While a pap smear samples cells from the cervix it doesn’t always show conclusively what is happening on the cervix. Abnormal cells in the pap smear usually mean an underlying abnormality in the skin of the cervix. A small number of women with abnormal pap smears will develop cancer of the cervix if left untreated for a long time (10-15 years). Prompt assessment and treatment will usually mean a simple treatment to remove the abnormal tissue will prevent it developing into cancer.
Women with an abnormal pap smear need to have a colposcopy to determine what is happening to their cervix. The colposcope is a low power microscope which is used to examine the cervix more closely. Colposcopy is performed in the rooms and the cervix is washed with a weak solution of acetic acid (the acid in vinegar) which stains the abnormal cells on the cervix white. This identifies the area(s) from which the abnormal cells on the pap smear are coming and a small biopsy is taken. This is sent off to the pathologist for diagnosis. At most visits I will be able to give you a good idea of what this diagnosis is likely to be and what further treatment will be required. Overall the process takes 5-10 minutes, is uncomfortable (like a pap smear) but more invasive of your personal space. However, it is important to realise that the alternative, avoidance, does put you at risk of later developing cancer of the cervix.
Further treatment will be organised after the results from the pathologist are received. The treatment involves shaving off the abnormal area of the cervix, either under local anaesthetic or light general anaesthesia as day surgery if preferred. The piece of tissue is sent off to the pathologist to ensure that all the abnormal cells have been removed. Close follow up with Pap smears and colposcopy is required for two years following treatment but the risk of a recurrent abnormality is less than 5% if all the abnormal cells are removed at the first procedure.