What is cervical cancer screening?

Screening tests can find early problems before you get sick.  The Pap test is a screening test for cervical cancer. It looks for abnormal cells on your cervix that could turn into cancer over time. That way, problems can be found and treated before they ever turn into cancer. It is important to know that no screening test is 100 per cent accurate.

Understanding your Pap smear results

Having a Pap smear every two years offers the best chance of preventing cervical cancer.

The Pap smear is a quick and simple test used to check for changes to the cells of the cervix that may lead to cervical cancer. A doctor or nurse takes a sample of cells from the surface of the cervix and sends to a laboratory for analysis and the results are usually available within a week.

Most Pap smear results are normal. A small number show changes in the cells of the cervix; mostly minor infections that usually clear up naturally or are easily treated. In a very small number of cases the abnormality persists and if left untreated, may develop into cervical cancer. When detected early, changes to the cells of the cervix can be treated.

When should I have a Pap smear?

All women between the ages of 18 and 70 should have a Pap smear every two years.

What is HPV?

HPV is a common virus – Human Papilloma Virus.  There are several types of HPV.

Some HPV types can cause changes on a woman’s cervix that can lead to cervical cancer over time.

Other HPV types can cause genital warts. But the HPV types that can cause genital warts are different from the types that can cause cancer.

Most of the time, the body’s immune system fights off HPV naturally within two years– before HPV causes any health problems.  It is only when HPV stays on a woman’s cervix for many years that it can cause cervical cancer.  We do do not know why HPV lingers in certain cases but not others.

How could I get HPV?

HPV is passed on through intercourse. Most people never even know they have HPV, or that they are passing it to their partner. So it may not be possible to know who gave you HPV or when you got it.

HPV is present in 99.7 per cent of cervical cancer cases. However, not all HPV infections lead to cervical cancer.

HPV is NOT the same as HIV (the AIDS virus).

What about the vaccine for cervical cancer?

Vaccines are now available that prevent the common types of HPV infection that cause cervical cancers. Currently the available vaccines do not protect against all the types of HPV that can cause cervical cancers. All vaccinated and unvaccinated women still need regular Pap smears.

What is an unsatisfactory Pap smear?

An unsatisfactory Pap smear means that the laboratory staff could not see the cells well enough to give a report.

In this case, you may be asked to have a repeat Pap smear. This is not a cause for alarm.

What does an abnormal Pap smear result mean?

An abnormal Pap smear result means that some cells from your cervix looked different from normal cells. This occurs in around 1 in 10 Pap smears.

It is natural to feel anxious or worried if you have just found out that your Pap smear result is abnormal, however less than one per cent of abnormalities are cancer.

Low Grade Abnormality

If you have a low grade abnormality and your previous Pap smears were normal, your doctor will ask you to come back for a repeat Pap smear in one year. Low grade abnormalities result from slight changes in the cells of the cervix, which may be the result of a mild infection such as thrush or HPV or lack of oestrogen at menopause. Or it could be a early sign of precancerous lesion.

High Grade Abnormality

High grade abnormalities can result in more severe changes to the surface layers of the cervix. If left untreated they have a greater chance of developing into cervical cancer.

It usually takes at least 10 years before high grade abnormalities develop into cervical cancer(as long as you are having regular pap smear). If you have a high grade abnormality your doctor will refer you to a specialist for further investigations and treatment.

How will I know when to have my next Pap smear?

Most doctors have an established recall system to notify you when your next Pap smear is due.  Most state health departments have established Pap smear registries that provide a safety net recall system although you can opt out.  Remember, if you have any concerns or questions, please contact your doctor.

Management after referral to Dr Musa

This will include:

Colposcopy – a colposcope (an instrument that magnifies the cells of the cervix) and gives a closer view of the extent and nature of the problem

Occasionally, cervical biopsy – a small tissue sample from your cervix is removed during the colposcopy and sent for examination in a laboratory.

Treatment of pap test abnormalities

If a high-grade abnormality is confirmed with cervical biopsy (usually takes a week for results to get back from lab), recommendation is to remove the abnormal cells from your cervix.

Dr Musa usually performs a LLETZ – Wire-loop excision – where the abnormal area of cervix is removed using a loop of wire. This acts as a treatment as well as further diagnosis for deeper abnormalities not picked up with a biopsy.

Pap tests after treatment

Women who have had treatment for high-grade abnormal cell changes need more regular pap tests for the first two years following treatment.



Endometriosis is a chronic condition characterised by the growth of endometrial tissue in sites other than the uterine cavity, most commonly the pelvic cavity (including the ovaries)

Adenomyosis is the invasion of the middle layer of uterus by endometrial tissue. This leads to painful as well as heavy periods.

Extrauterine endometrial tissue causes inflammation, pain and the formation of adhesions.

Endometriosis is estimated to affect 5-10% of women of reproductive age

Risk for first-degree relatives of women with severe endometriosis is six times higher than that for relatives of unaffected women.


We are still unclear regarding cause for endometriosis. Suggested theories have included:

Retrograde menstruation.

Lymphatic or haematogenous spread.



Common symptoms include:

Painful periods

Painful intercourse

Cyclical or chronic pelvic pain.


The clinical presentation is variable, with some women experiencing several severe symptoms and others having no symptoms at all.


For a definitive diagnosis of endometriosis, laparoscopy is the gold standard investigation but it is invasive with a small risk of major complications – eg, bowel perforation.

Pelvic Ultrasound is advised to assess for Endometriomas- (ovarian cyst).


The treatment of endometriosis is usually individually based, depending on the nature and severity of symptoms and the need for future fertility.

Medical treatment may reduce symptoms in some of patients, but none of the treatment options has been shown to reduce recurrence of symptoms once treatment has stopped.

Surgical options include removing severe and deeply infiltrating lesions (which may reduce pain related to endometriosis), ovarian cystectomy (for endometriomas), adhesiolysis, and bilateral oophorectomy (often with a hysterectomy).

Management may also include pain management specialists and clinical psychologists.


The natural course of the disease is variable and may or may not be progressive.

In the five years after surgery or medical treatment, 20-50% of women will have a recurrence.