Q. What is a Pap smear?
A. A Pap smear is a sample of the cells from the outside of the neck of the womb (cervix). It is obtained by the Doctor (GP) or specialist Nurse during a gentle internal examination using a simple device.
Q. Why do I need a Pap smear?
A. Regular Pap smears are effective in detecting abnormal cells (pre-cancer cells) of the cervix before cancer develops.
Q. Are these abnormal cells the same as cancer?
A. No. They are pre-cancer cells. Certain grades (high-grade) pap smears have potential to progress into cancer in future if left untreated.
Q. How are Pap smears graded?
A. Pap smears are graded into 3 main categories, based on the degree of abnormalities of the cells. These are medically referred to as ‘ Cervical Intraepithelial Neoplasia (CIN)’ or Squamous Intraepithelial Lesion (SIL).
CIN 1 or LSIL are low-grade lesions. CIN 2/ 3 or HSIL are high-grade lesions. Less commonly, abnormality of ‘glandular cells’ types may be reported.
Q. What about HPV? Should I be concerned?
A. HPV is a common virus. It is found in up to 1 in 4 women of reproductive age. Continued absence of HPV is reassuring as it indicates that abnormal cells are highly unlikely to develop. It is usually cleared up within 12 to 24 months. Additionally, it is often used to confirm the medium term success of treatment.
Q. What exactly is colposcopy?
A. It is a more detailed Pap smear, usually in the Doctor’s rooms.
Q. What is the reason for colposcopy appointment?
A. The most frequent reason is that: one or two of your recent pap smears (tests) as having abnormal cells.
Q. How does this work?
A. The specialist Gynaecologist takes a closer look of the neck of your womb (cervix) using a special magnifying lens with inbuilt light source (a colposcope).
Q. Is this painful?
A. No. It feels exactly like a pap test.
The colposcope stays outside your body. The neck of the womb is given a slight wash with a solution (acetic acid) in order to highlight any abnormal cells.
Q. How long does the actual examination take?
A. It lasts about 15 mins.
Q. What else can I expect?
A. Your Pap smear may be repeated and a biopsy of your cervix is often taken.
Q. What is this biopsy?
A. It is a small piece of sample of the cervix, usually size of an office pinhead. This is sent off to laboratory (pathology) for further check. A local anaesthetic spray is often used. You may feel slight discomfort.
Q. Any special preparation for the appointment?
A. No. It is similar to attending GP/Nurse for a pap smear. Having a period at the time is usually fine.
Q. What next after this appointment?
A. You can expect light bleeding or spotting for couple of days.
A future appointment will be made on the day to obtain results and plan treatment (if required).
Q. Do most women need treatment?
A. No. Only a small proportion of all women require treatment. This is usually based on the biopsy results.
Q. What is this treatment?
A. Treatment involves removal of a small piece of cervix where the abnormal cells are located. The most common is wire loop excision referred to as LLETZ (Large Loop Excision of Transformation Zone) or LEEP (Loop Electrosurgical Excision Procedure). These have the advantage of being performed as a day surgery either under local or general anaesthetic.
“Cone biopsy” is a more extensive, but less frequently performed treatment under general anaesthetic (GA). Other treatment options are laser and diathermy.
Q. What precautions do I need to take if I had treatment?
A. The key is to prevent infection by avoiding intercourse, use tampon or swimming immediately following treatment. You should avoid these activities for as long as you have vaginal bleeding/discharge, which could last up to 4 to 6 weeks. You should take antibiotics if recommend by your doctor and report heavier or new onset bleeding promptly.
Q. What about follow up after treatment?
A. This is very important. You will be required to attend for check up in 4 to 6 months. Subsequently, we ensure that you have 2 clear pap smear/HPV testing 12 months apart. Depending on your smear history, it may then be possible to return to routine pap screening.
Q. Any possible long-term complications from treatment?
A. Treatments are generally very safe. There is a small risk of preterm birth after multiple LLETZ/LEEP treatments or a cone biopsy. Inform your obstetrician who will advise if special precaution or treatment is required in pregnancy.