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Abnormal Smear / Cone Biopsy

I encourage women to have a regular pap smear as a normal part of their health care. A pap smear involves removal of cells from the cervix which are then examined in a laboratory under a microscope.

About 9 in 10 women will have a normal pap smear. However, 1 in 10 may be told that the result was positive. If this is the case it does not mean that one has “cancer” but the pap smear will require further investigation. The next step may be either to repeat the pap smear or a colposcopy may be necessary.

What is a Colposcopy?

This is the examination of the cervix through a special microscope called a colposcope. It is performed to get a better view of the cervix in a magnified way and a biopsy can then be taken.

This is done in the consulting rooms and is not painful in any way. It is similar to having a pap smear performed.


The results of the colposcopy and biopsy are generally reported as being either:

  • Normal
  • Low grade squamous intraepithelial abnormality (LSIL)
  • High grade squamous intraepithelial abnormality (HSIL)


In general terms a low grade lesion requires regular follow up, as in 80% of cases it will disappear. Only 4% will progress to a higher grade abnormality. This will be outlined at a consultation.

A high grade lesion generally needs to be treated.

Treatments available

LLETZ (large loop excision of the transformation zone of the cervix).
This is where an electrical current running through a wire loop is used to excise the abnormality on the cervix.

This is where a freezing technique is used to destroy the affected area.

Electro diathermy.
This destroys the cells by using a heat producing electrical current.

Laser treatment.
This is where a high density light beam is used to destroy abnormal cells.

Cone biopsy.
This is a procedure where a cone shaped wedge of tissue is removed from the cervix. This assists in the confirmation of the diagnosis and removal of the abnormal tissue at the same time.

Most of the treatments outlined above take place at a Day Surgery Unit or in the doctor’s rooms.

You should feel well enough for your normal work the same or the following day. Any cramping or period-like pain that one experiences will be relieved with a mild painkiller. The area heals over the next few weeks and there may be a slight pinkish vaginal discharge which takes a few weeks to settle. Intercourse should be avoided over those weeks until the discharge settles


The wart virus (HPV) is a common finding in pap smears. One may not be aware of any warts or other symptoms but it can be detected on the pap smear.

There are different sub-types of this HPV infection and a few have been linked to cancer of the cervix. Unfortunately the pap smear cannot detect which type is associated with cancer of the cervix. However, there are special tests that can pick up the virus type.

If HPV is detected on the pap smear then you will need a smear every 6 months for a year. If the virus is still present after that then a colposcopy is necessary to be certain that there are no other cell changes on the cervix.

If the smear returns to normal then after two normal results, annual smears are satisfactory.

Obviously if the colposcopy shows abnormal cells then the appropriate management for the stage of CIN would be necessary. – See Abnormal Pap Smears.