e-Bug: Case Study Case Study .

e-Bug: 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 .
Case Study
Hello Julie. Thank you for agreeing
to share your experiences for the e-
Bug project!
I wanted to ask you what happened
when you learned that you had
changes in the cervix?
Dr Pia Touboul
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