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This information is aimed at colposcopists, colposcopy nurse specialists and colposcopy nurse. It may also be useful for other healthcare professionals, including primary care staff.
As with all surgical treatments, treatment to remove abnormal cells can have side effects. Patients may also be left dealing with significant psychological effects. It’s important to be aware of all this so you can give patients the information they need to decide about treatment. Here are some tips that may be helpful in communicating with your patients.
Treatment is one option. But it isn’t the only option, even for high-grade cell changes. Patients should know they have the choice not to be treated immediately.
Conservative management means a patient will be followed up in six months to see whether cell changes have progressed or regressed. The decision of whether or not to treat can be reviewed then.
What’s key is to make sure patients know they have options. You can support them by making sure they know about the benefits and potential risks of having treatment, and not having it.
We know you want to do what’s best for your patients. LLETZ is an effective treatment for cell changes and it’s usually safe and straightforward so it may seem a simple decision to go ahead. Our research shows most patients have a positive experience of treatment at colposcopy clinics, and are pleased they had the procedure.
But it can be easy for healthcare professionals to underestimate the impact of treatment in such an intimate and sensitive part of the body. To you, it may seem low-risk and routine. But to a woman or person with a cervix, it can have a big impact, both physically and psychologically. It’s important to make sure someone has all the information they need, and to give them time to think about the risks and benefits of treatment. Some women and people with a cervix have told us they’ve felt pushed into treatment. For many, it’s really helpful to have a chance to think it all through before they have a treatment appointment.
It can be tempting to think patients don’t really need to know the details. But there’s a lot of confusion and fear around colposcopy and LLETZ. Patients may have worries that don’t reflect what really happens during treatment. And they may not share them with you. So you can help by telling them very clearly what’s going to happen during the procedure, such as how much tissue you’ll remove. Give them time to ask questions if they wish.
Some women and people with a cervix have told us doctors have downplayed side effects. The most common is bleeding. While this is expected, and a normal part of the healing process, it can sometimes be very heavy. It may disrupt someone’s life for weeks. If a patient has plans, such as going on holiday or dating, it can really get in the way. It’s better to be clear about what may happen after the procedure so patients are prepared and can plan.
There are other side effects that are still not well understood, including pelvic pain and pain after sex. Explaining in advance there’s a risk of these, however small, means your patients can make informed decisions.
The risk of miscarriage and premature birth are low with LLETZ. But it’s important to make sure patients are aware of the risk before they have treatment. Although the chances of problems are small, they should be encouraged to tell their midwife about having LLETZ so they can be monitored during pregnancy.
Some patients may be very worried about what treatment means for their fertility. You can help by explaining the risks against the benefits of treatment. Make sure they know they can speak to you about their concerns.
Patients may experience a lot of different feelings after treatment. Some women and people with a cervix are relieved it’s over and just want to get back to normal life. But for others, it can have a lasting emotional impact.
Anxiety is very common. Patients may worry about whether treatment’s worked and whether they will end up developing cancer. Sadly, some women and people with a cervix feel ashamed about needing treatment because they link it with sexual transmission.
Treatment may also affect confidence and body image, and some women and people with a cervix have told us it’s had an impact on their relationship and sex life.
Make sure you offer your support. Simply explaining some patients experience difficult emotions after treatment can help normalise low mood and anxiety. You could then ask if there’s any other support you can offer.
You may feel you don’t have the time, capacity or knowledge to give patients all the support they need. It’s also important to be aware patients may find it difficult to talk to you about intimate issues. For these reasons, it’s a good idea to make sure they’re aware of other sources of support. You could let patients know about our website and our helpline, which is staffed by people with personal or professional experience of cell changes and treatment: 0808 802 8000.