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Pap Smear & Colposcopy

Pap Smear & Colposcopy office/outpatient
IN REVIEWPENDING CLINICAL VERIFICATION
Indications
  • Cervical screening per programme
  • Abnormal cytology/HPV-positive triage
  • Post-treatment surveillance
Consent points
  • Purpose/limitations
  • Discomfort/spotting expected
  • Follow-up pathway explained
Equipment
  • Speculum, cytobrush/spatula or HPV swab, fixative/media
  • Colposcope + acetic acid 3-5% + Lugol iodine
Anaesthesia
  • None usually; biopsy 1-2 min sting

Preparation

  • Avoid menses; no intercourse/vaginals 48 h
  • Pregnancy noted (colposcopy safe; treatment deferred)
Procedure steps
  1. Visualise SCJ fully (document type)
  2. Acetowhiting assessment + vascular patterns
  3. Directed biopsies of worst lesion
  4. ECC where transformation zone not seen/glandular concern
Complications & management
Bleeding post-biopsy

Pressure/silver nitrate; rare packing

Vasovagal

Position/reassure; recover before discharge

Postoperative care

  • Spotting advice; avoid tampons 72 h post-biopsy

Admission & discharge

Care setting: Usually outpatient screening/colposcopy/day treatment

Admission/discharge guidance checked 2026-10-18 against the linked sources. This is a clinical checklist for an individual decision, not an automatic discharge order.

When admission or continued hospital care is needed

  • Uncontrolled bleeding, severe pain, infection concern, an anaesthetic complication or suspected invasive cancer with acute complications requires assessment/admission as indicated.

When clinic, day care or home care may be suitable

  • HPV positivity, screening abnormalities and uncomplicated colposcopy/biopsy are normally managed without admission. Ensure abnormal results reach the colposcopy pathway.

Before going home

  • After biopsy/treatment, bleeding and pain are controlled and the patient understands what was done, expected symptoms and who communicates results.

Discharge medicines and treatment changes

  • Provide only the indicated analgesia or other procedure-specific prescription; routine HPV positivity is not an indication for antibiotics.
Medicine doses — use only when indicated

Use the medicines selected for this patient. Listed alternatives are not instructions to prescribe all of them together. Confirm the actual remaining course, pregnancy/postnatal context and monitoring plan.

Short-term pain relief when appropriate after the procedure.

Paracetamol (acetaminophen) — oral pain reliefMédecins Sans Frontières · Current online monographchecked
Dose1 g (two 500 mg tablets) per dose
RouteOral
FrequencyEvery 6–8 hours when needed; maximum 4 doses in 24 hours
DurationAccording to clinical response: reduce/stop as pain improves. Record the prescribed supply and review date; persistent or increasing pain needs reassessment rather than an automatic repeat course.
PreparationCheck tablet strength: two 500 mg tablets = 1 g. Count paracetamol in every combination/OTC product towards the total; this is not an IV preparation.
Max dose4 g in 24 hours for the stated adult population. Lower weight, hepatic impairment or other risk factors require an individual reduced prescription; do not automatically use this maximum.
  • Indication: Short-term maternal postoperative/postpartum pain or other mild pain after assessment; adult ≥50 kg
  • MSF oral monograph: no pregnancy or breastfeeding contraindication. The dose does not replace assessment of the cause of pain.
Monitoring
  • Pain and functional recovery; investigate increasing pain, fever or other warning symptoms.
  • Check all prescribed/OTC paracetamol, weight and hepatic risk; suspected excess dosing requires urgent assessment.
Contraindications: Paracetamol allergy; avoid duplicate paracetamol-containing products. · Hepatic impairment needs caution and a clinician-adjusted regimen. This adult ≥50 kg card is not a weight-based prescription for smaller adults or children.

Tests, pending results and their reviewer

  • Record biopsy/histology and screening follow-up ownership; a missed result is not an acceptable discharge endpoint.

Home care and counselling

  • Give the exact bleeding, vaginal-product/sex and activity advice for biopsy versus LLETZ or another treatment; instructions differ by procedure.

Follow-up: when and what to review

WhenAction / responsible service
At the stated histology/results date
Review and communicate results, with a fallback contact if no result arrives.
At the booked screening/colposcopy interval
Complete recommended surveillance or treatment; new symptoms need assessment sooner.

Return urgently

  • Heavy bleeding, offensive discharge, fever or severe/worsening pelvic pain needs prompt assessment.

Open the complete discharge checklist →

Sources for this plan:
NHS · Current NHS patient informationcheckedMédecins Sans Frontières · Current online monographchecked
Follow-up: Results appointment with defined next-step rules · Sources: CDC (USA), NHS, Médecins Sans Frontières, NICE, India MoHFW / NHM, WHO, RCOG, NICE
CDC (USA) · 2021 edition (current as of check)checkedNHS · Current NHS patient informationcheckedMédecins Sans Frontières · Current online monographcheckedNICE · NG194, recommendationscheckedIndia MoHFW / NHM · LaQshya district-hospital SOP, linked editioncheckedWHO · 2022 official recommendation summarycheckedRCOG · Current public recovery informationcheckedNICE · CG50, recommendationschecked