Most women attending for a colposcopy consultation have significant anxiety in advance of the appointment (see Chapter 19. Psychosocial care). This is often related to uncertainty about the diagnosis and possible treatment, but may reflect concern regarding the approaching gynaecological (colposcopic) examination. ColposcopistsHealth professionals, usually gynaecologists, trained to perform colposcopy. should take measures to alleviate these anxieties while protecting each woman’s dignity and privacy. A Cochrane review of interventions to reduce anxiety in women undergoing colposcopy, which included six randomised controlled trials, found that music during colposcopy significantly reduced anxiety levels and pain during the procedure.
Effective information and communication is essential for all women. There is good evidence that accurate and well-presented information improves women’s experience of colposcopy and reduces anxiety. Women may not remember all of the verbal information given at the time of consultation or treatment and, ideally, written information should be available where appropriate.
Ideally, women should be given relevant information at the time of cervical screening and before colposcopy. Most hospital colposcopy clinics and many colposcopists will have their own information pamphlets or leaflets. Information is also available from proprietary sources (usually free of charge) or from the the Commonwealth and state- and territory-based programs of the National Cervical Screening Program (NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears.).
It is essential that women be given the opportunity to discuss their management and any concerns they may have time at the time of consultation or treatment.
Questions that women may ask include the following:
- What do my test results mean?
- Do I need more tests and if so, why?
- What treatment do you advise and why?
- Are there any other options?
- Will I need time off work?
- Will I be able to drive myself home after my treatment?
- Will there be bleeding or vaginal discharge after treatment?
- How often will I need to come back to see you?
- When is my next checkup due?
- Is there anything I can do to help myself in the future?
- Can you give me some information about HPVHuman papillomavirus?
Prior to the first visit for colposcopy
Written information sent to the woman should include:
- a basic description of the causes of cervical pre-cancer and cancer and the relationship to HPV infection.
- a list of the grades of abnormality that are reported in the screening test results a with brief explanation of what they mean.
- a description of the colposcopic examination and possible biopsy
- the potential outcomes of the colposcopic assessment, including commonly used treatment modalities.
At the time of the colposcopy consultation
ColposcopistsHealth professionals, usually gynaecologists, trained to perform colposcopy. should be sensitive to the psychophysiological needs of individual women undergoing colposcopy:
- Matching intra-procedural information with different coping styles reduces psychophysiological disturbance in women undergoing colposcopy.
- Check that the woman did receive the pre-visit information. If not she can read it while waiting for her consultation.
- Remind the woman about the technique of colposcopy and the possible need for a cervical biopsy.
- During the examination keep her informed as to what can be seen and what is happening and especially if and when a biopsy is taken.
- If a video-colposcopy is available and the woman wishes to watch the colposcopic image, this should be encouraged but be aware that in some women this can cause anxiety.
- Following the examination and if a biopsy has been performed, the woman should be given clear advice regarding the transient occurrence of mild pelvic discomfort and vaginal ‘spotting’ and should be advised to avoid sexual intercourse for a few days.
- If a biopsy has been taken she should be given clear instructions, preferably in writing, as to how she will obtain the results of the biopsy.
- Prior to leaving the consultation visit, particularly if it appears likely that she will require treatment, the woman should be given verbal and written information about any potential treatment procedures and their complications that may affect her consent to be treated.
- If treatment is not likely but she needs a follow up visit or needs to see her GP, this information should be clearly articulated and should be confirmed in writing.
At the time of a treatment visit
The colposcopist should:
- confirm that the woman understands and consents to treatment
- if colposcopy is done under local anaesthesia, keep the woman informed about the procedure in real time
- after the procedure, ensure that the woman is given verbal and written information about potential common complications, especially bleeding and infection and what she should do if they occur. This should be reinforced by written information, including advice as to how the pathology results of any treatment will be obtained.
- provide information about necessary follow-up after treatment.
Information should include the following advice:
- Some women experience abdominal cramps after treatment. This can feel like a painful period. It is also normal to have a dark or watery vaginal discharge for up to 4 weeks. This may include the passing of small clots while the cervix heals.
- Avoid using tampons for 4 weeks after treatment.
- Abstain from sexual intercourse for 4 weeks after treatment.
- Avoid strenuous exercise or swimming for 10–14 days after treatment.
- Some women may have temporary alteration in menstrual pattern after an excisional treatment, including heavier and more painful flow in the subsequent period.
Note: Culturally and linguistically appropriate information should be available for Aboriginal and Torres Strait Islander women and women who speak a language other than English, preferably in their first language. However, it is often not possible for written information to be available in all languages. Women should be offered access to interpreter services when required (information on interpreter services can be accessed from Translating and Interpreting Services.
- Wilkinson C, Jones JM, McBride J. Anxiety caused by abnormal result of cervical smear test: a controlled trial. BMJ 1990 Feb 17;300(6722):440 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/2107898.
- Marteau TM, Walker P, Giles J, Smail M. Anxieties in women undergoing colposcopy. Br J Obstet Gynaecol 1990 Sep;97(9):859-61 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/2242376.
- Lerman C, Miller SM, Scarborough R, Hanjani P, Nolte S, Smith D. Adverse psychologic consequences of positive cytologic cervical screening. Am J Obstet Gynecol 1991 Sep;165(3):658-62 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/1892194.
- Galaal K, Bryant A, Deane KH, Al-Khaduri M, Lopes AD. Interventions for reducing anxiety in women undergoing colposcopy. Cochrane Database Syst Rev 2011 Dec 7;(12):CD006013 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22161395.
- Marteau TM. Reducing anxiety in women referred for colposcopy using an information booklet. Br J Health Psych 1996;1: 181–189.
- Freeman-Wang T, Walker P, Linehan J, Coffey C, Glasser B, Sherr L. Anxiety levels in women attending colposcopy clinics for treatment for cervical intraepithelial neoplasia: a randomised trial of written and video information. BJOG 2001 May;108(5):482-4 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/11368133.
- PapScreen Victoria. For women. [homepage on the internet] Victoria: Cancer Council; Available from: http://www.papscreen.org.au/forwomen.
- Australian Government Department of Health. National Cervical Screening Program:Cervical Screening. [homepage on the internet] Commonwealth of Australia; [cited 2016; updated 2016 Feb 9]. Available from: http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/cervical-screening-2.
- Kola S, Walsh JC, Hughes BM, Howard S. Matching intra-procedural information with coping style reduces psychophysiological arousal in women undergoing colposcopy. J Behav Med 2013 Aug;36(4):401-12 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22729966.
- Australian Commission on Safety and Quality in Health Care. Health Literacy:Taking action to improve safety and quality. Sydney: ACSQHC; 2014 [cited 2016] Available from: http://www.safetyandquality.gov.au/wp-content/uploads/2014/08/Health-Literacy-Taking-action-to-improve-safety-and-quality.pdf.