Colposcopy
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 as was used to see it to take the 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.
Management
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.
Follow-up
Following treatment, women are next assessed at 4 months with colposcopy and smear and then 6 months later by smear
test alone. If both these assessments are normal, women are referred back
to their referring doctor for subsequent smear tests, which can be at
normal intervals of 1-2 yearly depending on the final pathological
diagnosis.
Billing
Because almost all treatments and tests are performed in the Unit
without need for hospitalisation, there is no
disadvantage to those women without private health insurance. Fees are
generally set at a level between the Medical Benefits Schedule and those
recommended by the AMA. A typical out of pocket expense for consultation, colposcopy, diagnostic biopsy and subsequent treatment
is less than $350. Fees can be varied for individuals in financial hardship
or payment can be structured over time. No one will be denied treatment due
to financial problems. Pathology tests are bulk-billed so no additional
expenses will occur.
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