'Pap', or as they are now called, 'cervical screening' tests are a necessary part of well-woman healthcare. These tests pick up evidence of infection with a very common virus, called human papilloma virus(HPV) that nearly every sexually active adult will be exposed to at some point in time and that, in rare cases, leads to cancer and more commonly causes abnormal precancerous changes that require observation (called surveillance) or treatment to remove the abnormal cells and reduce the risk of cancer in the long term.
Most HPV infections and abnormal results occurs in young adulthood, but can occur at any time in a woman's life. It is important to know this infection does not cause symptoms unless advanced cancer develops, making regular screening for early changes essential.
There are many types of this virus, some of which (types 16 and 18 in particular) are more likely to lead to problems than other types. Gardisil, the 3 course vaccination given to teenagers protects against the most common types that cause cancer and genital warts, but because there are so many types, it is still important to have cervical screening tests.
My cervical screening test is abnormal, what should I do?
Most women who have minor abnormalities require a repeat in 12 months with their family doctor (GP) with the expectation that the body will naturally clear the virus in this time much like a common cold, however if you have a high risk virus type, are older, have chronic illness, are overdue for cervical screening or have symptoms such as bleeding, you will be recommended to see a gynaecologist for colposcopy.
Smoking makes it much more likely that you will fail to clear the virus and progress to more significant abnormalities that require treatment, and for this reason if you smoke, ceasing is strongly recommended.
Colposcopy
Colposcopy is simply a method to look at you cervix magnified and identify any potential abnormal cells with the use of visual appearance under a special microscope (colposcope) and application of special solutions to highlight abnormal areas. At colposcopy, abnormal areas will be gently biopsied to confirm the impression before you are offered treatment to be certain it is necessary. Although it sounds painful, most women feel the biopsy much like a menstrual cramp and can return to usual duties immediately after their appointment.
You can expect brown spotting after your colposcopy/biopsy and can resume sexual intercourse when it settles. Most results are back within a week or two, and if the result shows abnormalities at higher risk of progressing to cancer over time, you will be offered treatment, called a LLETZ procedure, to reduce this risk by removing the abnormal area.
The LLETZ procedure is relatively minor surgery which is usually performed under general anaesthetic and takes about fifteen minutes. Most women go home once their anaesthetic has worn off and will have brown vaginal spotting or light bleeding for 4-7 days and should not use tampons or have intercourse until your follow up appointment. Infection is uncommon, but if you have significant pain, heavy bleeding or smelly discharge you need to be seen to rule this out or treat it.
Follow up testing at one and two years is used to be sure the virus has been cleared and after this point you can resume 5 yearly screening again.
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