread of HPV, as well as protect you from becoming re-infected with different strains of HIV.

Don't forget to schedule a Pap smear exam if you are due for one. Based on your medical history and previous Pap smear results, ask your doctor how often Pap smears are recommended.

Be active in your gynecological health and ask your doctor questions.

Although it may seem embarrassing, it could save your life.

Paulla Elmore is a case manager in AIDS Project Los Angeles' Case Management Services Department.