Treatment following an abnormal cervical smear
Why do I need treatment?
Your results have shown that you have abnormal cells on your cervix (neck of your womb). These need to be treated to prevent cancer developing in the future.
What do you mean by abnormal cells?
The name given to abnormal cells on the cervix is cervical intraepithelial neoplasia (CIN). Sometimes the abnormal cells are from a different part of the cervix and are known as cervical glandular intraepithelial neoplasia (CGIN).
CIN is often divided into three types - CIN1, CIN2 and CIN3. In CIN1 there is only a very slight change in the cells. CIN1 often goes back to normal on its own without any treatment.
In CIN2 and CIN3 there are more changes which are less likely to return to normal on their own. About one out of three women with CIN3 would develop cancer in the future if these changes were not treated. At the moment it is impossible to tell in which women the cells would change, and so you should have treatment to prevent cancer developing.
Are there different types of treatment?
Yes. The different treatments either destroy or remove the abnormal area.
Laser treatment uses a beam of light to destroy abnormal cells. Loop biopsy (sometimes known as DLB or LLETZ) removes abnormal cells using a small wire loop. Cold coagulation, cryocautery and diathermy destroy abnormal cells using a probe placed on the cervix. A few women need a cone biopsy - this removes a small area of the cervix.
How do you choose which treatment is best for me?
The doctor or nurse at the colposcopy clinic will use the results of your smear, the way your cervix looks and the results of your biopsy to decide the most suitable treatment for you. They will discuss this with you before you have the treatment.
Where will I be treated?
For most women who need treatment, this is done in the outpatient clinic. A local anaesthetic is normally used. This is very much like your colposcopy visit and takes about 15 to 20 minutes. You may like to bring a friend or relative with you.
The treatment will be done by a doctor or nurse, and there will be another nurse in the room.
What will happen?
The colposcopy nurse will help you position yourself on a special couch or bed which will support your legs. A speculum (the instrument your doctor or nurse used when you had your smear taken) is placed inside your vagina. Different liquids may be dabbed onto your cervix, which help to show up any abnormal areas. The doctor or nurse will look at these areas using the colposcope. You may then have some local anaesthetic injected into the cervix, before the treatment is done.
In some clinics you are able to watch your examination on a TV monitor. With your permission, your colposcopist can use the camera to take a picture of your cervix to store with your hospital records.
Does it hurt?
You will feel a stinging sensation for a few seconds when the local anaesthetic is applied to your cervix. The local anaesthetic acts very quickly and should stop you feeling any pain. You may feel a pushing sensation inside.
What else will I notice?
There may be noises from the equipment used to treat you. If you are having a loop biopsy or diathermy there may be a burning smell.
What happens if I can't be treated in the outpatient clinic?
If the area to be treated is difficult to treat in the outpatient clinic or if you need a cone biopsy, you will need a general anaesthetic (you will be asleep and will need to stay a short time in hospital). An appointment will be arranged.
What about side effects?
You may have a bloodstained discharge following your treatment. It is better to avoid tampons for four weeks and use sanitary pads instead. Some women may feel a period-like discomfort after the examination. If you notice any heavy bleeding, pain or discharge, then you will need to contact the clinic or your GP. It is normal to feel a little upset after the treatment.
You may need to take things easy for the rest of the day. If you do feel at all unwell after the visit you should not drive until you have recovered.
What about my chances of getting pregnant if I have treatment?
Most of the treatments used do not affect your chances of getting pregnant in the future. Some treatments can increase your chance of giving birth earlier than expected in future pregnancies. This is called premature labour. This extra risk is small but you may wish to discuss this with the staff in the clinic.
What about sex?
If you are using a coil for contraception, you should either not have sex or use condoms for seven days before your treatment. This is in case your coil needs to be removed.
You should not have sex for a month following treatment. This allows the treated area to heal. There is no need to change your method of contraception.
I've found out I'm pregnant
You will need to contact the clinic to let them know that you are pregnant as treatment is usually postponed until at least twelve weeks after the end of your pregnancy. You will probably need another colposcopy examination during your pregnancy.
Will I need follow-up?
Usually you will be advised to have a repeat smear after six months. This might be at the clinic or at your GP’s surgery. You will need another test six months later and then yearly smear tests until you are returned to smears every three years.
Does the treatment work?
Treatment is about 95% successful. However, a small number of women treated may need more treatment. It is therefore very important to have regular follow-up smears.
[CSW08(Ver4)August2010]