I recently had my yearly Pap and pelvic exam. My doctor wants to see me in four months again for another Pap smear because the last one showed that I had "parakeratosis." Is this serious? What does it lead to? My doctor said that it was a "change in the cells." I don't know what that means. Does wearing tampons have anything to do with it?

Beth

Parakeratosis is a thickening -- a buildup of cells, very much like a scale. Parakeratosis is often associated with chronic irritation and inflammation. This can occur due to a chronic yeast infection, for example, or if the uterus is prolapsed and the cervix, therefore, is pushed down to the vaginal opening, where it can more easily become inflamed. Using a diaphragm may lead to parakeratosis. Although it is possible that frequent prolonged tampon use might be a factor, using a tampon for a couple of days a month does not usually cause parakeratosis.

Parakeratosis occasionally is associated with more serious conditions such as cervical dysplasia or even cancer. At the time of a Pap smear, if a thick, white scaly area (called a plaque) is visible to the naked eye, the doctor should take a biopsy (small sample of tissue) to make sure a more serious problem is not hidden beneath it. If parakeratosis is noted on the Pap smear only, there is no consensus as to the best way to follow up. Many gynecologists will repeat a Pap a few months later, while others recommend colposcopy (examination of the cervix under magnification) to look for abnormalities. If a repeat Pap is chosen and the parakeratosis persists, the cervix should be thoroughly examined and a biopsy performed.