ABNORMAL PAP SMEAR

 

A pap smear is a screening test that is performed in order to check if the cells of the cervix have become abnormal. It is advised that it is to be done 2 years after you become sexually active, until you reach the age of 70. Though a pap smear is done every 2 years if the smears are abnormal, the interval may vary depending on the clinical scenario. With availability of new tests, it may be possible that the interval can be much longer if the smears are normal. Taking a pap smear may be a little bit uncomfortable for some women but it is not painful and is well tolerated by most women. Scrapings are taken from the area where the changes occur with a brush, spread on a slide and fixed with a solution and sent to the pathology lab.The pathologist will report it as normal or abnormal. Thin prep is also done at the same time, which gives more accurate information, but there will be a small cost charged by the lab.

 

The pathologist reports as: 

• Low grade epithelial abnormality (LGEA)

• High grade epithelial abnormality (HGEA)

• Micro invasive cancer

It is important to note that an abnormal pap smear does not necessarily suggest cancer, but if it is not followed up and treated appropriately, it might develop into cancer later on.

 

Treatment of possible LGEA/HGEA depends on your symptoms (post coital bleeding/ menstrual irregularities), your age (whether or not you are over 30 years old), whether it was your first ever pap smear, presence of risk factors (mutliple sexual partners, heavy smoker) etc. In these situations, you will be advised to have a colposcopy. If the colposcopy is normal, no treatment is required but you will need to have follow up pap smears. 

 

LGEA changes are caused by inflammation caused by HPV virus or infection with other bacteria, virus or fungi. They are alleviated with time and 80% of HPV infections are cleared within 12 months.

 

In the event of possible HGEA, your GP will refer you to a gynaecologist for a colposcopy. Your gynaecologist will do a biopsy and advise you accordingly. 

 

Treatment options

Large loop excision of Transformation zone

A semi circular wire loop is used to remove the abnormal area with thermal energy. Many gynaecologists prefer to do this under general anaesthesia, but some will do it in their rooms under local anaesthetic. It is done as a day procedure and you will be able to return to work in 2 to 3 days time. You will have bloody discharge for about 1 – 2 weeks. Many gynaecologists prefer this form of treatment as the specimen is sent to histopathology, which can give more accurate information. 

 

Laser Treatment

This procedure can be done in the doctor's office or as a day procedure. A laser (beam of special light) is used to vaporise or cut out the abnormal tissue. Bleeding is usually minimal and vaginal discharge can last up to four weeks.

 

Cone Biopsy

Cone biopsy is done when: 

• Glandular abnormality is detected on pap smear

• When early cancer is suspected

• Discrepancy between pap smear and colposcopy findings

It is performed under general anaesthetic as a day procedure, where a cone shaped section of cervix containing the abnormal cells is removed using a knife or laser. The raw area will be cauterised to stop bleeding. You may have blood stained vaginal discharge and mild lower abdominal pain for a few weeks.

 

Complications of treatment

Though laser, loop excision and cone biopsy are relatively safe procedures, complications can occur.

Possible complications are: 

• Haemorrhage: 10 – 14 days post surgery. Patients sometimes require admission to hospital for suturing or vaginal packing.

• Infection – usually treated with antibiotics.

• Cervical incompetence – can occur after a cone biopsy or loop excision as the cervix may be weakened and predispose to second trimester miscarriage or pre-term labour.

• Burns to vagina and vulva – not painful and heal well without any complications.

 

 

 

CONTRACEPTION

 

Contraception is the use of various methods in order to prevent a woman from falling pregnant. Any woman in their child bearing age is recommended to use some form of contraception if they don't want to fall pregnant as 90% of fertile couples will fall pregnant in the abscence of any contraception. Various forms of contraceptive methods are available, each having their own risks and benefits. Temporary and permanent methods are available and temporary methods allow women to go off contraception, if and when they want to have a baby. 

 

Available contraceptive methods include: 

• Natural 

  • Abstinence

  • Withdrawal

  • Temperature method

  • Use of ovulation kit

• Barrier method - male and female condoms

• Hormonal

  • Contraceptive tablets

• Injectable

  • Depo proveera 

• Implant

  • Implanon 

• NuvaRing

• Mirena IUCD

• Non-hormonal

  • Copper IUCD

• Permanent methods

  • Female: tubal ligation - done under general anaesthetic as a day procedure

  • Male: vasectomy - done under local anaesthetic 

 

The choice of contraception will depend on: 

• Age

• Associated medical conditions

• Compliance

• Any menstrual irregularities 

• Smoking

• Pelvic infections in the past

• Whether a temporary or permanent method is needed

 

Your doctor will discuss all the availble options and help you select the correct choice that is suitable for you.