It can be quite a shock to be told that you have an abnormal cervical smear.
You must remember that these are very common; one in ten cervical smears are classified as ‘abnormal’ so don’t be distressed. In the majority of cases abnormal smears do not mean that you have cancer. We hope this section gives you enough information to understand why smears are performed and answers to some questions
A cervical smear is a sample of cells taken from the entrance to the cervix (or neck of the womb) that can detect abnormal cells before they can change into cancer. This then allows time to remove these cells before cancer develops.
In extremely rare cases cervical smears may detect an abnormality in the presence of a cancer of the cervix. Treatment can be sought quickly.
Cervical smears are collected in fluid filled bottles. This development is called ‘liquid based cytology’ and aims to reduce the likelihood of any sample being unsatisfactory for examination (see inadequate smears).
To maximise the uptake of abnormal cells we at Marble Arch Health test the cervical smear in 2 ways
Presence of abnormal cells
Presence of Human Papilloma Virus
This means that you can have the most accurate test available and be treated as quickly as possible.
Dr Orla Conlon has more than 20 years experience in Colposcopy.
Only accredited laboratories are used to process cervical smears.
Only accredited laboratories are used to process cervical smears.
Again it is important to repeat that the overwhelming majority of women who have an abnormal cervical smear do not have cervical cancer. However some women may have changes in the neck of the womb (cervix) that we call pre-cancer or CIN (Cervical Intraepithelial Neoplasia). When we find areas of pre-cancerous changes on the cervix it is very easy to remove them completely.
The exact cause of changes in the cells of the cervix is still unknown. However, these changes are often associated with the Human Papilloma Virus (HPV) which can be transmitted by sexual intercourse. Smoking also increases the risk of abnormal cells in the cervix.
Approximately 80% of both men and women have had the HPV infection at some time throughout their lifetime. In most cases on the cervix it clears naturally without the woman knowing it is there. There are over 150 HPV viruses; only a small number can cause abnormal changes to the cells of the cervix: types 16, 18, 31, 33, 35. Some forms of the virus can cause genital warts. In some women, however, the virus remains present for a number of years and cervical abnormalities will, in a small number of cases, develop into cancer if left untreated.
You may have been told that your smear shows borderline or mild changes. These abnormal cells can change back to normal cells again. That is why it is better not to rush in to remove these cells straight away, but to repeat the smear in 6 months. If the second smear is normal you will not require any treatment but you will need further follow up smears 6 monthly & then yearly. If the mild changes persist you will be asked to attend for Colposcopy.
This sometimes happens. It is not because the smear was taken incorrectly, but for some reason or another the process required to produce a sample for the lab, your smear has been unable to provide a satisfactory specimen. There can be many reasons for this. There may be a simple delivery problem or a difficulty in the preparation process. If you have reached menopause a different brush may be needed to get the cells from inside the neck of the womb and whoever has taken your smear may advise you of this. It is important to remember that an inadequate smear does not mean your smear was abnormal but that it was unreadable. Unfortunately, this is an inconvenience but please don’t worry. Ask your doctor or practice nurse why your smear was inadequate and then return at your convenience for the smear to be taken again. You can also come to Marble Arch Private Health for your repeat cervical smear. The liquid-based cytology technique has made this problem less likely but occasionally women may be referred to a Colposcopy clinic if the problem persists.
Colposcopy examines the abnormal cells of the cervix in more detail to see if treatment is required.
Colposcopy is quite a daunting experience for many women. It combines the anxiety of worry that there are cells present that could potentially turn to cancer if left for 5 to 15 years and the fear of actually having to undergo the procedure.
Not everyone feels comfortable having colposcopy. The majority of women have Colposcopy done under a local anaesthetic. We have highly trained staff to support you through a Colposcopy examination.
Colposcopy can be more uncomfortable for women who haven’t had a vaginal birth and also in women who are in the menopause or perimenopause, where the vagina is much drier and narrower. If this is a problem for you, you could use a little extra vaginal oestrogen for a few weeks before coming to colposcopy which will make the procedure a lot less painful, e.g. every night for 2 weeks.
In some cases, Dr Orla Conlon can offer this procedure under sedation or a light general anaesthetic where for some women Colposcopy would be too much to bear.
If you do have an overwhelming fear of colposcopy, a previous traumatic experience, a difficult vaginal delivery or if you have been a victim of rape or child sexual abuse, Dr Orla Conlon will support you through this procedure and facilitate your needs.
Dr Orla Conlon believes that no woman should suffer while having Colposcopy.
The instrument used is called a ‘colposcope’; it is just a magnifying glass / microscope which lets the doctor look more closely at the changes on the cervix.
The same type of vaginal speculum is used that you would have had for your cervical smear.
Then Two different solutions are used to stain the cervix. These are Acetic Acid (white vinegar) and Iodine (a brown liquid). The abnormal cells react with these solutions in a different way to the normal cells on the cervix. That is how Dr Orla Conlon decides the degree of abnormality and whether or not you will need treatment.
If you need a biopsy of your cervix (this is a small sample taken to send to the lab for analysis), you will be offered an injection of local anaesthetic. This is the same local anaesthetic that is used in the Dentist. It also has Adrenalin in it, which helps stop bleeding but the Adrenalin can make you feel a bit shaky and have palpitations. This is completely normal and nothing to worry about. Getting the injection can cause a sharp period-like pain. This is the worst part of Colposcopy. Once the injection is in, you will be aware that Dr Orla Conlon is treating your cervix but it should not be sore.
Dr Orla Conlon has over 25 years of experience in Colposcopy. She holds the British Society of Colposcopy and Cervical Pathology (BSCCP) accreditation for Colposcopy.
Colposcopy examines the abnormal cells of the cervix in more detail to see if treatment.
The instrument used is called a ‘colposcope’; it is just a magnifying glass / microscope which lets the doctor look more closely at the changes on the cervix. It does not go inside you, but some women may find the examination a bit uncomfortable. Two different solutions are usually used to stain the cervix. These are Acetic Acid and Iodine. The abnormal cells react in a different way to the normal cells. That is how the doctor decides the degree of abnormality and whether or not you will need treatment.
Dr Orla Conlon has over 20 years experience in Colposcopy.
If you need treatment following colposcopy you will usually have this done there and then at the Colposcopy Clinic. You will be given an injection of local anaesthetic into the neck of your womb; this will just cause a little ‘stinging’ sensation for a few seconds. When the local anaesthetic is working the doctor then removes the area of abnormal cells with a small instrument called a ‘hot loop’ ( loop excision of cervix). There is a small risk of bleeding but this will be stopped before the end of the procedure. There should be no need for you to stay in the hospital overnight. Treatment is usually very successful.
After treatment you will have some dark brown vaginal discharge, this is normal and may last for up to 2 weeks. There is a small risk that you will have heavy vaginal bleeding. If this occurs you must contact the Colposcopy Clinic or your nearest Gynaecology Hospital Department immediately, sometimes this bleeding can be heavy and you will need to be admitted to hospital. Due to this risk of bleeding, we advise you not to have intercourse for at least 2 weeks and not to use tampons with your next period. If you follow these guidelines your risk of bleeding is very low.
We do not routinely give antibiotics after a colposcopy procedure, but there is a risk that you may get an infection. If you notice the discharge becoming foul-smelling you will have to get a course of antibiotics.
After treatment you will need regular check ups, which may include repeat smears, to make sure that the cervix is healthy. Occasionally all the abnormal cells are not completely removed or more cells may have changed to abnormal again. If this happens you may need a repeat Colposcopy and further treatment.
Sex does not make the abnormality worse and you cannot pass on changes or abnormal cells.
If you have treatment you should avoid intercourse for at least 2 weeks or longer if a vaginal discharge persists.
Otherwise, enjoy sex as usual, but you should use an effective contraceptive. It is important not to get pregnant until your abnormality is dealt with, as the hormones produced during pregnancy make treatment more difficult.