Female Diagnostic Procedures

Using Pap Smears and Colposcopy as Female Diagnostic Procedures

Approximately 500,000 newly diagnosed cervical cancer cases, and 275,000 attributed deaths, are reported each year, making cervical cancer the second cause of cancer-related deaths in women around the world.The actual incidence of cervical cancer has decreased significantly (by more than 50 percent) in the previous 30 years. This drop is largely the result of the increasing use of cervical cancer screening techniques, including Pap smears and colposcopy. In the U.S., the incidence of cervical cancer has fallen from approximately 15 cases per 100,000 women (1975) to 6.5 cases per 100,000 (2006). Early detection is the best preventive measure. A Pap smear entails exfoliating cervical cells allowing for microscopic analysis to detect either cancerous or precancerous lesions. In the event of abnormal cells, additional diagnostic testing is often warranted, including a colposcopy (directed biopsy), where a specialized light and low-powered microscope is used as a more extensive method of visualizing the cervix.

Female Diagnostic Procedures

Pap Smear

A Pap smear (Papanicolaou test) is a microscopic examination where cells are gently scraped from the cervical opening. This is a screening test used to detect cervical cancer. The majority of cervical cancers can be detected and treated early, ifwomen undergo routine Pap smears. This diagnostic procedure involves lying on a table and placing both feet in stirrups. A clinician then places a speculum into the vagina, allowing for better visualization.

Who Needs a Pap Smear

Pap screening tests should start when a female turns 21 years of age or becomes sexually active. Subsequently, a Pap smear should be performed every two years, unless abnormalities are detected. Once a woman reaches 65 to 70 years, she can stop having Pap tests, assuming she has had three normal tests within the previous 10 years. Women who have had a total hysterectomy (uterus and cervix removed) may not require this screening test, as long as she has no history of cervical or other pelvic cancers.

Preparation and Considerations

  • A patient should tell her doctor if she takes birth control pills (may interfere with results), had previous abnormal Pap smears, and/or may be pregnant.
  • Avoid douching, intercourse, or the use of tampons 24 hours before.
  • Avoid scheduling a Pap smear while menstruating (may affect the accuracy of the test).
  • Empty the bladder right before.
  • Test may cause slight discomfort (like menstrual cramps) and/or pressure.
  • Minor bleeding afterwards is normal.

Interpreting Results

A normal (negative) Pap smear means no abnormal cells are present in the cervix. If a Pap smear detects abnormal changes, further testing or follow-up is required. The course of action depends on the specific results, previous Pap smear history, and individual risk factors for cervical cancer.

In the case of minor cell changes, it is recommended that the Pap smear be repeated at three to six months. Additional follow-up testingmay include a colposcopy (directed biopsy) or human papillomavirus test, to detect HPV types which typically cause cervical cancer.

Colposcopy

Colposcopy (directed biopsy) is a specialized way of viewing the cervix, and it utilizes a light microscope to make viewing of the cervix much easier. The cervix and vagina are swabbed gently, using a vinegar or iodine solution to remove mucus covering the surface, highlighting abnormal areas before a speculum is gently inserted into the vagina. The doctor then places the colposcope at the opening of the vagina to examine the area. However, the colposcope does not enter or even touch the patient in any way. Photographs may also be taken. If there are any abnormal looking sections, small tissue samples are removed with small biopsy tools and sent to the lab for analysis.

Who Needs a Colposcopy

This diagnostic procedure is performed in order to detect cervical cancer or abnormal changes that may lead to cervical cancer. Typically, it is done when a woman receives abnormal Pap smear results. In addition, a colposcopy may be suggested if a female notices bleeding following sexual intercourse, or her doctor observes any abnormal areas on the cervix and vagina during a routine pelvic examination. These areas may include:

  • Any abnormal growth(s) on the cervix or vagina.
  • Genital warts from the human papillomavirus (HPV).
  • Cervical inflammation and/or irritation.

Preparation and Considerations

  • Empty the bladder and/or bowels beforehand.
  • Avoid intercourse for 24 hours before.
  • A patient should tell her doctor if she is/ may be pregnant.
  • Avoid procedure during a heavy period, unless the period is considered abnormal.
  • Advil or Tylenol may be taken beforehand.
  • May be more discomfort thana regular Pap smear (slight stinging from the cleansing solution, pinching, or cramping when tissue specimens are removed).
  • Mild cramping or a dark discharge for one to three days after is possible.
  • Slight bleeding after the biopsy is normal, for up to seven days.
  • Heavy bleeding is not normal. Any excessive bleeding (soaking a pad within an hour) should be reported.
  • Do not douche, use tampons, creams, or have sex for seven days after a directed biopsy.

Interpreting Results

A normal (negative) result means there was no cancerous or abnormal changes seen. The doctor will tell the patient if any abnormalities were detected, such as:

  • Abnormalities in the blood vessels.
  • Swollen, inflamed, or atrophic (wasted) areas.
  • Cervical polyps.
  • Genital warts.
  • White patches on the cervix.

Abnormal biopsy results can result from:

  • Cervical cancer.
  • Cervical dysplasia (precancerous changes).
  • Cervical warts (HPV).

If the colposcopy does not definitively indicate why a Pap test was abnormal, a healthcare provider may recommend a more extensive biopsy procedure.

Resources

  • eMedicine (2013). Pap Smear. Retrieved from: http://emedicine.medscape.com/article/1947979-overview
  • Medline Plus (2013). Colposcopy. Retrieved from: http://www.nlm.nih.gov/medlineplus/ency/article/003913.htm

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