Cervical smears are designed as a screening test for cervical pre-cancerous conditions. They do not detect uterine or ovarian cancers. An abnormal pap smear does not necessarily mean cancer. There are many reasons why smears are abnormal result including many low-grade infections or technical problems with the smear itself. As the smear is a screening test, it indicates that there may be an abnormality, but a colposcopy is often required to confirm the site and nature of the abnormality.
The procedure
A colposcopy is similar to having a smear performed, but it requires additional time as the cervix is examined using a colposcope / microscope. During this examination, acetic acid (vinegar) and / or Iodine solution is used to stain the cervix to indicate the areas of abnormality. If an abnormality is detected, a biopsy may be required. A biopsy does cause a slight discomfort, but it is well tolerated by most patients. Less than 2% of the time, a biopsy of the cervix may cause a vaso-vagal reaction (feeling faint, nausea and light headedness).
When do I need Colposcopy?
- Abnormal smear
- Investigate a history of post coital bleeding (bleeding after intercourse) or any unusual vaginal discharge
- Unusual appearance or consistency of the cervix
What if I need treatment?
Should treatment be required this is most often done as a day surgical procedure either under local or general anaesthetic. This is known as a LLETZ procedure. A larger treatment specimen called a CONE biopsy may sometimes be necessary also as a day surgical procedure depending on size and position and severity of the lesion being treated.
Is treatment effective?
Treatment for premalignant conditions of the cervix is usually extremely effective in curing the condition as a once off procedure and rarely interferes with future fertility and delivery. This will be discussed in detail if you require treatment.
What follow up do I need?
This will be discussed with you on the basis of your individual circumstances but generally current recommendations after successful treatment require a colposcopy at 6months post treatment (no biopsy required unless an abnormality is detected) after which most patients will have a further smear and HPV test in a further 6 months with their GP.
A follow up plan will be clearly outlined and documented for you. In some situations, longer and more intensive surveillance is required but this will be discussed with you.
