Abnormal Cervical Screening: Explaining Colposcopy
Your Role — Doctor
Gynaecology Clinic
Your 32-year-old patient's cervical screening test was positive for high-risk HPV with borderline/low-grade cell changes, and they have been referred for colposcopy. The patient is frightened, equating this with cancer, and embarrassed and worried about what HPV means for their relationship. You need to explain the results, what colposcopy involves, and reassure appropriately.
- •Explain the screening result in plain terms: high-risk HPV with minor cell changes, and what that does and does not mean.
- •Reassure that this is not cancer, while explaining why colposcopy is needed to look more closely.
- •Explain what colposcopy involves practically (similar to a smear, a magnified look, possible small biopsy) to reduce anxiety.
- •Sensitively address concerns and possible embarrassment about HPV, including how common it is and relationship implications.
- •Outline next steps and follow-up, provide written information, and check understanding.
The Interlocutor
Played by the actor / assessor
You are 32 and got a letter saying your smear was abnormal and you need a colposcopy. You are frightened it means cancer. You've also read that HPV is a sexually transmitted infection and you're embarrassed and worried it means your partner has been unfaithful, or that you'll pass something on.
- •Say the letter frightened you — you think 'abnormal' means cancer.
- •Ask directly whether you have cancer.
- •Ask what HPV is and whether it means your partner has cheated or that you've done something wrong.
- •Ask what the colposcopy actually involves and whether it will hurt.
- •If the doctor explains clearly and reassures you, feel much calmer and agree to attend the colposcopy.
Sample Role-play
Hello Ms Farrell, I'm Dr Ito. Thank you for coming in. I know getting a letter like this is worrying, so I'd like to explain exactly what your result means. Is that okay?
Yes please. 'Abnormal' — does that mean I've got cancer?
Let me put your mind at rest on that straight away: no, this result does not mean you have cancer. What it shows is two things — the presence of a common virus called HPV, and some very minor changes in the cells of your cervix. These changes are not cancer, and colposcopy is simply a closer look to be thorough.
Oh thank goodness. But then why do I need this colposcopy at all?
It's precautionary and sensible. Minor cell changes usually settle by themselves, but a small number, if left unchecked over years, could slowly progress. Colposcopy lets us look closely now so that, if anything needs a little treatment, we catch it very early — long before it could ever become a problem. It's screening working exactly as it should.
You mentioned HPV. Isn't that a sexually transmitted thing? Does it mean my partner has cheated?
This is such a common worry, so I'm glad you asked. HPV is extremely common — most sexually active people get it at some point, and it very often causes no symptoms and clears on its own. Crucially, it can lie dormant for many years, so a positive test tells us nothing about when it was acquired or about anyone's faithfulness. It is not a sign that anyone has done anything wrong.
That's a relief — I'd got myself into a state about it. What actually happens in the colposcopy?
It's very like having a smear. You'll lie back as you did for your screening, and the specialist uses a magnifying scope — which stays outside your body — to look closely at the cervix. They may dab on a liquid that highlights any changes, and sometimes take a tiny sample. It usually takes about fifteen minutes, and most people find it uncomfortable at most rather than painful.
Will I need treatment there and then?
Sometimes yes, sometimes no. If they see an area that needs it, they can often remove it in the same visit with a quick, simple procedure under local anaesthetic. If not, they may just watch and repeat screening. Either way, they'll explain everything to you before doing anything.
Okay. That's far less scary than I thought.
I'm really glad. I'll arrange the appointment and give you a leaflet that covers all of this, including what to expect afterwards. Please call if any questions come up before then — no worry is too small.
Thank you. I came in terrified and I feel so much better.
You did the right thing coming and asking — that's what we're here for. Attending your screening and this follow-up is looking after yourself really well.
Useful Phrases
Clinical Background
Primary HPV cervical screening detects high-risk HPV; if positive, cytology triages to colposcopy. Low-grade/borderline changes with hrHPV are referred for colposcopy for closer assessment ± biopsy; many regress spontaneously. HPV is highly prevalent, often transient, and can remain latent for years — a positive result carries no implication about timing or partner fidelity, an important source of anxiety and stigma. Colposcopy is well tolerated; treatment (e.g., LLETZ) may be done for confirmed high-grade CIN. Clear, destigmatising explanation improves attendance and reduces distress.
Common Mistakes to Avoid
- ✕Not proactively reassuring that the result is not cancer, leaving the patient's core fear unaddressed.
- ✕Failing to destigmatise HPV and address relationship/fidelity concerns that drive shame and non-attendance.
- ✕Describing colposcopy vaguely rather than concretely, leaving procedural anxiety unaddressed.