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What my patients have said ...

I would like to take this opportunity to thank you for your kindness during my recent hysterectomy... as you know I have had several gynaecological operations and I can honestly say that, although this operation was by far the most serious one, it was the least upsetting, both physically and psychologically. This was mainly due to your expertise in the operating theatre. It took a great deal of time and trouble to ensure that there would be minimal scarring and bruising so that my postoperative recovery would be shortened. However I was also impressed by the time you spent to listen to patients and explain the procedures. All too often patients feel a passive partner in their surgery which is unhelpful psychologically but you ensured that I was kept informed at all times. Thank you.... I would also like to take this opportunity to pass on my thanks to your surgical team and your secretary. Everyone with whom I came into contact was extremely helpful and considerate which was very much appreciated.... I hope you will pass on my best wishes to all your staff. You undoubtedly have built a good team and I wish them and yourself all the best for the future. I will have no hesitation in recommending your skills to any friend who might need a gynaecologist.

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Abnormal smear

A cervical smear is designed to detect abnormalities of the cervix (and vagina). It is not designed to detect cancers of the womb or ovary. When smear results are reported back to the patient they can be any from the following list:

  • Normal
  • Borderline
  • Mild
  • Moderate
  • Severe
  • Cancerous
  • Inadequate
  • Ungradeable

The vast majority are, of course, normal. A small proportion ( 1 to 3%) are deemed inadequate due to various reasons. These may include not having enough cells of interest (eg after the menopause), or too much blood obscuring the cells of interest (eg if smear carried out during a menstrual period), or too many other irrelevant cells obscuring the picture (eg cervix infection causing too many inflammatory cells).

A precancerous result includes borderline, mild, moderate, severe or ungradeable. A borderline or mild result is deemed a "low grade" abnormality whereas a moderate and severe result is deemed a "high grade" abnormality. Some laboratories report an ungradeable category and this merely implies that some precancerous change has been noted on the smear but the degree is uncertain and hence could be anything from borderline to severe (or sometimes cancerous).

A "cancerous" smear result is very rare and is reported when there are features worse than severe to suggest the possibility of transition to cancer from precancer. These are referred urgently for colposcopy for further investigations.

What happens after an abnormal smear result?

Following an inadequate result, the smear is usually repeated after a few weeks. Occasionally the doctor may prescribe some hormone cream (if inadequate cells following menopause) or antibiotics (if suspecting cervix inflammation) prior to repeating the smear. After two consecutive inadequate smears a referral for colposcopy is arranged.

Following a low grade abnormality (borderline or mild) the smear is repeated after 6 months usually by the GP. If there is a persistent abnormality of any sort, a referral for colposcopy is arranged. With a high grade abnormality (moderate or severe), a referral for colposcopy is arranged as soon as the result is available.

In the Surrey region, the laboratory reporting the results often bypasses the GP and initiates a "direct referral" to the colposcopy clinic. Therefore, when a patient is notified of an abnormal result by the laboratory, it also simultaneously sends a letter to the hospital colposcopy clinic asking it to arrange an appointment for colposcopy. There is usually a wait of between 4 to 8 weeks.

Most private health insurances will cover colposcopy under their scheme. Therefore, if you wish to avoid the wait then a private referral is much quicker (usually within 1 week). The results of the colposcopy examination and any biopsies taken are also available more quickly after a private colposcopy. If you wish to pursue this route then contact your insurer to pre-authorise the private referral.

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