Cervical Smear, Colposcopy and HPV

What is a cervical smear?

A cervical smear or Pap smear is a sample of cells taken from the outside of the cervix (or neck of the womb) that allows detection of pre-cancerous abnormalities of the cervix. These changes can then be treated successfully before cancer develops. Smear tests are simply screening tools, which signal that more careful attention should be directed at the cervix. In fact sometimes smears can be reported as abnormal even though no abnormality exists on further examination. The latest technique to collect smears is to collect them in fluid filled bottles. The main advantage of this technique is that it reduces the likelihood of any sample being unsatisfactory for examination.

What is colposcopy?

Colposcopy is simply a more detailed examination of the cervix. Instead of looking at the cervix with the naked eye, a special magnifying binoculars - the colposcope - is used to see the changes at high magnification.

Dr Salma Kayani’s clinic is equipped with camera equipment so that you can watch the examination if you wish. The examination may take a little longer than a standard smear test. Dr Salma Kayani performing the colposcopy will explain, what is being done to you, before and during the examination.

What is HPV?

HPV or Human Papilloma Virus is an extremely common virus that is almost always introduced by sexual intercourse. There are more than 150 types of HPV viruses. Some HPV types cause warts and others can lead to cancer, especially cervical cancer. There are more than 40 HPV types that can infect the genital areas of males and females.


Examination of patient using a Colposcope


Following are the symptoms for any problems in the cervix:

  • Recurrent or Persistent Vaginal Discharge
  • Recurrent vaginal infections
  • Vaginal pain
  • Bleeding after intercourse
  • Spotting in between your periods
  • General pelvic discomfort
Effect On Your Life

Being told that you have an abnormal cervical smear can be very scary. Any abnormal smear test is also called a pre-cancerous change.

Anything associated with the word “cancer,” even if it has “pre-” in front of it, is going to sound at least a little terrifying. But the important thing to remember is that early detection saves lives. The earlier you can catch these cells, the earlier you can get rid of them or even just have your doctor keep a close eye on them. Cervical cancer is a slow disease that takes years to grow into a beast that can harm you. For this reason, it’s recommended that you get a pap smear every year after you start sexual activity.

Training Skills and Experience of Dr (Mrs) Salma Kayani

Dr Salma Kayani is a British Society of Colposcopy and Cervical Pathology (BSCCP) UK, Certified Colposcopist since 2003.

To maintain your status as a Certified Colposcopist from United Kingdom, you have to get yourself re-certified after every three years.

Below are the re-certification criteria, which have to be fulfilled every three years to qualify to hold the BSCCP Accreditation:

  • Submit the 3-year audit of your practice and clinical outcomes to the British Society of Colposcopy and Cervical Pathology (BSCCP)
  • Attend an international conference on Colposcopy and Cervical Pathology every two years
  • Attend a Royal College of Obstetricians and Gynaecologists (RCOG) and British Society of Colposcopy and Cervical Pathology (BSCCP) approved training refresher programme.

It is an honour for Dr Salma Kayani that she has been successfully going through this process every three years since 2003.

Since 2012, the British Society of Colposcopy and Cervical Pathology (BSCCP) have also given Dr Salma Kayani the status of Accredited Trainer.

Audit of Clinical Practice

Since 2003, every three years Dr Salma Kayani submit her audit of clinical practice to the British Society of Colposcopy and Cervical Pathology (BSCCP), UK, for their review and assessment, after which Dr Salma undergoes a formal BSCCP re-certification process.

  • Certified 2003
  • Re certified 2006
  • Re certified 2009
  • Re certified 2012
  • Re certified 2015
  • Next re-certification due in 2018

The field of Colposcopy, Cervical Smear and Human Papilloma Virus (HPV) is rapidly evolving with new research and treatments coming in every three years.

This process of re-certification and re-accreditation ensures that Dr Salma Kayani’s practice is up-to-date and evidence based, so that she can offer the best treatment to her patients.


How can pre cancerous changes or Cervical Intraepithelial Neoplasia (CIN) be treated?

There are a number of different ways that pre cancerous changes or CIN can be treated.

  • The treatment options available are either to remove a small part of the cervix or neck of the womb
  • Or to treat by heating or freezing the tissue
  • Cervical cone biopsy

The reason for choosing one treatment instead of another may depend upon the site or size of any abnormality or the exact microscopic appearance of the pre-cancerous abnormality (CIN 1, 2 or 3, cGIN). All treatment methods are highly effective.

Is a hysterectomy the answer to problems of the cervix?

A hysterectomy is very rarely used as a specific treatment for women with abnormal smears. It may be recommended after 2 or 3 local treatments have failed to remove a pre-cancerous problem, or if for technical reasons further smears cannot be taken from a cervix having had multiple treatments. Other women suitable for hysterectomy may have other difficulties such as heavy periods and abnormal cells making a hysterectomy a practical common solution. A hysterectomy may be recommended for an early cervical cancer or a glandular abnormality.

I have heard about a virus called HPV. What is it?

The single most important risk factor for developing cervical cancer is infection with Human Papilloma Virus (HPV). This is a tiny virus which infects skin or mucosa. There are over 150 different types of HPV. They infect only humans and different types infect only specific sites e.g genital area or skin

HPV is a very common sexually transmitted infection. Many HPV types are called ‘low risk’ types and these do not cause cancer. The HPV types commonly linked with cervical and cervical pre-cancer (usually called CIN) are called high risk (or oncogenic). High risk types of Human Papilloma Virus (hrHPV) are detected in almost all cervical cancers and persistent infection with hrHPV is the single most important factor in the development of CIN and of invasive cancer. HPV 16 is the most prevalent type being found in about 70% of cervical cancers and HPV 18 the next most prevalent.

When can I have a test for HPV?

The test is taken in exactly the same way as a cervical cytology (smear) test and sometimes can be done on the same sample without having to have a second examination.

How do people get HPV?

HPV is transmitted through intimate skin-to-skin contact. You can get HPV by having vaginal, anal, or oral sex with someone who has the virus. It is most commonly spread during vaginal or anal sex. HPV is the most common sexually transmitted infection (STI). Anyone who is sexually active can get HPV, even if you have had sex with only one person. HPV can be passed even when an infected person has no signs or symptoms. You can develop symptoms years after you have sex with someone who is infected, making it hard to know when you first became infected.

What can HPV infection cause?

HPV infections will persist and can cause certain cancers and other diseases. HPV infections can cause:

  • cancers of the cervix, vagina, and vulva in women
  • cancers of the penis in men
  • cancers of the anus and back of the throat, including the base of the tongue and tonsils (oropharynx) in women and men

HPV can also cause genital warts in men and women.

How many people get cancer and/or genital warts from HPV?

Every year, about 17,600 women and 9,300 men are affected by cancers caused by HPV. About 180,000 women and 160,000 men are affected by genital warts caused by HPV every year.

What other ways someone could get HPV?

It’s not very common, but sometimes a pregnant woman with HPV can pass it to her baby during delivery. In these cases, the child can develop recurrent respiratory papillomatosis (RRP), a rare condition where warts caused by HPV (similar to genital warts) grow in the throat.

Can you get HPV from the toilet seat?

There haven’t been any cases of people getting HPV from surfaces in the environment, such as toilet seats. However, someone could be exposed to HPV from objects (toys) shared during sexual activity if the object has been used by an infected person.

Who should get HPV vaccine?

Anyone can take the vaccine course.

  • All girls and boys who are 11 or 12 years old should get the recommended series of HPV vaccine.
  • Teen boys and girls who did not get the vaccine when they were younger should get it now.
  • The vaccine is also recommended for
    • gay and bisexual young men
    • young men and women with weakened immune systems (including HIV) if they did not get HPV vaccine when they were younger.

Should boys get HPV vaccine too?

HPV vaccines are also recommended for boys. These vaccines help prevent boys from getting infected with the types of HPV than can cause cancers of the back of the throat, penis and anus. The vaccine also prevents genital warts. When boys are vaccinated, they are less likely to spread HPV to their current and future partners.

How long will the HPV vaccine provide protection?

HPV vaccine offers long-lasting protection against HPV infection and HPV associated disease. Protection produced by HPV vaccine lasts at least 8-10 years according to data from clinical trials and ongoing research. There is no evidence to suggest that HPV vaccine loses the ability to provide protection over time.

Will the vaccine require a booster?

The HPV vaccine series requires three shots given over six months; booster doses are not recommended.

Will the vaccine cause cancer?

HPV vaccine cannot cause HPV infection or cancer. HPV vaccine is made from one protein from the virus that cannot cause HPV infection or cancer. Not receiving HPV vaccine at the recommended ages can leave one vulnerable to cancers caused by HPV.

Will the vaccine cause fertility issues?

No. There are no data that suggest getting HPV vaccine will have an effect on future fertility. In fact, getting vaccinated and protecting against cervical cancer can help women have healthy pregnancies and have healthy babies.