e-Bug: Case Study Case Study Dr Pia Touboul, an e-Bug partner from France, interviews a pregnant 25 year old female called Julie about the vaccination against papillomavirus . Dr Pia Touboul Hello Julie. Thank you for agreeing to share your experiences for the eBug project! I wanted to ask you what happened when you learned that you had changes in the cervix? Julie, 25 I had a smear test 2 years ago, although it wasn't obligatory; it was because I was changing pill. And they realised as a consequence that there was a type 2 or 3 dysplasia. I had had a smear test a year before that, so in the normal course of events I didn't need to have another one done. OK. And then how did you react? It was a shock for me! My GP generally takes care of my gynaecological monitoring, and she called me to explain that there was a small abnormality, nothing very serious. Except that I immediately thought "Cancer"! Even though she had absolutely not said that and was quite reassuring. And she was very specific and really, yes really, clear! But I didn't digest it in that way at all, and so it completely stunned me. I called my mum straight away. She's a doctor too. She explained things a little bit more and tried to reassure me, but I was still really concerned even so... I had cancer and that’s actually a frightening word, AND because it was in the uterus, and so I wasn't thinking, emotion overrode reason. And being a woman, I was also afraid for a future pregnancy... e-Bug: Case Study For future pregnancies, you thought about that straight away? Yeah, cancer, reproduction and therefore children to come... these were the first things that frightened me actually. And I think I developed a firmly rooted fear around it, which was difficult to shake off afterwards. What happened after this result? I had a biopsy to confirm the type of dysplasia. And this dysplasia was very advanced for my age, considering I had recently had a smear test! So they took the decision to perform a cone biopsy. There you are. While I was waiting for this cone biopsy, I was... well, I was so worried and I didn't take information in at all. I understood it and I was actually very good at explaining it to other people who were worried on my behalf; I was very good at reassuring others, but I hadn't digested it for myself. Not for yourself... and what did that mean in practice? Well, I was very anxious, everything seemed really SERIOUS, but I internalised a lot and was sleeping badly. I called my mum every day to ask her questions and I made the mistake of looking things up on the internet that really was dire. And how were the studies going? Were you finding it hard to concentrate? Well, it was difficult, yes. I struggled to complete my reflective work. It was challenging to concentrate on it; it was as if I wasn't there, a bit absent, so to speak. e-Bug: Case Study And so after that, you underwent surgery? Did it go well? Yes, it went well. The gynaecologist explained everything clearly to me And your worry, did that subside after the operation? Not really. Actually, I set aside the worry about cancer but I was very concerned that it would be more complicated to have children, that I would have difficult pregnancies, suffer from miscarriages. To make matter worse, I had decided to have an IUD fitted, but my gynaecologist wasn't able to fit it and explained that it was because of the scar tissue from the cone biopsy. So I said to myself, if my body isn't capable of accepting an IUD, how are all those little sperm cells going to be able to get in properly, to make a baby. So, you’re now pregnant... Yes, four and a half months gone. Now I'm starting to get anxious again, about the birth. Actually, what worries me is how the cone biopsy scarring might affect the birth. Did you have the vaccination against cervical cancer? No. I didn't even consider it because I didn't fall into the age bracket. If you were 16 today, at the start of your sexual life, and you were offered this cancer vaccination, do you think you would have it? e-Bug: Case Study I think I would have thought about having it. For your child, do you intend to have him or her vaccinated in general? Yes, absolutely. The recommended vaccines at any rate, yes! If it’s a GIRL, do you think you will encourage her to have the vaccination against cervical cancer when she's a teenager? Yes, I think it should be discussed. Do you discuss vaccinations among your circle of friends? Sometimes we did, yes, but it was a lot of opinions, either very for or very against, but not based on personal reflection. And regarding cervical cancer, well, it's quite an intimate area and that's our own business and nobody else’s, you know? In conclusion, how do you view this experience? If I could have, I would rather have avoided this episode in my life. Acknowledgments Dr Pia Touboul Julie