to ask if anyone works in gynaecology, as I'm increasingly confused

[Dontwanttopanic]

My gynaecologist (a private one, as I'm away from home and was told by the NHS walk in centre that I should see a gynaecologist urgently for post-coital bleeding and pain, although they weren't allowed to refer me themselves) has done an internal examination and has taken a smear test but hasn't carried out a colposcopy. He says that he will decide whether one is necessary depending on the results of the smear. When I got home and googled colposcopies, the internet (I know, I know - hence why I'm asking the question) suggested that smear tests shouldn't be used as a diagnostic tool and can't pick up everything. If that's correct, surely it would be necessary to have a colposcopy anyway, whatever the smear test result? I have an appointment with my own GP for later this week to have a chat about it, but I was wondering whether anyone had any professional knowledge of this so that I can calm down between now and my appointment and also so that I can try to ask the right questions when I go to the GP. At the moment, I'm obviously hugely relieved that there was nothing visible from an internal examination, but it seems to be the case that all that means is that there is no advanced cervical cancer, not that there's no cancer at all. God, I don't want to be trying to self-diagnose from the internet. DD is 15 months. I'm trying not to worry more than is absolutely necessary and I'd be really grateful if any MN gynaecologists could enlighten me. Thanks so much.

Have they ruled out a cervical erosion, which is the most common reason for your symptoms?

^ explained my post-sex bleeding. Nurse said she could see the inflammation at the recommended smear test (was due one anyway).

It's normal to have a smear first. This will show if there is any dyskaryosis (changes to the cells). No changes would result in a 3 year call back. Mild would be monitored for six months and moderate/severe would necessitate a colposcopy to ascertain exactly what's going on.

As a PP said a cervical erosion is the most likely answer but step away from google! It's not your friend. I've had severe dyskaryosis in the past, had colposcopies and the loop diathermy to treat some changes. I can confirm all is now well and all subsequent smears have been normal.

I know it's scary and you've done the right thing getting checked but odds are all is well. Xxx

If he was worried he would have recommended a colposcopy as he would earn more money from it. The fact he didn't think it necessary at this stage should be reassuring. They are not going to turn money down unless there is a really good chance of it being unneccesary.

The gynaecologist said he couldn't see any evidence of erosion...

By the way a cervical erosion is harmless, no where near as bad as it sounds and easily treated.

(GP not gynaecologist)

You are right that a smear is not a diagnostic test. The gynaecologist may have done a smear because you were due one anyway (or s/he didn't know when you'd last had one). It's sensible to do them opportunistically but a smear wouldn't be used to diagnose the source of the bleeding.

The other possibility is that it was a swab or endometrial biopsy, rather than a smear and the gynaecologist was being vague in the description (which is a bit rubbish).

You won't necessarily need a colposcopy - it depends on what the likely cause of the bleeding is.

Discuss what happened with your GP to clarify but it's worth checking that the GP has received a letter from your gynaecologist before you see the GP or she will be as much in the dark as you. If you ring the practice secretary, she can tell you whether the letter has come through.

Correction, should have said - a smear wouldn't be used in isolation, to diagnose the source of the bleeding.

I believe that a smear test should not be offered to a woman with possible symptoms.

As an aside, I find the idea of an opportunistic smear quite appalling. It implies a lack of informed consent if the procedure is offered in such a way that it would be difficult to refuse.

I believe that a smear test should not be offered to a woman with possible symptoms. As an aside, I find the idea of an opportunistic smear quite appalling. It implies a lack of informed consent if the procedure is offered in such a way that it would be difficult to refuse

Good grief - opportunistic does not mean without consent! It just means that it's a good idea to do one (if due) when a woman has to have an internal for another reason. You still have to ask consent. Saves women having the hassle & discomfort of a speculum exam twice, which is surely a good thing?

It is not correct that "a smear test should not be offered to a woman with possible symptoms".

That sounds normal to me, as in my case I also had a smear test first. I had post coital bleeding and was treated in the same way by the NHS. I had a smear test initially and following the results of that, had a colposcopy which gave me the diagnosis of CIN3 for which I was treated.

I have been misinformed. I was taught that a smear test was a tool to prevent cervical cancer and not to be used to diagnose cancer.

I have intermittent PCB and IMB, and am waiting about to have a Hysteroscopy for biopsies, polyp removal (1 cervical & 1 endometrial) and diathermy for an erosion. Hopefully one of those will solve the problem! :)

My last smear was clear and I went about symptoms after that so they didn't repeat the smear but sent me straight to a gynae and I was put on an "urgent" list for Hysterocopy under GA, but that can still be a 10 week wait.

My understanding is that a smear test is to check for pre-cancerous changes to cells in the cervix? It can't prevent them happening, but has a good chance of detecting them if they are there so that treatment can begin if needed.

Thanks very much, everyone. I appreciate your taking the time to respond.

Just been to my gp about the same thing, she's taken swabs and referred me straight for a colposcopy, should be seen in two weeks apparently. I'd be pushing your gp if you're concerned and still bleeding.

Can I just add, if you're offered colposcopy, make sure you accept the anaesthetic, even though it takes longer. It's more painful than people think without it