Adverse psychological outcomes following colposcopy and related procedures: a systematic review

Abstract

Background Although colposcopy is the leading follow-up option for women with abnormal cervical cytology, little is known about its psychological consequences. Selection criteria Eligible studies assessed psychological wellbeing at one or more time-points post-colposcopy.Data collection and analysis Two reviewers independently screened titles and abstracts. Full texts of potentially eligible papers were reviewed. Data were abstracted from, and a quality appraisal performed of, eligible papers.Main results Twenty-three papers reporting 16 studies were eligible. Colposcopy and related procedures can lead to adverse psychological outcomes, particularly anxiety. Ten studies investigated predictors of adverse psychological outcomes; management type and treatment had no impact on this. Seven studies investigated temporal trends in psychological outcomes post-colposcopy; findings were mixed, especially in relation to anxiety and distress. Studies were methodologically heterogeneous.Conclusions Follow-up investigations and procedures for abnormal cervical cytology can cause adverse psychological outcomes among women. However, little is known about the predictors of these outcomes or how long they persist. There is a need for a more standardised approach to the examination of the psychological impact of colposcopy, especially longer-term outcomes.

Role of cervical cytology in surveillance after radical trachelectomy for cervical cancer

“…Our findings are in agreement with those of previous studies showing that for women with a history of cervical cancer who are currently in surveillance, Pap tests do not appear to substantially impact management decisions (3, 6, 7). Previous studies have also shown that among patients with dysplasia, Pap tests may be a source of additional office visits, procedures, and anxiety (6–9).…”

Long-Term Worries after Colposcopy: Which Women Are at Increased Risk?

“…Baseline questionnaires were completed 8 weeks, on average, after women had received their abnormal cervical cytology result. This study, therefore, adds both to the longstanding evidence on the adverse psychological effects of receipt of an abnormal cervical smear (Fylan, 1998) and the growing evidence on the psychological burden of colposcopy and related procedures (Galaal, Deane, Sangal, & Lopes et al, 2007;O'Connor et al, 2015). In terms of the former, our findings extend observations from qualitative studies which have reported concerns about cancer, infertility and sex among women who have received abnormal cytology results (LagroJanssen, & Schijf, 2005;McDonald, Neutens, Fischer, & Jessee, 1989) by quantifying the percentages of women affected.…”

“…In addition to the large sample size, a major strength of this study is that, whereas most previous studies considered generic outcomes (e.g., anxiety;O'Connor et al, 2015), we assessed specific issues that concern women being followed for abnormal cervical screening test results. We also assessed outcomes over a longer period after colposcopy than previous studies.…”

“…accrued that some women experience adverse psychological effects following colposcopy and related procedures (see, for example, Bell et al, 1995;Hellsten, Lindqvist, & Sj€ ostr€ om, 2008b;O'Connor et al, 2015;Orbell, Hagger, Brown, & Tidy, 2004). Several studies show that women undergoing colposcopy have poorer psychological well-being compared with control groups (Bell et al, 1995;Gath, Hallam, Mynors-Wallis, Day, & Bond, 1995;Hellsten, Sjostrom, & Lindqvist, 2008a;Hellsten et al, 2008b).…”

“…Several studies show that women undergoing colposcopy have poorer psychological well-being compared with control groups (Bell et al, 1995;Gath, Hallam, Mynors-Wallis, Day, & Bond, 1995;Hellsten, Sjostrom, & Lindqvist, 2008a;Hellsten et al, 2008b). In addition, some studies indicate that notable proportions of women may experience adverse psychological effects months after colposcopy (Heinonen, Tapper, Leminen, Sintonen, & Roine, 2013;Hellsten et al, 2008a;Sharp et al, 2011) Despite this accumulating evidence, little is known about predictors of post-colposcopy psychological well-being (O'Connor et al, 2015). We have previously shown that having an abnormal (as compared with a normal) transformation zone at colposcopy is a strong predictor of distress six weeks afterwards (Sharp et al, 2011).…”