I am uncertain where to start.

This is a story I had been meaning to write about, but never quite had enough within me to share, though the closest around me would have heard about it along the way.

I am not sure why it actually takes quite a lot out of me to be revisiting it, that I procrastinated writing this post for the longest time, and even as I am doing it now, I could feel the nerves tangling themselves up in a bundle. I swear my heart rate is increasing and my breaths are getting shallower, and I know this is what I have been avoiding to experience again, that’s why I very nearly wanted to give up writing this.

It was no big deal. It should be no biggie. But perhaps this episode in my life had had much more implications than just something that had came and went, especially when it had happened at a time when I was pretty lost, ignorant and scared.

I will be the first to admit it, I have a fear for pap smears. BIG, MASSIVE FEAR. I get all worked up and defensive whenever I have to go for my pap smears, and it is an emotional thing for me to do so that I would be on the verge of bursting into tears whenever I have to do one.

It is not painful, it is nothing scary and it has something to do with the psychological fear more than anything else which I have since learnt to deal with these couple of years.

But it has everything to do with my first pap smear. That very first one.

And I know, it is a story that has to be shared, with each and every lady out there.

***

So where do I start, really?

It was in 2003, when I was 22, and I had already started blogging, but somehow this only appeared in fragments of subtlety.

I know no one really believes in the bull about intuition, or grace of God if you don’t share the same faith as me, but I really have no other explanation than this.

It was a day when I woke up and nothing felt right. I started crying for no particular reason, and there was a nagging thought in me which I tried to wave away.

I must be mad, I thought to myself (AHEM, I know some of you already think I am, but still…!), but the tears and uneasiness didn’t stop.

I remember it was one of those time when I MSN-ed (or should I say IRC) quite a bit with Faith, and somehow I was feeling so thoroughly miserable that I decided to speak to her.

I told her I just felt something wasn’t right with me, and I wanted to see a doctor. I told her I have this incredible urge to see a gynaecologist because I am just so freaking scared. I told her I couldn’t stop crying with this nagging feeling. I told her I couldn’t understand why I feel this way especially since I had never done even a basic body check up prior to that day, and I just wanted to get my vijayjay and its neighbours checked. I told her it was my intuition and that I know I sounded pretty crazy to be over-reacting with all the tears.

I MEAN SERIOUSLY, WHERE GOT PEOPLE WAKE UP AND FEEL THIS WAY ONE?!

Instead of assuming I was really out of my mind and close the chat window reassuring me and asking me to brush the thoughts aside, she actually told me if it was upsetting me this much, why not just go for a check up to buy myself some peace of mind?

Er… where to go for check up huh? I asked.

Then, I remembered couple of days before I was having meals at Jurong East central and remembered this clinic for women.

I then did a search and found its number.

I even asked Faith if I should really call, cos I wasn’t working and moolah had meant quite a bit to me. But then again, I didn’t know how it was going to work, so I didn’t know other channels to go through (I mean, I could have gone to a GP right?).

I was feeling a tad shy, and I called to ask if they have a female doctor, which they told me they do, but she would only be at the clinic 2 days of the week.

Since it was a specialist clinic, it would mean appointments were pretty packed and since I was pretty clueless, I just said I wanted to see a gynae.

For what? I was asked. Don’t know, just basic check up. Pregnant? No, am not.

I couldn’t possibly say I woke up crying and wanted a check up cos I scared my female bits give up on me right?!

So anyway, I said I wanted an appointment soonest possible, and a date was given.

After making the appointment, the uneasiness worn off, and I got a tad regretful for over-reacting the way I did. And I half expected that when the day passed, I would end up thinking how silly I was, and cancelled the appointment.

As the day progressed, I was ready to give the appointment a miss, and a call came in from the clinic to tell me that they have a cancellation on that very day. It was very last minute, and they have only one slot, the final slot for the day, at 6pm.

Since it was on the very day itself when I called, I actually jumped on the opportunity to say yes, instead of cancelling.

So off to the clinic I went.

When I got to see Dr Chua, she asked me what was my concern, and I just said I wanted to do a check up, and what would she suggest.

She suggested a pap smear, some blood tests and ultrasound was done to look at my ovaries, which she spotted some cysts.

I was told to open up my legs cos I was just too shy, half giggled my way through. I felt something cold, and as I was making small talk with my gynae asking what the procedure was for and if I really had to do it, and it was over before I knew it.

And that, marked my first pap smear, and perhaps the only one that was the easiest for me. I could still joke and make small talk, you know?!

Cysts were my prime concern and other than that, I was sent home pretty promptly without much stuff to be concerned about.

I didn’t have any sort of pain, didn’t have any funky discharge nor abnormal bleeding, nor did I offer any boarding space for things like cauliflowers and mushrooms.

So off I went, feeling pretty alright, and a slight pinch from the bill, booboo-ing my earlier outburst, crediting it to a bout of PMS, and everything was left long forgotten.

***

A call came in one afternoon a few days later.

The clinic. I almost forgot why they would call me.

There was a slight urgency in the caller’s voice when she identified herself, and she had called to ask if I had recently did my check up with Dr Chua.

My pap smear had turned out abnormal and I was told to return for another check up to make sure the report was accurate.

This is where my memory starts to get a little fuzzy, cos it was perhaps the point in time I tried to bury the whole episode.

I was not nervous, cos I simply didn’t understand what an abnormal pap smear meant, but thought I could speak to my gynae to ask what it was all about.

I got to speak to her, and she tried to assure me it was just further tests to eliminate possibilities, and then arranged for me to go for a biopsy (didn’t know what it was either!) with a certain A/Prof Arunachalam Ilancheran at NUH. An appointment was already set for me.

I was pretty uncomfortable with the arrangement, because I had wanted to female gynae all along, but I was told that, for the field it was related to, there was no female gynae she could refer me to.

That got me puzzled, greatly.

Still, I thought nothing of it, so reluctantly agreed.

And then, I relied greatly on the power of internet search to find out what an abnormal pap smear had meant, and what a biopsy is about.

THAT WAS WHEN INTERNET TOLD ME WHAT MY GYNAE DIDN’T WANT TO SAY.

Biopsy is done when there is a suspicion of cancerous cells, and an abnormal pap smear is a major concern.

Still, I tried to keep cool, and that it must have been some kind of mistake (tsk, denial, denial, denial!).

I still wasn’t as worried, as I was more concerned with showing my vijayjay to another male.

The alarm bells rang when I got to NUH, and realised what my gynae had meant when she said he was the ideal person in that field, gynaecology + oncology. Oncology.. wait a minute.. isn’t that.. CANCER?

WTF?!

My gynae was there too for the biopsy.

And I had such mix of emotions that I was confused, afraid, and very much in a daze.

My legs were propped up onto the stirrups, and it was the most unpleasant thing that was told to me, perhaps cos I was feeling so apprehensive and guarded. I was told they needed more sample for further tests, and the biopsy would be done pretty swiftly with little discomfort.

It was when I was told how it was done that I had great discomfort.

A colposcope with a bulb (NOT THE NORMAL LIGHT BULB OKAY, MY VIJAYJAY CANNOT FIT!), magnifier & a camera would be inserted to view the cervix and yes, I watched my you-know-where close up on the monitor next to me. Not. sexy. at. all.

Vinegar was then applied onto the walls, and the abnormal cells would then turn white. He then snipped a part of the tissue (not kleenex, my poor cervix) for sample, which would cause some bleeding, and the discomfort was cleverly masked when he asked me to cough.

Results were out in a couple of days and this time, I think my female gynae called me. Personally.

I was told my condition was actually more severe than they originally thought it was, and they would immediately slot me a date to go for treatment.

If it was mild dysplasia, CIN I, no treatment would be required and it would usually go away on its own.

I was told I had severe dysplasia, and it was CIN III (Severe dysplasia that spans more than 2/3 of the epithelium, and may involve the full thickness. This lesion may sometimes also be referred to as cervical carcinoma in situ) also considered as stage 0 cancer and surgery was needed ASAP as it would very swiftly progressed to Stage 1 cancer if not treated.

The call ended with me in a daze.

HUH?

Cancer?

WHY?!

HOW?!

Bear in mind that I had absolutely NO symptoms except for that weird hunch.

Questions I failed to ask, I got my answers via Friend Google and Friend Yahoo.

I then got acquainted with the term HPV.

I remember calling up asking my gynae why, how and all the questions that came flooding my mind.

Do I have HPV? WHY DO I HAVE HPV? The dilemma, the frustrations, the hurt, and boy, did I even feel a tad of betrayal.

And most of all, shame.

***

Everything defied logic.

And cos it is a STI, who the hell can I even relate it to, except my then boyfriend without being judged? The lack of education on the issue made me incredibly helpless, and pretty much, had no one to turn to.

Even from brochures or even the POCC sites these are the risk factors you should consider:

1) All women who have ever been sexually active

2) First sexual intercourse at young age

3) Multiple sexual partners in their lifetime

4) Smokers

5) Suffered from STDs

I was 1) of course.

But I was a late bloomer, cough.

I wasn’t a slut when I was younger (not that I am now… but that’s subjective you see. HAHAHA. JOKE, OKAY?) and I wasn’t that sexually experienced.

I was with a boyfriend whom I loved dearly, and we see each other 24/7 and I didn’t even hang out with other guys cos he didn’t like it that if HPV was airborne, I was unlikely to catch it either.

I never did smoke prior to that.

No STDs, from my earlier checkup.

So I had to get it from SOMEWHERE, right?

SO. That left me with questions for my gynae, I remember she had asked me not read too much into things.

But I was young, I was ignorant. Then the answer was supposedly clear.

You see, even if you are monogamous, or you only have ONE sexual partner, the sexual history of your partner would play a big part.

Say, your partner, only had one partner prior to you, and you are a virgin, what if the partner before you had 3 partners, and those 3 partners had had 8 partner each, and the number had just grown exponentially.

HPV does not have any symptoms for guys and neither for girls, and since it has not much effect on guys, and many ladies might have caught it which the body immune system would have overcome that.

Back then, I only felt shame, and I did feel a tad bitter that I have something like this, that I plunged badly into depression, and the relationship was dealt quite an enormous blow as well.

I couldn’t get my head around it and I just kept crying, and I was frustrated cos I had no outlet. No support.

***

When the day of the surgery came, I remember I was so fearful that I was in a daze.

That very morning, my then partner brought me to the Science Centre McDee’s for a meal, and got me one of those The Dog cushion. It was because I needed some form of cheering up from all the built up anxiety.

I felt so resentful of the whole process that I was so hostile to the doctors and nurses and just couldn’t find it within me to go through with it.

I shall shamefully admit that I even had wanted to kick the doctor away cos I didn’t want him near me.

I was trembling so much that I actually reached out for the assuring nurse (till today, I can’t thank you enough) and she held my hand throughout.

The process was relatively uncomplicated, it was the same stirrups in the same room I had my biopsy, you don’t even need an operating theatre.

This time, it was excruciating because of the psychological barrier I had.

I was trying so hard not to cry.

Local anaesthesia was administered, and then the horror played out like a movie on the screen as I smelt it happening.

Laser treatment means that the bad cells were burnt off and the sound and smell of it, still deeply etched in my mind for what was an absolutely traumatic experience for me.

When I walked out, I was pale, perhaps cos from the fright, and I actually remember walking from the building to NUH main lobby by this linkway which had these automatic doors, I just had to collapse and sit with my back to the wall to absorb whatever had happened.

In absolute dramatic fashion, I was clutching to the report which stated that I had HPV strain 16 (if I remember correctly) that had caused the lesions.

I was alone (technically I wasn’t cos I had walked out on my own in my state of trance, but still, with no one understanding it, I felt I was all alone). I was scared. I didn’t know what was happening. I didn’t think anyone would understand. So that actually brought on a bout of depression cos of the anxiety, fear, and like I mentioned, shame.

I was told to return back for check up to make sure all cells were removed, and I remember I was so upset that I asked does it mean if all weren’t removed, I would have to go thru it all over again.

I returned, and I was clear.

I was told to return every half a year for a pap smear, compared to the recommended once every 1 – 3 years.

But I know a part of me wasn’t the same anymore, because of the stigma of having HPV, a sexually transmitted infection, and this was 7 years ago before campaigns raised the awareness and gave us more learned information on this.

It is believed that 75% to 90% of those who are sexually active have HPV at some point of their lives.

It could easily be you, and that your immune system couldn’t cope and help you recover.

And because I had no one to turn to, or to get support from, not even my family knows about this, I was reluctant to return for my pap smears.

It was only until last year, in year 2009, 6 years after my surgery, that I had returned to do a pap smear. Only because I had wanted to get an insurance policy for Minibean.

It was not an easy task for me, for all the emotional turmoil and attachment I had associated pap smear with, and thankfully for all the great, great friends I had (whom I had to SMS throughout the entire process so they could cheer me on), whom I had opened up to and did not judge me for it, I got through it despite being so afraid of it.

It was 6 years too late, I know, but I am glad I finally got through with it, and it didn’t feel half as bad, it wasn’t even painful.

This year, I had returned to do my pap smear with polyclinic and am set to make it a yearly affair. Though the reception I had the polyclinic was a little different, cos of the history of CIN III, a doctor had to do the procedure and I was told to return within half a year.

I was so relieved and happy when the pap smear results turned out normal. But most importantly, with the recent Power Over Cervical Cancer campaigns, it has helped me to overcome my initial fear and liberate the emotional burden I had, and pushed me to be more conscientious with protecting myself, cos seriously, 6 years for my pap smear when I am high at risk? That’s stupidity for you.

***

Here are some important facts that I hope to share with ladies out there, and if you belong to the gender with hanging bits between your groins, it is crucial for you to take note and share it with people you care dearly for.

• In Singapore, cervical cancer takes the life of one woman every 5 days.
• About 200 new cases are diagnosed every year, with 100 of them not surviving it.
• Cervical cancer is when the cells in the cervix change or grow abnormally, thus the need for pap smear to detect the abnormality.
• Almost all cervical cancer is caused by HPV a virus which is very common, but not as commonly understood or heard.
• It could take decades to develop and you need not have cancer in the family history to develop it.
• Early stages of cervical cancer have no symptoms, and only a pap smear can detect it like it did for me.

It is evident why this is a cause I strongly support and believe in, because that ONE pap smear, saved my life, and I really would hate to see people around me have to go through with what I had went thru, or are not lucky enough to detect it as early as I did.

That’s why when the campaign had started couple of months back, I was quick to pledge my support for the cause.

With the recent campaigns, more ladies know how to protect themselves from this with regular pap smears, but there would be some who would think they do not have any need to do so because they are low at risk, but I hope my example would make you think twice, and get your pap smear done soon.

LIKE NOW! Go make your appointment ASAP. You need kaki, I can go give you moral support!

***

And if your pap smear is clear, prevention can reduce the risk of cervical cancer greatly too.

And if you are NOT sexually active, the vaccination is perfect for you cos it is aimed at those who are NOT YET sexually active (9 – 26 years old) before HPV could even sneak up on you. It may even be a good idea to vaccinate your child against HPV.

I am all for the vaccination despite already had previous history of HPV.

In fact, though I know that the vaccination would not prevent me against the strain of HPV I already had (which you might not even know you have), I made the decision to go for the vaccination as it could still help me prevent against other strains of cancer-causing HPV strains, and I might still benefit from it.

Thanks to Nadnut’s invitation, I had my vaccination done on last Saturday at Dr Leslie Tay (OMG, he is the man behind ieatishootipost! -fangirl mode on-)’s clinic.

I have to admit that I had put it off for the longest time as the cost was of issue to me and I wasn’t sure if the jab was gonna make much difference, but with the special offer and Dr Tay’s responses to my queries, I decided to go ahead.

Thus, I would like to encourage those who have had past experiences with CIN, to also consider going for the jab to protect yourself from other strains of HPV.

The jab was done at Dr Leslie Tay’s Karri Family Clinic at Tampines, and I was pretty surprised to see some fellow bloggers whom I have not seen in a long, long while there as well.

I was incredibly late (not an Easterner, lost my way and crashed lightly into the cashcard machine cos I was in too much a daze) and was the last one to have my jab.

It was over in a flash, less than a second, and I think I would have been out of the room less than 10 seconds if not of the camwhoring!

Here’s how it went:

He said if I could go through child birth (luckily detected early right, or else how such bundle of brilliance could come out of my you-know-where?!), this should be nothing.

I was sulking not because from the needle, but because I was just too sick from the long journey! The jab was painless! Only thing was, my plaster was placed on my blood mole mistaken for the jab hole…

And I got free stickers from the quite cute Dr Tay which I brought home for Minibean (okay, yes, they are disney princesses.. uhm.. hmm..).

We will be back in a month’s time for the 2nd dosage, and then in another 6 months for the booster.

If anyone of you are interested in getting your vaccination, do let me know and let’s see we can get a bulk discount, alright?

Suddenly getting all these off the chest is such liberation. Truthfully, even I, who had went thru a close shave with cervical cancer have so much to learn still. And if you think it couldn’t happen to you, neither did I think it could happen to me.

But, my first pap smear (and that strange intuition) did save my life. I was 22. Way below the average age of women diagnosed with cervical cancer (which is 40s). I did not appear to be in the high risk group. It hit me when I least expected it.

Well, the only certainty in life, is uncertainty, isn’t it? It boils down to how prepared you are for uncertainty.

Wah super long post, and bear in mind my cornea is scratched and I have double vision and tearing while writing this post which wasn’t as emotionally draining as I had anticipated it to be.

Well. If this could help even ONE of you, or convince ONE of you to take charge of this uncertainty, it will be all worthwhile.

***

Power Over Cervical Cancer is a campaign that aims to make Singapore the country with the lowest incidence of Cervical Cancer and they need your help to spread the word. Pledge your support for this cause and protect those you care about by telling them about Cervical Cancer. Together, we have POWER Over Cervical Cancer. Click the button below to begin!