Investigation options for abnormal pap and inconclusive colposcopy

Dear Dr. crown,

Thank you very much for taking the time to read this question. It has been very difficult to speak to the specialist that treated me, so it's immensely helpful that you are taking the time to answer the questions. I find a little more assurance from the questions and answers in the forum.

I have irregular bleeding problems for 4-5 years now, I have had regular pap smears every two years before in North America (I am 28), twice in total, with no HPV test, but the results had always been normal.

I had a pap smear in April 2021, the results were hrhpv positive and pap 3a. During the colposcopy, I was told that some abnormalities can be seen very deep in the cervix, such that the instrument cannot reach the spots and the doctor that treated me had to take several blind samples.

The samples turned out to be normal, therefore, I was advised to wait for 6 months and repeated the procedure again. The same thing happened this time, pap 3a, abnormalities deep in the cervix, blind sample, and samples turned out to be normal. I was advised to wait again.

I have not been sexually active for 3 years, I have the same partner for 8 years, and I have symptoms for quite a long time. My partner did not have any other partners before me, so I am afraid I am already infected with hrHPV for 10+ years. Combined with the fact that the abnormalities appeared to be very deep in the cervix, I am worried that the actual abnormality is much worse than what has been shown on the pap smear. I have read that if the abnormal cells are in the neck of the cervix, it's difficult to diagnose with pap smear, and even with colposcopy, because of the location cell samples are usually taken for pap smear. Is this correct? Would abnormal cells deep in the cervix be able to travel to the "transformation" region to be detected?

My GP would not refer me to another hospital because I have been referred once already, and I always see a different doctor when I visit the hospital with very little time available for discussion (the results were communicated to me by the assistant). Incidently, both times my colposcopy was done by doctors in training, and I am not sure how reliable (no offense) the results would be.

I was wondering what the risks are for waiting if a reliable diagnosis simply cannot be made, and what investigation options do I have/would you recommend? I am fairly uneasy that the only thing I can do is to wait around without knowing for sure whether a more serious problem is present, but I cannot find information on what alternatives would be available. I understand that I don't fall into a "high-risk" age group, however, I believe that there are cases of more serious problems (CIN III, cancer) even in my age group.

I would like to summarize my questions here:

1. Is there a part of cervix where abnormal cells can occur, but is inaccessible by colposcopy? Are there other diagnostic options that would be available and more accurate? I just read somewhere here that a loop can be done as a diagnostic tool. Should I insist on this to my specialist? If I get a loop done, would this be 100% accurate?

2. Given that I show symptons for a few years, and that I have not been sexually active for 3 years, and the abnormal areas are very deep in the cervix, do I have an increased risk of an advanced dysplasia that has not been diagnosed (because presumably I have HPV for many years)?

3. I would like to know if there are hospitals that are more specialized in treating such cases (I just wanted a thorough investigation, not to be sent back to wait another 6 months), and would be more open to discuss other diagnostic methods if colposcopy continues to yield no reliable result?

4. Is there a difference on the quality of health care in the outpatient center of (different) hospitals and an independent clinic specialized in gynecology? I am afraid I would have to see an independent clinic as I am unable to get a reliable diagnosis and am facing increasing wait time for an appointment in the hospital.

Thank you very much again for the opportunity to ask questions. I would like to apologize for the lengthy questions as I am navigating an unfamiliar healthcare system. Also quite scared because I read all these stories about normal pap but cervical cancer.