Female Health: Pap Smear Colposcopy

A Pap Smear is a test that every woman from the age of 25 (or within 5 years of becoming sexually active) till the age of 75 (or later if you have new sexual partners) should have every 2 years. A pap smear detects abnormal cells on the cervix (neck of the womb) which may progress into cancer if left untreated. The results of a pap smear can be normal or abnormal (CIN 1, CIN 2, CIN 3) none of which diagnose cancer. However, CIN 2 and 3 has to be treated and CIN 1 needs to be monitored.  

ASCUS (Atypical Squamous Cells of Undetermined Significance) is the diagnosis when the doctors can’t distinguish from the pap smear how abnormal the cells are – it could be either CIN 1 or 2 or 3…. Therefore, it needs further testing such as a colposcopy. ASCUS can also be caused by infection. Nowadays, many countries have changed pap smear testing to HPV testing. The vast majority of abnormal (pre-cancerous and eventually cancerous) cells on the cervix are caused by the HPV virus.

HPV (Human papillomavirus) is a very common sexually transmitted disease that is found in 95% of the sexually active population. HPV usually clears up without treatment and without causing any symptoms or lasting effects, but your gynaecology will want to rule out anything potentially more serious.

If you are at a low risk of contracting HPV (usually when you’re under 25), you will be given a screening test. If you are high-risk HPV or usually over 25, you will be recommended to undergo a colposcopy procedure, which will allow for any abnormal cells to be sent for a biopsy and tested for ‘precancerous cells’ which can indicate early signs of cancer if they aren’t treated.

What is a colposcopy?

You might have heard or seen the word colposcopy and wondered what it is, this is a simple procedure which involves a magnifying instrument and an acetic acid solution, which work together to provide the Gynaecologist with more insight into the abnormal cells occurring in your cervix. The solution, upon contact with these abnormal cells, will reflect light and enable the specialist to determine the potential problem areas. The latest colposcopy equipment that allows you to watch the procedure on a screen. This can help you get a better understanding of the treatment and why you need it as well as facilitating a discussion around your findings during the procedure.

A little discomfort can be expected with this procedure, but a colposcopy is virtually painless. Your Gynae, if suspicious, might decide to take a small amount of tissue and send it away for a biopsy to determine if there are any potentially cancerous cells. The result of the biopsy will establish whether an excision procedure to remove these cells will be necessary. Regular preventative screening is advisable thereafter.

Colposcope in Colposcopy Procedure

An instrument used for Colposcopy procedure is a called a the colposcope and it is a simple instrument that is designed to view a patient’s cervix to identify abnormalities. The Colposcope is used for early detection of cervical cancer and it is a non-invasive magnifying instrument with a built-in light source.

More on the Human Papilloma Virus

There are over 100 types of HPV, and only around 5% of women with an HPV infection will have an abnormal pap smear. Of that 5%, only a few women will develop a condition called ‘Cervical Intraepithelial Neoplasia’ (CIN) which is where the outer cells of the cervix could turn into cancer if not treated. CIN varies in severity from CIN1 to CIN3. CIN1 is considered low risk, with a small chance of the abnormal cells turning cancerous. CIN2 and CIN3, however, are higher risk and without treatment, may develop into cancer over time.

The vast majority of CIN 1 cases disappear within 18 to 24 months without any treatment. If you have CIN 1 you will be asked to come back every six months for a pap smear and possibly a colposcopy. In only about 5% of cases, the CIN1 may progress to CIN2/3

If you have CIN 2/3 you will need a minor procedure called LLETZ (Large Loop Excision of the Transformation Zone or Loop Diathermy) to remove the cells. CIN 2/3 only develops into cervical cancer in about 20% of cases and usually takes around 5 to 10 years to progress.

Coming to terms with any finding that includes the word ‘cancerous’ can be emotionally and physically challenging. Understanding where you stand, and the importance of frequent check-ups is essential to overcoming an abnormal result. The numbers associated with early detection of cervical cancer are reassuring and further encourage women of reproductive age to get into the habit of annual Gynaecological exams.  

So whatever you do, don’t see your abnormal pap smear result as a death sentence. See it is a sign from your body to prompt you into a female health management regime that could better your life overall.


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