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Ask Dr. Norm S. Your Own Question
Dr. Norm S.
Dr. Norm S., Board Certified OB/GYN
Category: OB GYN
Satisfied Customers: 11287
Experience:  Over 30 years of experience in OB/GYN practice, including teaching students. Fellow of American Board of Obstetrics and Gynecology.
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I have just had a colcoscopy after 3 inadequate Pap tests (

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I have just had a colcoscopy after 3 inadequate Pap tests ( I am 50 this year and post menopausal) The colcoscopy was normal no cell CIN seen - and no other test was taken at the time - they have asked me to go back for a another pap test in 3 months time - I am finding all these tests really stressful and I do not understand why I have to have another pap test if the col. was normal .. ? Please could you advise me its making me very anxious. Thank you
Do you know if any abnormal cells were seen, or were the Pap tests just indadequate because they didn't see endocervical cells? Thank you.
Customer: replied 5 years ago.

there were not enough cells to be seen -

When reading a Pap smear, we like to see endocervical cells, since this tells us we have gotten cells from the transitional zone, which is where cancer could develop. However, after menopause the transitional zone often moves higher in the cervix, where it is not easily reached by the Pap smear. Usually when a woman has no prior history of abnormal Pap smears, it's not considered very significant when no endocervical cells are seen, and the Pap smear can be repeated at the normal 1 year or longer interval. I'm assuming that they didn't see endocervical cells. If they didn't see hardly any cells at all, that sounds very strange. They just need to use a brush for doing the Pap smear, and there should always be enough cells (especially after repeating the smear). If it was endocervical cells that they didn't see (the most likely case), let me know, and I'll find an authoritative source stating that such cells don't need to be seen after menopause. If they didn't see enough of any cells, I would recommend getting a Pap smear elsewhere, since a good Pap smear should show cells.
Customer: replied 5 years ago.

i think they didn't see any endocervical cells - the test was done by my gynaecologist who is very experienced - he also did the colcoscopy and assured me that the was nothing to worry about but I don't understand why if the col was all fine they are insisting on another smear test ? Do you think that I have any thing to worry about - I had one boarderline result 14 years ago - cleared up with no treatment and have had all clear results for the last 13 years...

Customer: replied 5 years ago.
Relist: Other.
doctor went off line I think
I have been searching for an official document from the UK regarding absence of endocervical cells on Pap smear after menopause, but it's surprisingly difficult to find something official. I will keep looking.

I don't think you have anything to worry about. We worry when there are abnormal cells. We don't really worry when there are no endocervical cells.

The colposcopy may not help that much, since if there were an abnormal area, it could be high in the cervical canal, where the colposcope cannot see. However, if there is a concern, we can usually do an endocervical curettage (scrapings from the cervical canal), which is easy to do in the office. If that is negative and no abnormal cells are seen on Pap test, that rules out cervical cancer or precancer.
Dr. Norm S. and other OB GYN Specialists are ready to help you
The other way to manage your Pap smear would be to ask your doctor about HPV testing. In the US, when there is a slightly suspicious Pap smear, we do HPV testing to determine if it needs to be followed up. If the HPV test is negative, we ignore the atypical cells. If your doctor gets a negative HPV test from your cervix, that would be very reassuring that there is no significant abnormality.
Thank you for your payment and the bonus!
Customer: replied 5 years ago.

I am now feeling really anxious now that I know that the colcoscopy may have missed something, my gynaecologist kept saying i had nothing to worry about... am I right in thinking that the chances are small of me having cervical cancer ? I know in England there is a less than 1% chance of developing it and that if you have regular pap test and suggested treatment then you are highly unlikely to get it .... do I need to worry ? I don't want to keep having tests because I find the stress of waiting for the results very upsetting, if the chances are small i would rather not be tested unnecessarily, please can you reassure me ? thank you.

The chances of you having cervical cancer are extremely remote, especially as long as you've had regular Pap smears during your life. Not seeing endocervical cells is not suggestive of cancer, it just means that the Pap smear is not quite as reliable. In the US, many of us wouldn't even bother repeating a Pap smear in a postmenopausal woman just because there were no endocervical cells.

As I mentioned, you could ask your doctor either for an HPV test or an endocervical curettage. If either of those tests is negative, there is no chance that you have cervical cancer.
Customer: replied 5 years ago.

thank you very much, I feel less anxious I think I will ask for the HPV test.

You're very welcome.
Customer: replied 5 years ago.

I am sorry to keep going on about this ! You have been very helpful but one last question and i will pay again - I have just seen the letter from my Ob/Gyn and it says that the that Squamoclumnar junction was seen and no CIN was seen .. am I right in thinking that that is good news as this is the area which can be difficult to see in menopausal women... ?

You are correct that it's good news that the squamocolumnar junction was seen, as that's the area where cancer begins, and that's the area which can be difficult to see in menopausal women, as it tends to be located up inside the cervical canal. If the squamocolumnar junction was completely visualized, your risk of cervical cancer is very slight.

There is no need to pay again. I am happy to answer follow up questions.
Customer: replied 5 years ago.

how do I know if it was completely seen - it says it was just seen .?

I would assume that when it says it was seen, that implies that it was completely seen. As long as it was mostly seen, that's good enough. If cancer develops, it's in that area.
Dr. Norm S. and other OB GYN Specialists are ready to help you
Thank you very much for your payment. I do appreciate it.