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Abnormal Pap Smear

If you have an abnormal Pap smear, you will need further investigation to decide whether or not further treatment is necessary.  Adequate investigation and treatment can prevent cancer. 

What is the abnormality?

A number of different abnormalities are described below:

· Benign cellular change – Thismeans a few cells are slightly abnormal. This is not cancer.  This is often associated with an infection such as candida, trichomonas or bacterial vaginosis. Treatment of the infection may clear abnormal cells.  Benign changes without infection sometimes revert to normal by themselves. However, sometimes they progress to dysplasia, so a repeat pap smear is recommended. 

· Dysplasia -  Thismeans the cells in the smear test are more abnormal.  Dysplasia can vary from mild to severe and has various names, such as: 

CIN 1 = Mild dysplasia

CIN 2 = Moderate dysplasia

CIN 3 = Severe dysplasia. 

Although these cells are abnormal, they are not cancer of the cervix.  Cells which show dysplasia may: 

· Improve by themselves

· Stay the same

· Become more abnormal until they develop into cancer of the cervix. 

We cannot tell which dysplasias will progress to cancer. It is advisable to investigate and treat all abnormal smears which show dysplasia. 

· HPV (wart virus infection) is often associated with abnormal smears. HPV is a virus which can produce warts on the genitals — commonly on the vulval skin, vagina and cervix. HPV may also infect the skin but have no visible abnormality.  Wart virus infection is usually sexually transmitted. The wart virus may have been acquired recently or many years ago. It may have been present in the skin long before it produced the changes seen in the abnormal smear. 

What are the investigations?

The first investigation is a colposcopy.  A colposcope is a magnifying instrument which allows the doctor to examine the cervix.  Having a colposcopy is similar to a Pap smear. The doctor may take a small piece of tissue (biopsy) for examination by a pathologist.  The biopsy may produce a pinching sensation but is not usually painful.  There is often bleeding from the biopsy site - which the doctor will stop.  However, you may have some spotting for a few days afterwards.  The whole examination takes 10-15 minutes and may be  uncomfortable, but not painful. 

After the diagnosis, what next?

After your doctor has discussed the results of the colposcopy and biopsy with you, he/she will advise you of the treatment options.  The type of treatment depends on:

· The abnormality seen at colposcopy

· The grading of the abnormality

· Your age

· Whether you want more children

· Any gynaecological problems you may have. 

Is follow-up necessary?

Yes! Once you have had an abnormal smear you should always have regular pap smears. The responsibility for having regular smear tests is up to you! Discuss how often this needs to be with your doctor.  Treatment usually cures the abnormality, however, in a few women abnormal cells occur again. Follow-up smears will detect a recurrence or treatment failure. 

Link:

Abnormal Pap Smear Results Information  http://www.cervicalscreen.health.gov.au/

Cervical Cancer Vaccine  http://www.thehpvtest.com/