Cervical Screening.

Cervical screening is one of the most effective ways to prevent cervical cancer. The purpose of screening is to identify women at risk of developing cervical abnormalities before cancer develops, allowing early monitoring and treatment when necessary.

In New Zealand, cervical screening now uses primary HPV testing, which is more sensitive than traditional cervical smear testing and allows earlier identification of women who may require further assessment.

Most women who have an abnormal screening result do not have cervical cancer. In many cases, the immune system clears HPV naturally over time without causing any long-term problems.

What is HPV?

Human papillomavirus (HPV) is an extremely common virus spread through intimate skin-to-skin contact.

Most sexually active people will be exposed to HPV at some point during their lives.

There are many different types of HPV. Some are considered low-risk and may cause genital warts, while others are classified as high-risk because they can cause changes in the cells of the cervix.

In most women:

• HPV causes no symptoms

• the immune system clears the infection naturally

• HPV does not lead to cancer

However, when high-risk HPV persists over many years, cervical cell changes may develop.

What is HPV Testing?

HPV testing is now the primary cervical screening test in New Zealand.

The test looks for the presence of high-risk HPV types that are associated with cervical cancer.

A negative HPV test is very reassuring and means the risk of developing significant cervical abnormalities in the near future is extremely low.

If high-risk HPV is detected, additional testing may be required depending on the HPV type and whether cervical cell changes are present.

What is Cytology?

Cytology (sometimes referred to as a cervical smear) examines cervical cells under a microscope to look for abnormal changes.

If HPV is detected, cytology may be performed to help determine whether colposcopy is required.

Results may include:

Negative Cytology

No abnormal cells are identified.

Low-Grade Changes (LSIL)

Low-grade changes are common and often resolve spontaneously as the body clears HPV.

High-Grade Changes (HSIL)

High-grade changes are more significant and usually require colposcopic assessment and treatment.

Importantly, cervical cell changes are not cancer. They represent changes that may require monitoring or treatment to prevent progression.

HPV Vaccination

The HPV vaccine is one of the most successful cancer prevention programmes available.

Vaccination protects against the HPV types responsible for most cases of:

• cervical cancer

• vaginal cancer

• vulval cancer

• anal cancer

• genital warts

The vaccine is most effective when given before exposure to HPV but still provides benefit for many adults.

Even if you have received the HPV vaccine, regular cervical screening remains important.

HPV Vaccination (Gardasil 9)

Gardasil 9 protects against the HPV types responsible for approximately 90% of cervical cancers, as well as many vulval, vaginal, anal and throat cancers. It also protects against the HPV types that cause most genital warts.

The vaccine is safe, highly effective and is one of the most successful cancer prevention strategies available. Vaccination is recommended for all young people and may still provide benefit for many adults who have not previously been vaccinated.

Importantly, women who have received the HPV vaccine should still participate in regular cervical screening.

What is Colposcopy?

Colposcopy is a procedure used to examine the cervix in more detail following an abnormal cervical screening result.

A colposcope is a specialised microscope that remains outside the body and allows magnified examination of the cervix.

The procedure is usually performed in an outpatient setting and typically takes 15–30 minutes.

During colposcopy:

• the cervix is examined under magnification

• special solutions may be applied to highlight abnormal areas

• small biopsies may be taken if required

Most women tolerate the procedure well, although some experience mild discomfort or cramping.

Why Have I Been Referred for Colposcopy?

Common reasons for referral include:

• HPV 16 or HPV 18 detection

• persistent high-risk HPV infection

• abnormal cytology results

• previous cervical abnormalities requiring follow-up

• symptoms such as post-coital bleeding in selected situations

Being referred for colposcopy does not mean you have cervical cancer.

Most women referred to colposcopy have either normal findings, low-grade abnormalities, or pre-cancerous changes that can be treated effectively.

What Happens if a Biopsy Shows Abnormal Cells?

Management depends on the severity of the abnormality.

Low-Grade Changes (LSIL/CIN 1)

Low-grade abnormalities often resolve naturally and can frequently be managed with observation and repeat cervical screening.

High-Grade Changes (HSIL/CIN 2–3)

High-grade abnormalities are usually treated to prevent progression to cervical cancer.

Treatment is highly effective and has an excellent success rate.

What is a LLETZ Procedure?

LLETZ stands for Large Loop Excision of the Transformation Zone.

It is the most common treatment used for high-grade cervical abnormalities.

During the procedure:

• local anaesthetic is administered to the cervix

• a fine wire loop is used to remove the abnormal area

• the tissue is sent for laboratory analysis

LLETZ is typically performed as an outpatient procedure and most women return home shortly afterwards.

Recovery After LLETZ

Following treatment it is common to experience:

• mild cramping

• light bleeding or discharge

• spotting for several weeks

Most women can return to normal activities within a day or two.

To reduce the risk of infection, women are usually advised to avoid:

• sexual intercourse

• swimming

• baths

• tampons

for approximately four weeks following treatment.

Your treating doctor will provide individualised advice.

Follow-Up After Treatment

Most women require repeat HPV testing following treatment to confirm the abnormal cells have been successfully removed.

The vast majority of women have normal follow-up results and can return to routine surveillance.

Regular follow-up remains important even after successful treatment.