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1. Treatment methods

If treatment is needed, one of the following methods will be recommended, depending on the type of abnormality. The purpose of treatment is to remove the abnormal cells, and there are different ways to do this. Ask your specialist to explain the types of treatment and discuss options with you.

Wire loop excision

This is a way of removing the abnormal cells from the cervix using a wire loop. A speculum is inserted to open the vagina so the cervix can be clearly seen. A solution is applied to the surface of the cervix to make the areas of abnormal cells easier to see. Local anaesthetic is used to numb the cervix. The procedure takes about 15 minutes and most women can return to normal activities within two to three days.

This method is also known as a LEEP (Loop Electrosurgical Excision Procedure) or a LLETZ (Large Loop Excision of the Transformation Zone).

Cone biopsy

In this minor operation, a cone-shaped section of the cervix containing the abnormal cells is removed. This usually requires a general anaesthetic and a day or overnight hospital stay.

Only a small number of women will need a cone biopsy. It is the recommended treatment when the abnormal cells are higher in the cervical canal, to make sure that there is no cancer involved.

Laser

With this method, the abnormal cells are destroyed using heat from a laser beam. A speculum is inserted to open the vagina and allow the cervix to be clearly seen. A local anaesthetic is used and a solution is applied to make the abnormal cells easier to see.

Laser treatment takes about 20 to 30 minutes and is done in a specialist’s office, a hospital or clinic as a day procedure. The laser stops most bleeding during the treatment and healing occurs quickly.

Diathermy

This is another method of destroying abnormal cells using heat. It is usually done under general anaesthetic and may require a day in hospital. It can also be performed in a specialist’s office or out-patient clinic using a local anaesthetic.

Most women return to normal activities within a few days of treatment.

2. Making decisions about treatment

The best treatment for you will depend on the type and extent of the abnormality. Some specialists will also prefer one treatment method over another. You should make sure that you understand why the specialist recommends one particular plan of action or treatment over another.

Don’t be afraid to ask questions. Use the questions in Chapter 8 of this booklet to help you talk with your doctor. If there are things you do not understand, ask for further explanations. You may also want to ask for a second opinion from another specialist. Your specialist or local doctor will be able to refer you.

As with any medical procedure, there are risks involved. Talk this over with your doctor, and use the contact details in the back of this booklet if you want more information.

You are welcome to bring a partner, friend or other support person to your medical appointments. It may be helpful to have someone else there to ask questions and provide support for you.

Don’t be afraid to ask questions.

3. Care after treatment

Some women experience cramps and abdominal pain for a day or two after treatment. It is also normal to have a vaginal discharge that may be clear or blood-stained. A light, bloody discharge may continue for two to four weeks after treatment, and occasionally longer. If the discharge becomes smelly or turns to heavy bleeding, you should contact your treating specialist.

You should also tell your doctor if you develop a fever or a pain in the lower abdomen, as these may indicate infection. For three to four weeks after treatment, you are advised to avoid sex to allow your cervix to heal.

After a cone biopsy, it is recommended that you avoid heavy physical work and take things easy for several days.

4. How do I know the treatment has worked?

If you have treatment for a high grade abnormality, a Pap smear and colposcopy should be undertaken four to six months later. Then you will need to have a Pap smear and an HPV test each year, until both tests are negative two years in a row. These follow ups are done to make sure the treatment has worked.

Ask your doctor or nurse about when you should have your next Pap smear. And remember, if you have any problems, such as unexpected bleeding, painful intercourse or a heavy discharge, you should tell your doctor, even if you recently had a normal Pap smear.

5. Can treatment affect pregnancy?

Having treatment for abnormal cells on the cervix may affect your ability to have children, but this is very uncommon. Treatment is only carried out when it is absolutely necessary and there is concern about a high grade abnormality.

There are a few points about pregnancy you might like to think about.

• Having an abnormal Pap smear does not affect your chance of becoming pregnant. However, it is wise to have any abnormality checked and treated before you plan a pregnancy.
• If you are already pregnant when your abnormal Pap smear occurs, any action will depend on the type of abnormality.
• If you have a low grade abnormality, you will be followed up after your baby is born.
• If you have a high grade abnormality you will need a colposcopy. Colposcopy in pregnancy is safe.
• If a high grade abnormality is confirmed, it is normal for any treatment to be delayed until after the baby is born. This is safe as there is a very low risk of a high grade abnormality developing into cancer in this time.
• Having treatment in pregnancy is very rare. This is only done when a colposcopy shows evidence of possible cancer of the cervix and it is important to make a definite diagnosis. Such treatment does carry a risk of miscarriage or preterm labour. Your specialist will only recommend this action if it is absolutely necessary.
• If you have had treatment and later become pregnant, it is important to tell your doctor. There may be side effects of treatment which should be monitored during pregnancy. For instance, the cervix can be weakened after some forms of treatment. While it is still possible to become pregnant, a stitch may need to be inserted into the cervix to strengthen it and reduce the risk of miscarriage. The care of a specialist obstetrician is recommended in such cases.

Ask your doctor, nurse or health worker if you have any concerns.

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