Cervical Screening Tests (Pap Smear) & Colposcopy

What is a Cervical Screening Test (Pap Smear)?

A cervical screening test is a simple procedure that checks the health of the cervix, which is the lower part of the uterus connecting to the vagina.

In Australia, the National Cervical Screening Program primarily uses a Cervical Screening Test (CST) that detects high-risk human papillomavirus (HPV) types. HPV is a very common virus that can cause changes in cervical cells. If high-risk HPV is detected, the laboratory may then examine cervical cells for abnormalities.

The older “Pap smear” tested cervical cells directly for abnormal changes. While many people still use the term Pap smear, the current screening test is more sensitive and focuses on HPV detection first.

The test is performed during a routine pelvic examination. A small brush is gently inserted into the cervix to collect cells. The sample is sent to a laboratory for analysis.

Who is Suitable for Cervical Screening?

Cervical screening is recommended for:

• Women and people with a cervix aged 25 to 74 once becoming sexually active: Screening is usually advised every five years if results are normal.
• Those who have ever been sexually active: Even if sexual activity occurred only once.
• Women who have received the HPV vaccine: Vaccination reduces risk but does not eliminate it.
• Individuals with previous abnormal results: They may require more frequent monitoring.

Screening may not be required after a total hysterectomy (removal of the uterus and cervix), depending on previous history. Your doctor will advise you individually.

Benefits of Cervical Screening

• Early detection: Identifies HPV infection and early cell changes before cancer develops.
• Prevention of cervical cancer: Treatment of abnormal cells can prevent progression.
• Simple and quick procedure: Usually completed within a few minutes.
• Highly effective: Regular screening significantly reduces cervical cancer rates.
• Peace of mind: Reassurance when results are normal.

Cervical cancer often develops slowly over many years. Regular screening allows early intervention, when treatment is simpler and more effective.

Types of Cervical Screening

• HPV-based Cervical Screening Test: Detects high-risk HPV types.
• Liquid-based cytology (Pap test): Examines cervical cells for abnormalities (often performed if HPV is detected).
• Self-collected HPV testing: In some cases, eligible patients may collect a vaginal sample themselves under medical guidance.

Your doctor will recommend the most appropriate option based on your history and risk factors.

What to Do Before a Cervical Screening Test?

To improve accuracy:

• Avoid intercourse, vaginal creams, or douching for 24–48 hours before the test.
• Try not to schedule the test during heavy menstrual bleeding.
• Inform your doctor if you are pregnant or have symptoms such as unusual bleeding or discharge.

The procedure does not require fasting or anaesthesia.

Cervical Screening Test Procedure

The test is performed in a clinic setting:

• Positioning: You lie on an examination couch.
• Speculum insertion: A small instrument is gently inserted into the vagina to view the cervix.
• Sample collection: A soft brush collects cervical cells.
• Duration: The procedure usually takes less than five minutes.

You may feel mild discomfort or pressure, but it should not be painful. Most women tolerate it well.

What to Expect After a Cervical Screening Test?

• Mild spotting: Light bleeding may occur for a day.
• Normal activities: You can return to daily activities immediately.
• Results: Usually available within one to two weeks.

If HPV or abnormal cells are detected, further assessment may be recommended. This does not mean you have cancer. Most HPV infections clear naturally, and many cell changes are mild.

What is Colposcopy?

Colposcopy is a specialised examination of the cervix using a magnifying instrument called a colposcope. It is recommended if cervical screening results show abnormal findings.

A colposcope does not enter the body. It remains outside the vagina while the doctor examines the cervix under magnification and bright light.

Colposcopy allows:

• Detailed examination of abnormal areas
• Identification of suspicious lesions
• Targeted biopsy (small tissue sample) if needed

Who is Suitable for Colposcopy?

Colposcopy may be recommended for:

• Persistent high-risk HPV infection
• Abnormal cervical cell results
• Unexplained abnormal vaginal bleeding
• Visible cervical abnormalities during examination

It is a diagnostic procedure, not a treatment.

Colposcopy Procedure

• Speculum insertion: Similar to a cervical screening test.
• Application of special solutions: Vinegar-like solution or iodine is applied to highlight abnormal cells.
• Magnified examination: The doctor examines the cervix carefully.
• Biopsy (if needed): A small sample of tissue may be taken.

The procedure usually takes 10–20 minutes. If a biopsy is performed, you may feel a brief pinch or cramping.

What to Expect After a Colposcopy?

If no biopsy is taken:

• You can resume normal activities immediately.

If a biopsy is performed:

• Mild cramping: May last a few hours.
• Light bleeding or discharge: Can last several days.
• Avoid intercourse or tampons: For one week.

Biopsy results are usually available within one to two weeks.

Cervical Screening & Colposcopy Prognosis

When abnormalities are detected early:

• Treatment is highly effective.
• Progression to cancer can often be prevented.
• Long-term outcomes are excellent with regular follow-up.

Most cervical cell changes are low-grade and resolve without major intervention. Regular monitoring ensures safety and timely treatment if needed.

Cervical Screening & Colposcopy Risks

These procedures are generally very safe.

Possible risks include:

• Mild discomfort
• Temporary spotting or bleeding
• Rare infection after biopsy
• Anxiety while waiting for results

Serious complications are uncommon.

What if Cervical Screening is Delayed?

Delaying screening may:

• Allow HPV infection to persist unnoticed
• Increase the risk of untreated cell changes progressing
• Reduce the opportunity for early, simple treatment

Cervical cancer often develops without symptoms in the early stages. Regular screening is the most effective way to reduce risk.

Alternative or Additional Assessments

In certain cases, Dr Wong may recommend, depending on your results:

• Repeat testing at shorter intervals
• Treatment procedures such as LLETZ or cone biopsy, if high-grade changes are confirmed

Management plans are always individualised.