Diagnosis and Treatment of Abnormal Pap Smears


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What is a Colposcopy?

This is an in-office procedure that uses a device known as a colposcope to allow your doctor to examine your cervix stereoscopically, making it easier to recognize areas with abnormalities. The most common reason for needing a Colposcopy comes from abnormal Pap Smear results. Having a Colposcopy can detect cervical cancer at an early stage.

The process is similar to a pelvic exam, taking twenty to thirty minutes. A speculum is inserted into the vagina and then the colposcope, which is a lighted microscope on a stand, is placed at the opening of the vagina. A vinegar solution is applied to the cervix, which turns any abnormal tissue white, making it easier for your doctor to recognize and locate abnormal cells. Your doctor will examine your cervix. If he/ she finds areas of concern, a sample of tissue may be taken and sent to the lab. This is known as a biopsy. Mild cramping can occur if a biopsy is taken. Light bleeding or discharge may also occur. Infection is rare after a Colposcopy.

If a biopsy is performed, your results will be available within 7- 10 days after your appointment. At that time, your doctor will contact you to discuss the results and, if needed, further treatment options.

What is Cryosurgery?

Cervical cryosurgery, or cryotherapy, is a gynecological treatment that freezes a section of the cervix. Cryosurgery of the cervix is most often done to destroy abnormal cervical cells that show changes that may lead to cancer. These changes are called precancerous cells. Your gynecologist will probably use the term “cervical dysplasia”.

Cryosurgery is done only after a colposcopy confirms the presence of abnormal cervical cells. Cyrotherapy is also used for the treatment of cervicitis or inflammation of the cervix. Cryosurgery is not a treatment for cervical cancer.

Cryosurgery is performed in your doctor’s office while you are awake. It is similar to a pelvic exam: you will be asked to undress from the waist down, lie on an exam table with your feet in stirrups,a speculum is inserted into your vagina to hold the vaginal canal open so that your cervix can be seen.  However, that’s where the similarity ends.

Cryotherapy uses special instruments called cryo probes.  During cryosurgery the cyro probes are inserted into your vagina until they firmly cover the abnormal areas of cervical tissue.  Next, liquid nitrogen begins to flow through the cryo probes at a temperature of approximately -50 degrees Celsius.

This causes the metal cryo probes to freeze and destroy superficial abnormal cervical tissue.  The most effective treatment result is obtained by freezing for three minutes, letting the cervix thaw, and repeating the treatment for three more minutes.

Cryosurgery is relatively risk-free, producing fewer complications than any other gynecological procedure. After cryosurgery, you will need Pap tests every three to six months for a period of time. Once you have had several normal Pap smears in a row, your doctor will discuss with you how often you need future screening for cervical cancer.

What is LEEP (Loop Electrosurgical Excision Procedure)?

Dysplasia is diagnosed as the development of pre-cancerous cells in the cervix. Pap smears with abnormal results commonly have an underlying dysplasia. In order to treat dysplasia, the abnormal cells must be removed from the cervix. One way to do this is with a Loop Electrosurgical Excision Procedure, referred to simply as a LEEP procedure.

A LEEP procedure typically takes twenty to thirty minutes to perform. You will lie on your back, much like a pelvic exam or pap smear. A dispersive pad will be placed on your thigh to provide a safe return path for the electrosurgical current. A speculum is placed in the vagina. The doctor will use a loop electrode to remove the abnormal skin from the cervix. A high-intensity electrical current is passed through the loop electrode, shaving off a thin layer of cervical tissue. A local anesthetic is used to numb the cervix, thus the procedure is usually painless. If cramping occurs after the procedure, medication can be administered or prescribed to ease discomfort.

Follow up from a LEEP procedure is essential. Pap smears are usually done every three to four or every four to six months for two years. A Colposcopy may also be performed in the office if pap results continue to come back with abnormalities.

The LEEP procedure cannot be performed during your period. Ibuprofen can be taken prior to the procedure to help with potential discomfort afterwards. Tampons, douching and sexual intercourse must be avoided for about four weeks after having a LEEP procedure.