More Information:
- Well women's health care
- Abnormal cervical smears - colposcopy
- Family planning & contraception - hormonal, implants, IUD
- Infertility & ovulation induction
- Abnormal uterine bleeding - office endometrial biopsy
- Menopause & hormone replacement therapy
- Urinary incontinence
- Prolapse & pelvic floor reconstruction
- Dermogynaecology clinic & vulvar disease
- Vulvar skin care
- General anaesthesia or spinal block
- Self referral tests
Abnormal cervical smears & colposcopy
Women are encouraged to have a regular Pap smear as a normal part of their health care. This is because a Pap smear can detect changes or abnormalities in the cells of the cervix, which, if treated early, can prevent the development of cancer of the cervix. For approximately 9 women in 10, this test will tell their doctor that everything is normal. However, 1 in 10 women may be told that the result was “positive” or “abnormal.” If you are one of these women, you should not feel too anxious – it does not mean you have cancer. In fact, the whole point of Pap smears is to identify abnormalities before cancer develops. Having a “positive” smear means that some abnormality appears to be present which will require further investigation. There are other conditions such as inflammation, infection or Human Papilloma Virus (HPV) also known as wart virus, which will cause the Pap smear result to be reported as abnormal. If there is a bacterial infection in the vagina, treatment may be required, following which you may have the Pap smear repeated. Mostly, changes caused by the wart virus disappear naturally with time as the immune system overcomes the virus.
When the cervical smear is “abnormal” it will be reported as showing either low grade changes (LGSIL) or high grade changes (HGSIL). In this situation you will be referred for a special examination called a colposcopy whereby the cervix is inspected with a special instrument called a colposcope. The patient is placed in stirrups and a speculum is inserted into the vagina to display the cervix. The colposcope allows magnification of the cervix and after application of acetic acid (vinegar) the exact nature of the underlying abnormality can be established. If a lesion is found, a biopsy can be taken to confirm the diagnosis. This examination is done in the rooms while you are awake and takes no more than 15 minutes. Throughout the examination the doctor will explain what is going on and afterwards will discuss the findings as far as he is able at this stage. If minor changes only are seen, you may be told that treatment is not necessary but you will be reminded to report again for a Pap smear after a certain period of time. If an abnormality (dysplasia) is confirmed, arrangements will be made for treatment.
The terms dysplasia or CIN (cervical intraepithelial neoplasia), are the words used to describe the precancerous tissue that has developed on the surface of the cervix. There are three grades of dysplasia from mild to severe:
CIN 1 = mild dysplasia
CIN 2 = moderate dysplasia
CIN 3 = severe dysplasia
When the Pap smear is reported as LGSIL it refers to CIN 1 and HPV, whereas HGSIL refers to CIN 2 and CIN 3 as the probable underlying lesion on the cervix. It must be remembered that the Pap smear is not a diagnosis of the underlying lesion on the cervix and that this can only be established by colposcopy and biopsy.
Once a precancerous lesion has been confirmed on the cervix, it can be treated to prevent its progression to cancer. The aim of any treatment will be to destroy or remove the abnormal or dysplastic tissue on the cervix and this is often done by electrocoagulation loop excision or diathermy. Under certain circumstances a cone biopsy may need to be done for both diagnostic and therapeutic purposes. Both these procedures are done under a general anaesthetic.
After your treatment you will need to return 3 months, 6 months and 12 months later for follow up smears to ensure complete eradication of the dysplasia from the cervix. Thereafter cervical smears are taken every 12 months until 70 years of age.