A normal colposcopy examination fails to provide psychological reassurance for women who have had low-grade abnormal cervical cytology

S. C. Cotton, L. Sharp, J. Little, N. M. Gray, L. G. Walker, D. K. Whynes, M. E. Cruickshank, The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)


Objective: Worldwide, each year, large numbers of women are referred for colposcopy following low-grade abnormal cervical cytology. Many have no visible abnormality on examination. The risk of cervical intra-epithelial neoplasia grade 2/3 (CIN2/3) in these women is low. It is unknown whether, for women, a normal colposcopy resolves the anxiety which often follows the receipt of an abnormal cytology result. We investigated the prevalence of adverse psychological outcomes over 30 months following a normal colposcopy. 

Methods: This cohort study was nested within the UK TOMBOLA randomized controlled trial. Women aged 20-59 years, with recent low-grade cytology, who had a satisfactory colposcopy examination and normal transformation zone, completed the Hospital Anxiety and Depression Scale (HADS) and Process Outcome Specific Measure (POSM) at recruitment and during follow-up (12, 18, 24 and 30 months post-recruitment). Outcomes included percentages reporting significant anxiety (HADS anxiety subscale score ≥11), significant depression (HADS depression subscale score ≥8) or worries about the result of the next cytology test, cervical cancer, having sex, future fertility and general health at each time point (point prevalence) and during follow-up (cumulative prevalence). 

Results: The study included 727 women. All psychological measures (except depression) had high prevalence at recruitment, falling substantially by 12 months. During follow-up, the cumulative prevalence of significant anxiety was 27% and significant depression was 21%. The most frequently reported worry was that the next cytology test would be abnormal (cumulative prevalence of 71%; point prevalence of ≥50% at 12 and 18 months). The cumulative prevalence values of worries about cervical cancer, having sex and future fertility were 33%, 20% and 16%, respectively.

 Conclusions: For some women who have low-grade cytology, a normal colposcopy does not appear to provide psychological reassurance.

Original languageEnglish
Pages (from-to)178-187
Number of pages10
Issue number3
Early online date6 Aug 2014
Publication statusPublished - Jun 2015

Bibliographical note

Funded by
Medical Research Council. Grant Number: G9700808


  • Anxiety
  • Cervical screening
  • Colposcopy
  • Cytology
  • Depression
  • Psychological wellbeing


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