What are the common myths and facts about cervical screening?
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What to expect when you have a colposcopy
If you've been for a cervical screening and your test result is abnormal, it's easy to go into panic mode. However, while one in 20 women receive an abnormal smear test result, only around one in 2,000 will have cervical cancer. If your test is abnormal, you will likely be asked to have a colposcopy - a simple procedure to examine the cervix, vulva and vagina in more detail, using a magnifying instrument called a colposcope. So what exactly is a colposcopy - and what does it entail?
What is a colposcopy?
Although it sounds scary, a colposcopy is a common and simple way to check whether there are abnormal cells in the cervix and whether they need to be removed. Normally, a colposcopy is carried out in a hospital outpatient clinic and takes around 20 minutes, after which you can go home.
"If you have cell changes found after cervical screening, you may be invited to a colposcopy," says Samantha Dixon, chief executive of Jo’s Cervical Cancer Trust. "Colposcopy lets a doctor have a closer look at your cervix. It's similar to cervical screening, but takes a bit longer. It uses a microscope (which stays outside the body) to see whether you have cell changes, where they are and how many cells have changed," she explains.
"Colposcopy helps identify whether the cell changes need treatment to stop them from possibly developing into cervical cancer. This may sound daunting, but try to remember that many cell changes do not need treatment."
About four in every 10 people who have a colposcopy receive a normal result, meaning no treatment is needed but they should continue to have cervical screenings to check for abnormal cells.
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What will happen during a colposcopy procedure?
When you arrive at the hospital or clinic, the doctor or colposcopist - a specialist nurse - will explain the procedure to you to put your mind at ease. You will need to take your clothes off from the waist down and you'll be given a sheet to cover yourself.
"Your colposcopist will gently put a new, clean speculum into your vagina," says Dixon. "They will usually put some liquid on your cervix. This helps show any areas where there are cell changes. They may then take a sample of tissue from your cervix. This is sometimes called a biopsy. This will be examined to see if there are cell changes on that area of your cervix."
Some women may experience cramping after a colposcopy biopsy is taken and may experience light bleeding for a few days. If the bleeding becomes heavier or if you are still bleeding after a week, it's important to speak to your GP for advice.
Although the risk of infection is small, it's advisable to avoid sex and to avoid using tampons while the cervix is healing. Colposcopies are safe for pregnant women, but it is important to tell the nurse or doctor if you think you may be pregnant. Whoever is carrying out the colposcopy will tell you how you will receive your results, which may be by post.
Who is referred for a colposcopy?
There are several reasons why you may be referred for a colposcopy after having a cervical screening. It may be because the screening detected abnormal cells, or because the nurse carrying out the test thought your cervix did not look as healthy as it should.
You may also be asked to have a colposcopy if you didn't receive a clear result after several screenings. Some people may be referred if they have symptoms such as bleeding between periods, during or after sex, bleeding after menopause, or changes to vaginal discharge.
What is LLETZ treatment?
Sometimes, your colposcopist can tell that cell changes need treatment during your first colposcopy appointment.
"This is sometimes called 'see and treat'. Any treatment should be explained to you before it happens and only done with your consent," says Dixon. "You can ask as many questions as you need to before and, if you need more time to process, ask to have it done at another appointment.
"The most common treatment is a large loop excision of the transformation zone (LLETZ). This removes a small area of the cervix where the cell changes are. You will have a local anaesthetic before LLETZ, to numb the area being treated."
According to the Royal College of Gynaecologists, LLETZ can stop cell changes from potentially developing into cervical cancer and is successful in more than 90% of cases. This means no further treatment is needed and you will go back to having regular cervical screenings in future.
LLETZ side effects
After the anaesthetic has worn off, it is normal to experience pain or discomfort, vaginal bleeding and changes to vaginal discharge. Around 85% of people experience bleeding and 67% have pain after LLETZ. These side effects can last anywhere between a few days a month, but if you are worried, speak to your doctor. If the discharge smells bad or is yellow or green in colour, you may have an infection and require antibiotics from your GP.
It's important to note that there are possible risks associated with LLETZ, including an increased risk of late miscarriage, premature birth and a narrowing of the cervix. Going through any procedure can also impact psychological well-being and lead to anxiety and stress too. Rather than struggling alone, speak to trusted friends or family.
If health worries are significantly impacting your mental health, you can speak to your doctor or self-refer for counselling.
Although LLETZ is the most common way to remove abnormal cells, there are other procedures too. A cone biopsy, normally carried out under general anaesthetic, is where a cone-shaped piece of tissue containing the abnormal cells is cut from the cervix.
Sometimes, cells with minor changes are frozen and destroyed via cryotherapy, or removed via a laser. Cold coagulation is a procedure where heat is applied to the cervix to burn away the abnormal cells.
"If you have questions or concerns about any aspect of cervical cancer prevention, you can contact Jo's Cervical Cancer Trust's Helpline on 0808 802 8000," adds Dixon.