Screening and treatment of common gynecological diseases

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Colposcopy

Abnormalities tend to occur at the opening of the cervix to the birth canal, where it enters the womb. A colposcopy allows a doctor or trained nurse to find these abnormalities.

In some women, the presence of "abnormal cells" carries the risk of developing cervical cancer. A colposcopy is used to determine whether treatment will be needed to deal with these cells.

When a colposcopy is needed

You may need a colposcopy after having a routine cervical screening test. Other reasons for having a colposcopy may include:
-    some of the cells in your cervical screening sample are abnormal (but not necessarily cancerous)
-    you are infected with human papillomavirus (HPV), which is the main cause of the abnormal cell changes and might lead to cancer
-    you've had several screening tests, but it wasn't possible to give you a result
-    the nurse or doctor who carried out your screening test thought your cervix didn't look as healthy as it should

A colposcopy can also be used to investigate things such as unexplained vaginal bleeding (for example, after sex) or an inflamed cervix.

What happens during a colposcopy?

The procedure is usually carried out in an outpatient hospital clinic by a specialist called a colposcopist. This can be a doctor or a specially trained nurse.

You'll be asked to lie down in a special type of chair with padded supports to rest your legs on. A device called a speculum will be inserted into your vagina and gently opened to allow the colposcopist to examine your cervix.

A microscope (colposcope) with a strong light will be used to look at your cervix. The colposcope doesn't enter the vagina and remains outside your body. If the colposcope has a camera attached to it, you may be able to see images of your cervix on a small screen. Some solutions will be applied to the cervix to highlight the abnormal areas.

If any abnormal areas are identified, a small sample of tissue (a biopsy) may be removed for closer examination. A biopsy is similar to a small pinch or scratch in terms of sensation, and shouldn’t be too painful. The purpose of a biopsy is to confirm whether your screening test has been correct in identifying a problem.

However, the colposcopist will sometimes be confident that the screening test has been correct without the need for a biopsy, and may decide to proceed immediately to treatment (see below).

The colposcopy procedure usually takes about five minutes, but it can take longer (10 to 15 minutes) if treatment is carried out. Overall, including the time it takes to discuss your problem with the colposcopist, your appointment should last 20 to 30 minutes.

A colposcopy can be slightly uncomfortable for some women. If you find it painful, you should tell the colposcopist, who will try to deal with your discomfort or stop the procedure entirely

Colposcopy results

The colposcopist will usually be able to tell straight away if there are abnormal cells in your cervix. Biopsy results usually take about four weeks and a copy will be sent to both you and your GP in the post.

About 4 out of 10 women who have a colposcopy have a normal result. A normal result means your cervix appears healthy and you have a low risk of developing cervical cancer before your next screening test. Depending on your age, you'll be invited for a cervical screening appointment in three or five years.

About 6 out of 10 women who have a colposcopy have abnormal cells in their cervix. This doesn't mean they are cancerous cells, but they can sometimes develop into cancer if left untreated.

Very rarely, some women are found to have cervical cancer during a colposcopy. If you have cancer, you'll be quickly referred to a specialist team for care and treatment.
As cervical cancer detected through screening tends to be diagnosed at an early stage, the outcome of treatment tends to be better. This is why it's important for women to attend their screening test when invited.

Cryotherapy

During the cryotherapy procedure, a speculum is inserted into the vagina so that the cervix can be seen. Next, an instrument like a probe is inserted into the vagina until the nozzle covers the abnormal areas of cervical tissue. Either nitrous oxide or carbon dioxide is then applied to the abnormal cells to freeze and destroy precancerous tissue at a temperature of approximately -50 degrees Celsius.  

During cryotherapy, you may experience some cramping.  After cryotherapy, you should be able to return to most normal activities within one day. It is normal to experience a watery discharge for the first few weeks: this is caused by the shedding of dead cervical tissue.  However, if this is accompanied by abdominal pain, fever, or heavy vaginal bleeding for greater than 2 days, you should see a doctor immediately.

You should abstain from sex, and avoid inserting anything into your vagina for 2-3 weeks following treatment, and it’s important that you return to the clinic for a follow-up review.

Cryotherapy is highly effective, with a relapse rate at 12 months following treatment of only 4%.  Cryotherapy is an excellent treatment option because it can be used immediately after visual inspection with acetic acid (VIA) or HPV testing to provide screening and treatment in a single visit.

Cervical polyps

Often polyps don’t cause any symptoms and may only be found during a routine gynecological examination. Symptoms that can occur include bleeding after sexual intercourse, bleeding between periods, bleeding after menopause or vaginal discharge.

Though polyps are generally benign, removal is still recommended if they are found. There are several reasons removing cervical polyps is recommended:

• They can be tested for malignancy (about 1% of polyps are found to be cancerous),
• Relief of symptoms such as abnormal vaginal bleeding
• They can make it difficult to perform pap smears and VIA
• If left, polyps can continue to grow.

Removal of a polyp is a quick and simple procedure and can be performed at a Marie Stopes International clinic by a trained doctor. The polyp is removed using a special pair of forceps and cryotherapy is then applied, a process of using gas at subfreezing temperatures on a localized area to destroy the cells at the origin of the polyp to prevent recurrence.

Genital warts

Your healthcare provider usually diagnoses genital warts by seeing them.  Women with genital warts should also be examined for possible human papillomavirus (HPV) infection of the cervix.

While in some cases it is possible for warts to disappear without treatment, there is no way to ensure this will happen. Therefore if you suspect you have genital warts you should visit your local Marie Stopes International clinic or local doctor for an examination. If identified; an outbreak of warts can be removed by a healthcare professional using a number of methods depending on the size and location of the warts. The sooner the warts are treated, the better the response.

Although treatments can get rid of the warts, there is no treatment for HPV. Because the virus is still present in your body, warts often come back after treatment. Recurrences of genital warts after treatment occur in about one in three people, in which case further treatment is required.

Bartholin’s gland cyst

These cysts are generally small and painless and may not cause any symptoms.  However, if they become infected this can cause a painful abscess to form.

Doctors believe that several bacteria such as E. coli and STIs such as chlamydia and gonorrhea can cause the infections that lead to Bartholin's abcesses forming.

Bartholin's cysts can occur in women of reproductive age.  If you notice a lump, acute pain or inflammation at the opening of your vagina, it is important that you seek prompt medical attention, as other possible causes, such as cancer, need to be ruled out.

If a Bartholin's cyst or abscess is diagnosed, your doctor will decide the best line of treatment; this may include antibiotic treatment, conservative treatment of symptoms at home with warm baths, or drainage of the abscess, depending on the severity of your symptoms.

Nabothian Cyst

Rarely, large Nabothian cysts may lead to gross enlargement of the cervix, which can cause pain or fullness for the affected woman.  Generally, Nabothian cysts are only treated (with electrocautery ablation or excision) when they measure greater than 1cm.

STIs

The best way to protect yourself from an STI (and an unplanned pregnancy) is to always use a condom. If you have ever had unprotected sex, even just once, you’re at risk. A simple sexual health check is all you need to ensure you are in the clear. So even if you don’t have any obvious signs, never assume you’re off the hook. On the other hand, just because you’ve got an itch it doesn’t necessarily mean you have an STI.

To make sure your sexual health gets the stamp of approval, it’s worth checking it out at either Marie Stopes International, a local family planning clinic or by visiting your doctor, as symptoms may vary from person to person.

There are several ways that you can be tested for STIs; this can include a urine test, blood tests or swab samples taken from your genital area.  Your doctor will discuss with you and recommend what STIs to test you for and what tests to perform based on your risk factors.

If you have an STI it’s important that you and your current partner(s) receive the same treatment at the same time; otherwise you may continue to pass the infection back and forth between you. All of your previous sexual partners whom you feel may be at risk should also be checked and treated.