Pap smear

Tests for: abnormal cells of the cervix (precancerous or cancerous cells)

A pap smear is a screening test for cervical cancer. Cervical cancer can affect young women, is often without symptoms in its early stages, and is preventable. Currently, pap smears are recommended for all women in BC age 21 (or 3 years after first sexual contact) until age 69.

Frequency: In the absence of abnormalities, is generally performed yearly for the first 3 years, then every second year. You may require more frequent pap smears if there is a history of abnormal cells.

Timing: Pap smears are best performed when you are between your periods (mid-cycle).

For more detailed information about the test, please visit the following website: http://www.bccancer.bc.ca/screening/cervix

Hysterosalpingogram (HSG)

Indication: Couples with difficulty conceiving, women experiencing recurrent miscarriages, following Essure sterilization.

​Tests for: Countour of uterine cavity, and whether fallopian tubes are open (patent).

This is a minor procedure performed in the radiology unit of the hospital.  Sedation is not required.  Your doctor will pass a thin, flexible catheter through the cervix in a sterile fashion.  Dye that is opaque on X-ray is then injected into the uterine cavity.  Images are then taken by the radiologist. The dye fills the countour of the uterus and the fallopian tubes.  Patent tubes will allow for free spillage of dye into the pelvis.

Preparation:  You may be given specific instructions on how to prepare for this procedure.  It is critical to ensure you are not pregnant: use contraception for the cycle leading up to the test.  Your physician's office may arrange for a blood pregnancy test to be performed prior to the procedure.  If you think that pregnancy is possible, please reschedule the procedure.

Most women experience mild to moderate discomfort during the test.  The discomfort is similar to menstrual cramps.  The discomfort usually resolves quickly after the procedure.  It can help to take extra strength ibuprofen about an hour prior to the HSG.

Most physicians perform the procedure on a day when they are on call at the hospital.  In the rare event that your doctor is very busy attending to an emergency situation, there is a possibility your HSG will have to be rescheduled for another date.

A useful fact sheet on HSG is published by the American Society of Reproductive Medicine.

Endometrial Biopsy

Tests for:  Abnormal cells in the lining of the womb; certain forms of uterine cancers or precancerous cells.

This is a minor procedure that can be performed in your physician’s office without sedation. A thin, sterile, flexible straw is passed into the womb. Suction is applied to obtain a sample of the lining of the womb (endometrium). The sample is sent to the pathologists to examine.

Preparation: Depending on your gynecologic history, your doctor may recommend that you take a medication before the biopsy to help soften the cervix, which can make the procedure better tolerated. If so, you will be given appropriate instructions in advance of the procedure.

An endometrial biopsy may be recommended for women with bleeding after menopause and/or a thick endometrial lining after menopause, women with abnormal menstrual bleeding, or to investigate some types of abnormal pap smears.

Vulvar Biopsy

Tests for:  Abnormal skin changes on the vulva including precancerous or cancerous cells.

This is a minor procedure that your physician may recommend if you have symptoms of vulvar irritation or if there are any skin changes noted on examination of your vulva. The area is cleaned with a disinfectant. Local freezing is carefully injected at the biopsy site, and a small sample, generally 3-4 mm in size, is obtained. If there are multiple areas of interest, your physician may take more than one sample. Your physician may then place a dissolving stitch across the wound. The skin heals very quickly in this area.

LEEP

Your colposcopy report may recommend a LEEP (loop electrosurgical excision procedure).

This is a procedure where a small portion of the cervix is removed for dual purposes:

1)   Provide a diagnosis (benign, precancerous, or malignant cells on the cervix?)

2)   Provide treatment for precancerous cells on the cervix.

A LEEP is a minor surgical procedure that can generally be performed in a few minutes at the hospital. Most women tolerate the procedure extremely well. There will be two registered nurses present along with the doctor performing the procedure. You will have some time to speak with the doctor alone first; the small risks of the procedure will be explained in detail and you will have the chance to ask questions.

Sedation is not required; we use ample freezing in the cervix. The LEEP begins similar to a colposcopy exam; the cervix is examined using a speculum and the magnifying lens. Freezing is then injected into the cervix. To be more effective, the freezing contains a small amount of adrenaline. It is a common benign side effect for your heart to race for a few moments after it is injected.

The doctor then uses the electrical loop to remove a small segment of the cervix, generally less than 1 cm in size.  The sample is sent to the pathologist to be examined.

Please see our post-procedure instructions. Speak with your doctor about any arrangements for communicating the results of your LEEP pathology report.

If you have precancerous cells on the cervix, a LEEP procedure is 90-95% effective in treating the condition. Follow-up is recommended at 6 and 12 months after the procedure in the colposcopy clinic. The clinic will call you directly to set up a time.

Depending on your age and eligibility, the doctor may recommend the HPV vaccine (see our Colposcopy section for links to more information).  This will not treat your current condition but may prevent recurrences.