|
Cervical Screening Why have a cervical smear test? A smear test is a simple examination to check the health of a woman’s cervix. It is called a smear test (or Pap smear) because the doctor or nurse takes a small sample of cervical cells and smears them onto a glass slide to be analysed under a microscope. If abnormal cells are found, in many cases they will go back to normal on their own, but sometimes they continue to develop. If left untreated, these cells may eventually develop into cancer. However, it usually takes more than ten years for this to happen, and cervical cancer can easily be prevented if abnormal changes are found and treated early. Who should have a smear test? The Department of Health recommends that women between the ages of 20 and 64 have routine cervical smears every three to five years as part of the NHS Screening Programme. Women in this age group who are registered with a GP should be sent a letter and information leaflet when it is time to have their smear test. Some women also keep their own personal records of test dates and results so they know when they’re due for screening even if they don’t receive a reminder. Statistics show that a woman’s risk of cervical cancer is cut by 84% if she has a smear test every five years, and 91% if she has a smear every three years. Some recommendations suggest women should have annual smear tests to reduce the risk even further (an additional 1-2%), but in the UK, you will need to go to a private clinic if you would like to have yearly smear tests. Private clinics offer cervical smears for about £60 (see resources).
There is disagreement about whether or not women who are under 20, and are sexually active, should have smear tests. While teenagers may be exposed to sexually transmitted infections, severe cervical abnormalities and cancer are extremely rare in women under the age of 20. In addition, the cervical cells of teenage girls may still be developing, and this can make it difficult to tell if cell changes are a natural part of the growth process or are pre-cancerous. Some GPs and clinics will not offer smear tests to women under 20, but others may. If you are under 20 and are concerned about your sexual health, talk to your doctor or nurse practitioner. If you don’t want to tell your GP that you’re sexually active, contact a well-woman, family planning or sexual health clinic (see resources). If you’re over 64 years old If you are over 64 and your last three smear results were normal you will no longer be invited for regular smears. Research suggests that women who have a history of normal smears are unlikely to develop cervical cancer at this age. If you are over 64 and have recently had an abnormal smear, however, you will continue to be scheduled for screening until you have had three normal results. If you have never had a cervical smear, or can’t remember the last time you did, you may want to consider talking to your doctor or nurse about scheduling a smear test. If you’ve never been sexually active Cervical cancer is extremely rare in women who have never been sexually active, therefore most recommendations suggest women don’t need to have smears until they’ve had sex. More than 90% of cervical cancers are linked to the sexually transmitted infection HPV (human papilloma virus), so if you have had sexual intercourse or genital-to-genital contact with a man or a woman, even just once, you should have regular smear tests. If you have sex with women only Lesbian women, even those who have never had sex with a man, are still at risk of developing abnormal cervical changes and should get regular smear tests. If you’ve had a hysterectomy Some women who’ve had a hysterectomy are still at risk of developing abnormal cells and should continue to have regular smear tests. If your womb was removed but you still have your cervix, you should continue to go for regular smears. If your womb and cervix were removed to prevent or treat cancer, you may still be asked to have a regular vaginal smear (also called a vault smear). This is similar to a cervical smear but the cell samples are taken from high in your vagina. If your womb and cervix were removed for a benign (non-cancerous) condition, such as fibroids or heavy bleeding, you do not need to have any more smear tests. If you’re pregnant A cervical smear does not interfere with a pregnancy and is a routine part of ante-natal care. If you had a smear a few months before getting pregnant, you will probably not be offered another one, but if it’s been more than a year, you will be advised to have a smear test. The smear test - what to expect You can have a smear test at your local GP surgery or at a sexual health, family planning, GUM or well-woman clinic. Most smear tests are done by female doctors or nurse practitioners, but if you want to be sure the person taking your smear sample is a woman, make your preference clear when you make your appointment. When a male doctor or nurse does a smear, it is generally recommended that a female assistant be in the room as well. It’s best to try to schedule your smear test for the middle of your menstrual cycle – about half way between one period and the next. It’s easiest to get a good cell sample from your cervix at this time. A smear cannot be taken during your period because it’s too difficult to get an adequate sample of cells, so keep this in mind when scheduling your appointment. Before your smear
The smear appointment Many women find the thought of a cervical smear worse than the actual smear itself. A smear test only takes about five minutes, and while it may be a little uncomfortable, it should not hurt. You will be asked to undress from the waist down and lie on your back on the examination table. You should be given a blanket or sheet to put over yourself, but if you aren’t, and you would like one, just ask. The doctor or nurse will ask you to bend your knees and let them fall open. Some women find this position difficult, so if you can’t lie this way, say so. You may be able to have the smear lying on your side with your knees drawn up in the foetal position.  The doctor or nurse will then insert a speculum into your vagina (see illustration). The speculum holds the vaginal walls open so your cervix can be seen. You may feel a slight pressure as the speculum pushes against your vagina. If your cervix is at an angle which makes it difficult to see, the doctor or nurse may ask you to help by pressing your hands on your lower abdomen, bringing your knees further up toward your chest, sitting up slightly or putting your hands under your buttocks. A good practitioner will explain the process as s/he goes along, but if you have any questions, ask for an explanation. Once your cervix is visible, the doctor or nurse will use a tiny brush or spatula to gently scrape off a sample of your cervical cells. The cells are then smeared onto a glass slide for a technician to look at under a microscope in a laboratory. Your doctor will remove the speculum and that’s it — the smear test is done. You may also be offered a pelvic examination before or after your smear test. This is to check the health of your womb (uterus) and takes only a few minutes. It’s sometimes called a bi-manual exam because the doctor or nurse uses both hands to feel for any unusual lumps or bumps in your pelvic area. With one gloved hand s/he will put two fingers inside your vagina while pushing gently on your abdomen with the other. You will be asked if you feel any pain or discomfort. Tell the doctor if it hurts even if you are not asked. The results of your smear test should be sent to you in writing within six weeks (two weeks if your smear was at a private clinic). If you haven’t had a letter within that time, contact the surgery or clinic and ask for them to check your file. If they tell you your results over the phone, or in person, make sure to get a written confirmation as well. New advances Liquid-based cytology (LBC) A new type of smear test, which uses liquid to store cells from the cervix, has been shown to be more accurate than the traditional slide smear, resulting in fewer false-negatives and inadequate smears. The sample is taken just like a standard smear, but instead of smearing the cells onto a glass slide, the top of the spatula, or brush, is placed in a small tube filled with preservative liquid. This enables the laboratory to separate out mucus and blood before analysing the cells. With liquid-based cytology the sample cells can also be tested for HPV (the sexually transmitted infection linked to 99% of cervical cancers) and chlamydia. This helps to identify HPV early – before cell changes have begun – and gives women with the virus the opportunity to have more frequent screening. If the results show both cell changes and HPV, the woman may be referred more quickly for tests and treatment. LBC is already used in some private clinics and may be available at some NHS clinics as part of ongoing trials. If the results of these trials show that LBC is cost-effective, it may be more widely available on the NHS within the next couple of years. Polarprobe The polarprobe is a small imaging instrument designed to scan the cervix for cell changes. Rather than scraping a sample of cells from your cervix, the polarprobe would scan your cervix, using electric impulses and light pulses to identify normal, pre-cancerous and cancerous tissue, and the results would be available at the end of the exam. This is a new technology still in its developmental stages. It may be some time before this technology is available for use. Vaccine Researchers are working to develop two types of vaccines for HPV – the sexually transmitted infection linked to 99% of cervical cancers. One of the vaccines would be used to treat people with HPV and/or cervical cancer, while the other would protect people who have not yet been infected. The latter, preventive vaccine has been shown to be very effective in recent clinical trials. The Cervical smear test — what to expect Normal, negative or clear smear A normal, negative or clear result means that when the technician looked at your smear under the microscope the cell structure appeared to be within normal limits. You are at very low risk of developing cervical cancer within the next five years. This result is good news but it does not give you the all clear for ever so it’s important to go for your next scheduled smear test. When you speak to your doctor, you may want to ask:
Inadequate or unsatisfactory smear About 1 in 10 smears need to be taken again because they couldn’t be analysed. This is usually because there were not enough sample cells on the slide, but it may be that:
An unsatisfactory or inadequate smear is not your fault. Ask the doctor or nurse why you need to have a repeat smear and when you should have it. If there were signs of an infection, you may need to have treatment first before you schedule another smear. Cervical ectropion (erosion) During a smear test, the doctor or nurse may detect cervical ectropion. It sounds worse than it is. Often found in young women, pregnant women and women who are on the pill, cervical ectropion is not a serious condition and has nothing to do with cancer. If you have cervical ectropion, it means that some cells which are usually only found in the cervical canal (see illustration) were found on the cervix itself. You may have no symptoms at all, but it may cause discharge or bleeding after sex and between periods. The condition usually goes away on its own, but if it doesn’t, it can be treated by destroying the out-of-place cells in the same way abnormal cells are treated (see treatments). Borderline or inflammatory smear A borderline result means that very slight changes were found in your cervical smear. The cells are not abnormal but they’re not quite normal either. A borderline result is probably not what you were hoping for, but these minor changes usually go back to normal on their own and are nothing to worry about. It may simply be that your cervix was irritated when the smear was taken or that your body was fighting an infection. In any case, you will be asked to return for a repeat smear, usually in 3 to 6 months, to check that the cells have in fact gone back to normal. If your repeat smear is normal, your doctor will most likely recommend that you go back to regular screening intervals, but you may be advised to have another smear in six months’ time just to be sure the cells have remained normal. If your repeat smear is borderline, you will either be asked to wait a bit longer and have another smear in a few months, or your doctor may suggest further investigations (see colposcopy). What an abnormal cervical smear result means An abnormal or positive smear result does not mean you have cancer. It means you have some changes in your cervical cells that may eventually develop into cancer and these need to be looked at more closely. Abnormal changes (also called dysplasia or dyskaryosis) may be mild, moderate or severe. Most mild changes will go back to normal on their own, but if your changes are moderate or severe, you may need treatment. Abnormal changes may also be called CIN1, CIN2 or CIN3. This is just another way of expressing mild, moderate and severe. CIN stands for cervical intra-epithelial neoplasia, which means ‘new changes in the outer layer of the cervix.’ The numbers 1, 2 and 3 refer to the depth of skin cells affected: CIN1 means the outer 1/3 of the cervix is affected, CIN2 means up to 2/3 of the skin thickness is affected and CIN3 means the full thickness of the cervical skin is affected. The amount of CIN can really only be measured following a colposcopy and biopsy, but it usually matches the initial smear rating and may therefore be used to describe results before the extent of changes has been confirmed. Mild changes (dyskariosis) or CIN1 If your smear result shows mild cell changes, you may be advised to have a repeat smear test in three to six months, and possibly another one a few months after that. The reason for waiting is that most mildly abnormal cells revert back to normal on their own without any treatment. Follow-up smears are to check if the cells have healed themselves. It is important that you go for your follow-up appointments, not only for peace of mind, but because any cells that have stayed the same, or continued to change, will need to be treated. Some doctors may suggest a colposcopy (closer examination of the cervix) when mild changes are found, but most will want to wait and see if the cells go back to normal on their own. If you don’t want to wait and would like a colposcopy, talk to your doctor. She or he may be able to ease some of your concerns or may refer you for further investigations. If you are not offered a referral from your GP, you could contact a private clinic about having a colposcopy. Questions to ask your doctor if your smear shows borderline or abnormal changes:
Moderate and severe changes (dyskariosis) or CIN2 and CIN3 If your abnormal smear result is moderate or severe, you will be referred for colposcopy. This is a closer examination of your cervix (see colposcopy) and will help to determine whether or not you need treatment. Although it may take years for cell changes to become cancerous, prompt treatment will stop the process from going any further. Carcinoma in situ Some women with CIN3 may be told they have carcinoma in situ. Although this is not cancer, it is very close to it. Carcinoma in situ means that some of the cells look cancerous but are still within the skin layer. Only when the suspect cells break through the skin and spread to the tissue below is it considered to be cancer. If you have carcinoma in situ you should be treated as soon as possible. Cervical glandular intra-epithelial neoplasia (CGIN) Occasionally a smear test will detect changes in the glandular cells of the cervical canal. These cells are different from the skin cells found on the cervix itself (squamous cells) and once they begin to change, they are unlikely to go back to normal on their own. Changes in glandular cells tend to be more serious than changes in squamous cells and some studies suggest that women with borderline CGIN should be referred for further investigations (colposcopy) immediately. If left untreated, glandular cells may develop into a cancer called adenocarcinoma (glandular cancer). How reliable are the results? Statistics show that cervical screening saves lives and prevents most cases of cervical cancer from developing, but it is not always accurate. You may be told you have a normal smear result when you actually have cell changes that were not picked up by the laboratory (known as a false-negative). You will probably never know whether or not this has happened to you, but hopefully any missed changes will either revert back to normal or will be picked up at your next smear. On the other hand, you may be told you have abnormal changes when you don’t (false-positive). In this case the colposcopy will reveal that your cells are normal and you will not be scheduled for treatment. Pregnancy and abnormal smear Colposcopy is safe during pregnancy but biopsy and treatment, if necessary, are usually postponed until after the baby is born. Abnormal cells will not affect your pregnancy, birth or the health of your baby. Most mild changes will go back to normal on their own and even moderate changes are unlikely to progress to cancer in nine months’ time. But if you have severe changes, it may be worrying to have to wait for treatment, particularly at what may be an emotionally-charged time in your life. Some research suggests LLETZ and laser therapy may be safe in the first trimester of pregnancy if only a small amount of tissue needs to be removed. Cone biopsy, cryosurgery and cold coagulation should not be used at any time during a pregnancy. Discuss your options and concerns with your doctor and/or nurse-midwife, and make sure you go to your follow-up appointments after the birth. Causes, risk factors and prevention The development of abnormal cells may be caused by a combination of factors, including: HPV (human papilloma virus) – this sexually transmitted infection, also known as the wart virus, is the main cause of abnormal cells. If you have never been exposed to HPV, you will probably never have abnormal cell changes either. But HPV is very common and most people have had it at some time in their life although they may not have known about it because there are often no symptoms. There are about 100 types of HPV but two types in particular are associated with cervical cell changes: HPV 16 and 18. There is no treatment for HPV and while it may stay in your system for a few months to a few years, the body’s immune system eventually fights off the virus. By this time, however, it may have already caused changes in your cervical cells. Using a condom during sex may help to prevent HPV. For more information on HPV and genital warts, see the Women’s Health online HPV leaflet. Contraception – there is some evidence that women who use the pill may have an increased risk of developing abnormal cell changes, but the reason for this is unclear. It may be that women on the pill are less likely to use a condom and are therefore at greater risk of HPV infection. Weak immune system – anything that weakens your immune system, from pregnancy to HIV, reduces your body’s ability to fight infections and may give abnormal cells a chance to grow. Smoking – studies show that smoking increases a woman’s chance of developing abnormal cell changes. If you have a mildly abnormal or borderline smear result, giving up smoking, even just until your follow-up smear, may help your cells go back to normal. DES – daughters of women who took the drug DES while they were pregnant may have an increased risk of developing CIN. The drug has been banned for use in pregnancy since the 1970s. If you are a DES daughter and have an abnormal smear result, tell your doctor that you have been exposed to DES. See Women's Health's online leaflet on DES for more information Further investigations Colposcopy & biopsy If you’ve received an abnormal smear result, you may be referred for colposcopy. This is a detailed examination of your cervix and is used to confirm your smear results and identify exactly where the abnormal cells are. The colposcopy results will help to determine what, if any, treatment you will be offered. Before you go for colposcopy:
 A colposcopy is done by a specially trained doctor or nurse (colposcopist) in a clinic or hospital outpatient department. The examination takes 10 to 20 minutes but the whole appointment may take about an hour. Colposcopy feels very much like a smear test but takes a little bit longer. You will be asked to undress from the waist down and lie on the examination table with your legs in leg rests. The doctor or nurse will insert a speculum to hold your vagina open and will look at your cervix through a large microscope. This is the colposcope. It will be about 12 inches in front of your vagina but it does not go inside you or touch you at all. Some clinics can connect the microscope to a video screen so that you can watch the procedure from the doctor’s eye view. You can ask for the screen to be turned off, or back on, at any time. Once the doctor locates your cervix, she or he will look at it closely for signs of cell changes and then dab it with a number of different liquids. The liquids help to highlight abnormal cells by causing the tissue to change colour. The colposcopist may use some or all of the following:
Biopsy Once the abnormal tissue has been identified, the doctor may want to take a biopsy (sample) from the most affected area of your cervix. S/he will take a small sample, about the size of a match head, and send it to a laboratory for further analysis. You may be given a local anaesthetic to numb the cervix before the sample is taken, but if you do feel the biopsy it may feel like a pinch or a sudden cramp. After colposcopy and biopsy Before you leave the hospital or clinic, ask the doctor what s/he found and what treatment, if any, is needed. If you’ve brought a friend with you, you may want to ask them into the room at this point to give you moral support and help remember what the doctor tells you. If a biopsy was taken it will be a week or two before the results are back, but your doctor may still be able to give you more information about what was found during colposcopy. Ask how and when you will be notified of the biopsy results and who you should contact if you have any further questions or concerns. What to expect after colposcopy and biopsy Spotting/bleeding – you may have a little bit of spotting or a dark discharge for a day or two after biopsy. You may want to use a sanitary towel to protect your underwear but don’t use tampons for about a week until your cervix heals. If the bleeding doesn’t stop within a couple of days or if you are concerned, contact your doctor. Pain – some women feel pelvic pain similar to period cramps after biopsy. Over-the-counter pain medication may help ease the pain, and it usually goes away within a day. If the pain continues or gets worse, contact your doctor. Sex – if you’ve had a colposcopy only (no biopsy or treatment), there are no restrictions on when you can have sex. If you’ve had a biopsy, however, it’s advised not to have penetrative sex for five days. This gives your cervix time to heal. Infection – occasionally the cervix becomes infected after a biopsy. If you develop a thick, smelly discharge, fever, or pains in your pelvic area a few days after your colposcopy, contact your doctor immediately. If the doctor can’t see all of the abnormal cells during a colposcopy, s/he may suggest a cone biopsy to get a sample of cells from inside the cervical canal. Cone biopsy may also be used as a treatment to remove abnormal cells, but has generally been replaced by a newer procedure called LLETZ (see treatments). If you do have a traditional cone biopsy, it is usually done at a separate appointment in hospital. You will be given either a local or general anaesthetic depending on the size of the sample to be taken and whether a laser or a surgical knife will be used. Talk to your doctor about this before your appointment so you know what to expect and how long you are likely to be in hospital. Once the anaesthetic has taken effect, the doctor will cut a small cone-shaped sample of tissue from your cervix to be sent to a laboratory for evaluation. After the sample has been taken you will have a pack of gauze inserted in your vagina to stop the bleeding. The gauze will be removed the next day but you may continue to have some bleeding and discharge for a few days. Before you leave the hospital, ask when you can expect your results. The biopsy may have removed all of the affected cells in which case you won’t need any more treatment. After the operation, try to take it easy and rest as much as possible. It may take a few weeks before you feel fully recovered and you should not do any strenuous exercise, heavy lifting or have penetrative sex for four to six weeks to give your cervix time to heal. Complications A very deep cone biopsy may damage or weaken the cervix, which may increase your risk of miscarriage in future pregnancies. This can be treated temporarily with a stitch inserted at the beginning of pregnancy and removed after the 38th week. A cone biopsy may also cause the opening of the cervix (the cervical os) to become tightly closed. This is a rare condition, but can lead to painful periods, difficulty becoming pregnant because sperm may not be able to get through the cervix to your womb, and labour complications. If you don’t have your period after the cone biopsy this may be a sign that your os has closed. Contact your doctor about this. If you have mild abnormalities or CIN1, you may not need treatment and instead will be asked to come back for another smear in a few months’ time. If you have moderate or severe changes (CIN2 or CIN3), however, you may be advised to have treatment. You may be offered treatment at your first colposcopy visit or you may have a separate appointment after colposcopy. Treatment involves either removing or destroying the abnormal cells while causing as little damage as possible to surrounding healthy tissue. The type of treatment you are offered depends on the results of your colposcopy and biopsy, and the facilities available at your hospital or clinic. All of the treatments for abnormal cells are extremely effective and most are done on an out-patient basis which means you can go home after treatment. If possible, arrange for someone to either come with you or pick you up afterwards. LLETZ/LEEP The most common treatment for removing abnormal cells is called LLETZ (large loop excision of the transformation zone). It’s also known as loop diathermy or LEEP (loop electro-surgical excision procedure). LLETZ is used for both diagnosing and treating abnormal cell changes and may be performed at your first visit for colposcopy. It takes about 5 to 10 minutes and is usually done under local anaesthetic. The doctor uses the colposcope to see a magnified image of your cervix and then, with a thin wire loop, cuts out the abnormal tissue. The loop is heated with an electric current, which cuts and seals the tissue at the same time. To ensure the electric current has a safe return path – and that it does not injure you – a sticky electrode is placed on your thigh before treatment. This may sound alarming but the procedure is very safe. LLETZ is not usually painful because of the local anaesthetic, however some women describe feeling a sharp period pain or a burning sensation. If you are worried about the pain, ask the doctor for a painkiller before the procedure. Aspirin is not advised because it may increase bleeding, but you may be given ibuprofen or paracetamol. The cut-out tissue will be sent for analysis to make sure all of the abnormal cells have been removed. If the cells on the outer edge of the sample are normal, you won’t need any more treatment. If there are abnormal cells along the edge, however, it may mean there are still some cell changes on your cervix and you will need another colposcopy to check. Laser therapy Laser treatment destroys abnormal cells by vaporising them with a hot beam of light. The procedure takes 5 to 10 minutes and before treatment you will be given a local anaesthetic to numb your cervix. You may still feel some pain during treatment and some women find the slight burning smell distressing. There will also be a machine in the room that extracts the smoke created by the vaporising tissue, and it may cause a lot of noise during treatment. Cold coagulation Despite its name, cold coagulation uses heat to destroy abnormal cells. The procedure takes just a few minutes and is usually done under local anaesthetic. This helps to numb your cervix, but you may still feel a slight period-like pain during treatment. The doctor places a hot probe on your cervix for about 30 seconds to burn away any abnormal tissue. To a large extent, cold coagulation has been replaced by LLETZ. Cryosurgery/cryotherapy Cryosurgery destroys abnormal cells by freezing them. The procedure may take up to 15 minutes and you will be given a local anaesthetic in your cervix. The doctor then places a very cold probe on your cervix and holds it there for two to three minutes. She or he may repeat the process a second time to make sure the cells are destroyed. Cryosurgery is not as effective as other treatments for cervical cell changes and is not commonly used. Cone biopsy Cone biopsy surgically removes the affected area either with a knife or laser, and may be used both to diagnose and treat cell changes. See cone biopsy for more information. Hysterectomy Hysterectomy surgically removes a woman’s womb and cervix. It should only be recommended for women who have recurrent abnormal smears or severe cell changes who also are past the menopause or have other gynaecological health issues, such as fibroids or heavy bleeding. Hysterectomy is a major operation and you will be in hospital for about a week. For more information, see the Women’s Health online hysterectomy leaflet. After treatment If you’ve had LLETZ, laser therapy, cold coagulation or cryosurgery, you will be able to go home as soon as your treatment is finished, but it may take 4 to 6 weeks before your body is completely recovered. Pain – you may have period-like pains for about a day following treatment, but an over-the-counter pain medication may help. Ask the doctor or nurse if there are any medications you should not take. Rest – you may feel fine after a day or two, but take it easy for about a week to help your body heal. Don’t lift heavy objects or do strenuous exercise and get as much rest as you need. Bleeding and discharge – you may be given a prescription for antibiotic cream to put in your vagina for a few days after treatment. Make sure to get this filled at the hospital or chemist before you go home. You should expect to have light bleeding and a vaginal discharge for at least a few days and as long as four weeks. If you had cryosurgery, you may have a lot of watery discharge. If the pain, bleeding or discharge gets worse rather than better, you may have an infection and should contact your doctor. Note: after treatment you may get your next period earlier than expected and it may be heavier then usual. Don’t use tampons during this period. Getting better – your cervix will need time to heal, so don’t use tampons, douche or have sexual intercourse until bleeding or discharge has stopped. This may vary from woman to woman but is generally about 3 to 4 weeks. If you have a follow-up appointment to check that your cervix is healing properly, this is a good time to raise any questions or concerns you have about the healing process and when you should have your next smear test. You may be advised to have a follow-up smear in six months and, if those results are normal, every year for a few years. Follow-up recommendations vary so ask your doctor what to expect. Organisations NHS cancer screening programme The NHS cervical screening programme produces basic information about smear tests that is available in 13 languages and in a format for women learning difficulties. You can download the leaflets and access their annual review and screening statistics on their website www.cancerscreening.nhs.uk/cervical/ Family planning, well-woman and GUM clinics To find your nearest family planning, well-woman or GUM clinic contact Women’s Health on 0845 125 5254 (Mon - Fri 9.30am - 1.30pm) or go to the fpa website: www.fpa.org.uk, click on “I need help now” and then “where do I go for help”. GUM (genito-urinary medicine) clinics are specialist sexual health centres that offer free, confidential health services. Some, but not all, offer cervical smears and colposcopy. To find a private clinic, check your local phone book or ask your GP for a recommendation. Marie Stopes Books Coping successfully with your cervical smear by Karen Evennett (Sheldon Press, 1996) What your doctor may not tell you about HPV and abnormal pap smears by Joel Palefsky, MD (Warner Books, 2002) |
|
|
Written by Tamara Beus and published in printed format (2003) by Women's Health
|
|