Women with an abnormal smear or with symptoms or signs suggestive of a cervical, vaginal or vulval abnormality are further investigated by colposcopy. This is an examination of the cervix, vagina or vulva under magnification after painting with a dye to make any abnormal areas stand out. The cervix is exposed using the same instrument (speculum) as is used to take a smear.
If an abnormal area is found a small sample of the abnormal skin may be removed at biopsy. This procedure is generally painless and provides a sample to be sent for analysis by the pathologist so a definitive diagnosis can be made.
If the diagnosis is of a low-grade abnormality (HPV or CIN 1), a wait and see approach is often taken since many of these changes will go away by themselves. The small number of these changes which progress to a high-grade abnormality can be treated if and when that change occurs. This demonstrates the importance of follow-up in the care of women with low-grade changes.
If the diagnosis is of a high-grade abnormality, removal of the abnormal skin is generally advised. Previously, this treatment involved a trip to hospital and an anaesthetic, but most women treated at ABSU can now have this procedure, without discomfort, under local anaesthetic in the Unit.
Treatment is by LLETZ or Fischer cone excision where the abnormal skin is removed by a diathermy wire after the cervix has been numbed with local anaesthetic. The procedure should not be uncomfortable. The removed skin is then sent to the pathology laboratory for analysis to confirm the diagnosis and to assess whether the whole abnormal area has been removed. This is accomplished 99% of the time with only 1% of women needing a repeat procedure due to incomplete excision.
After the procedure, the women will have some bleeding and discharge from the raw area for up to 3 weeks. The use of tampons and sexual intercourse should be avoided. If bleeding is heavy or worrisome, rest will usually cause it to stop. About 1% of treated women will require help to stop heavier bleeding. Your ABSU doctor will always be available to help if required.
Vaginal or vulval abnormalities generally require day case hospitalization and an anaesthetic for treatment.
Following treatment about 5% of women will have another abnormal smear. This can be treated again in the same way when it occurs. Ninety-five percent of women will never have another abnormal smear.
It is thought that the procedure does not interfere with subsequent fertility or pregnancies as only the very lower part of the cervix is removed.
Following treatment, women are next assessed at 6 months with colposcopy and smear and then 6 and 12 months later by smear test and HPV test. If both these assessments are normal, women are referred back to their referring doctor for routine screening.
Almost all treatments and tests are performed in the Unit without need for hospitalisation, therefore there is no disadvantage to those women without private health insurance. Fees are generally set at a according to the Australian Medical Association (AMA) rates. You will be charged for a consultation, colposcopy +/- biopsy. If treatment is required, this will incur an additional charge. Fees may be varied for individuals in financial hardship or payment can be structured over time. All fees will be discussed with you prior to any procedures and no-one will be denied treatment due to financial problems. Pathology tests are generally bulk billed by the pathologist.