Abnormal smear (Pap) test
Abnormal smear (Pap) test
The smear tesrt (Pap test) is a screening tool used to detect potential abnormalities in the cervix. The cervix is the lower part of the uterus at the top of the vagina.
An abnormal smear test result means that the Human Papilloma Virus (HPV) is present in the cervical cells. The HPV virus is very common and can lead to abnormalities in the cervix.
It is important to remember that almost all abnormal smear test results are not due to cancer.
A positive result will require further investigation with HPV test or colposcopy or combination.
HPV
Human papilloma virus is a very common virus and anyone who has ever had sex can have HPV. Four out of 5 people will have had HPV at some time in their lives.
There are more than 100 types of the virus. About 40 types of HPV can cause abnormal Pap Smears. HPV types may be “high-risk” types or “low-risk” types.
Most types of HPV are harmless, do not cause any symptoms, and go away on their own in one to two years. If you smoke, it is more likely that HPV will persist – so quitting smoking will help your immune system to clear the virus.
If left untreated HPV may cause changes in the cervix that may lead to cancer. This can take many years.
What happens if I am HPV positive?
If you are positive for high-risk HPV, you should see a Gynaecological Oncologist for a colposcopy. A colposcopy is a microscopic inspection of the cervix looking for abnormalities. Most people will not have any serious abnormalities but it is very important that you attend all your appointments.
If you are positive for low-risk HPV and the smear (Pap) test is abnormal you will be referred for a colposcopy. This does not mean there is an abnormality but that there are sufficient changes to warrant further investigations.
If you are positive for low-risk HPV and the smear (Pap) test is normal then you will be asked to return for another smear and/or HPV test in 12 months.
Colposcopy
A colposcopy is a procedure provided by a gynaecologist who examines your cervix with a microscope to help identify any abnormalities. This procedure differs from a Pap smear and may be recommended if you have an abnormal Pap smear result. During the examination, the colposcopist looks at your cervix with a colposcope. A solution is applied to the cervix. This makes areas, where there are changes in the cells, turn white helping the doctor to identify abnormalities. Having identified any abnormalities, the doctor may take a tiny biopsy from any areas of concern.
It is best to have a colposcopy outside of your period. However, as long as you are not bleeding heavily, it can be successfully performed at any time during your menstrual cycle. Prior to the test you should avoid sexual intercourse, the use of vaginal suppositories / creams and vaginal washes for 24-48 hours. You will also need to provide test results (Pap smears, vaginal swabs, any previous colposcopies and biopsy results) and information about your medical history including medication if you are taking any.
What you would feel if you underwent colposcopy is very similar to having your smear as the introduction of a vaginal speculum is necessary. The difference is that the process takes slightly longer (5-10 minutes in most cases). Some women may feel a burning sensation with the application of the solutions (diluted acetic acid solution and iodine lugol), however not necessarily. If a biopsy is indicated, the procedure is very quick to perform. What you may feel is mild period cramps. Should a biopsy be taken, you will need to avoid sexual intercourse and bathing for 2-5 days, until the brown vaginal discharge you will be experiencing settles.
LLETZ procedure
This procedure is done when your pap smear, colposcopy or biopsy has shown abnormal cells on the surface of your cervix. Treatment is usually recommended when there is a risk that the abnormal cells may progress to cancer of the cervix. The risk of developing cancer is small and only occurs if the abnormal areas are left without treatment for long periods of time.
The LLETZ treatment aims to totally remove the abnormal cells from the cervix. A wire loop with an electric current (diathermy) is used to shave off these cells. This leaves a raw area on the cervix which heals very well. Treatments are very safe and if performed appropriately they carry a very low risk ratio. Their likelihood of being successful and turning your smears back to normal is at least 95%. If you need a treatment, indications, risks, and future follow up will be discussed with you in detail.
You may experience some slight “period like” discomfort for a day or so. Initially bleeding varies from slight to as much as a period. You will probably have a vaginal discharge, brown or blood stained and later clear, usually for about three to four weeks.
For the first three to four weeks you should also avoid intercourse, bathing, swimming and heavy exercise in order to promote healing of the cervix and minimize the risk of infection. After the procedure pads rather than tampons should be used.
About Dr. Tranoulis
Dr. Tranoulis is a double-board certified colposcopist by the Royal College of Obstetricians & Gynaecologists (RCOG) and British Society of Colposcopy and Cervical Pathology (BSCCP). He completed his training in diagnostic and therapeutic colposcopy according to the curriculum of the British Society of Colposcopy and Cervical Pathology (BSCCP) and gained in-depth knowledge of the UK Cervical Screening Program, one of the most successful worldwide. He has extensive experience as a lead colposcopist at several Tertiary Hospitals in Great Britain.