Over 250 000 smears annually are reported as showing a low-grade abnormality in the UK NHS Cervical Screening Programmes (CSPs).1 Over recent years, there has been an increasing tendency to refer women with low-grade cytology to colposcopy for further investigation and treatment, if required, by excision or destruction.1 While several studies have reported psychosocial morbidity among women referred for colposcopy (reviewed in2), data on physical after-effects (such as pain or bleeding) and other consequences (such as impact on menstruation) experienced by women following colposcopy and related interventions are scant. Women referred for colposcopy following low-grade abnormal cytology may be managed by a range of options, including colposcopic examination without further intervention, colposcopy and punch biopsies, or colposcopy and LLETZ. We are not aware of any studies comparing the occurrence of after-effects between these different groups. Such data would make an important contribution to the debate concerning the relative benefits and harms of different management options at colposcopy.3
Of the few available studies on after-effects, some relate to cone biopsy, cold knife conisation or cryosurgery, 4–6 which are now rarely used in women with low-grade cytology. Several other studies concern LLETZ, but, of these, some are from the time when this technique was only starting to be commonly used and others relate to clinical practice in single centres and may not be widely generalisable.7–9 Some studies pertain to complications reported by the clinicians who conducted the procedures,10–12 rather than those reported by women themselves and the perspectives of these two groups might differ considerably.13 In addition, most of the clinicians’ reports relate to the time during and immediately after the procedure and consider major events or complications such as haemorrhage, which are well-recognised risks of LLETZ.14 Although such data are clinically important, they do not capture other important after-effects that occur in the subsequent days and weeks. While such after-effects may not always result in women coming into contact with health services again, they potentially impact on psychosocial wellbeing and quality-of-life15 and, as such, are important consequences of screening.
We compared the frequency of after-effects (pain, bleeding and discharge) and the impact on subsequent menstruation reported by women with low-grade cytology attending colposcopy and managed solely by colposcopic assessment, by punch biopsies or by LLETZ.