Q&A: Vaginal Dysplasia With Negative PAP tests; HPV Incubation Period
P writes: I'm 55 years old and have been going in for PAP exams all my adult life. They have always been normal. After 16 years of marriage, my first husband began cheating on me - I believe he started this about 6 years ago. We divorced in 1997, and then I remarried last year. Last month my gynecologist told me that I had HPV in the vaginal canal. I didn't even know what HPV was! When he briefly explained it to me I must have looked really shocked, because he hurried to say that the virus could have been incubating for years, but that now I have severe dysplasia and will need a vaginal cuff resection. The more I think about it, I find it may be more than just coincidence that I've had clean bills of health on PAP exams all these years until I remarried. Do you think it's possible that the virus could have incubated since 1995 and only broken out in the past year, or is it more likely that my second husband exposed me to the virus? The only two people I have had sex with are my first and second husbands. Although I remained faithful to the partner to whom I was married, I have wound up with HPV. Both men deny having exposed me to anything. Please let me know what you think.
First of all, I'm so sorry to hear you are going through this.
I see three separate questions here. Taking the last one first, neither husband would be likely to know whether or not he was exposing you to HPV. Condoms aren't adequate protection, and intercourse isn't even necessary to pass along HPV. Further, men seldom have any symptoms of the types of HPV that cause dysplasia.
Although no one can really say for sure, based purely on the information you gave it is far more likely that your exposure to HPV came from husband #1. Although the types of HPV that cause warts generally have fairly short incubation periods (weeks to months, occasionally longer), the types that cause dysplasia (especially with vaginal dysplasia, also called VAIN) usually take longer to cause their damage. One study found that most of the time it took one type of HPV (HPV-16) in the range of 7-12 years to progress to severe cervical dysplasia/carcinoma in situ. Although the incubation period varies a lot by HPV-type and from person to person, it would be unusual for HPV to cause severe vaginal dysplasia in a matter of months.
This leaves the question "why the negative Pap tests for all those years"? Besides the possibility that dysplasia might not have been present before now, Pap tests often don't pick up vaginal dysplasia. This is because Pap tests take cells from the cervix, not the vagina, since cervical dysplasia is much more common than vaginal dysplasia. You are actually lucky that the Pap test picked up your dysplasia before it became cancerous. (However, I can imagine you are probably not feeling all that lucky about now!)
Best wishes with your surgery and recovery!
For more information about HPV and Dysplasia:
More Q&A's About HPV and Dysplasia
Understanding HPV and Cervical Cancer
Myths and Misconceptions
Reviewed and Revised 11/01
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