After-effects reported by women having follow-up cervical cytology tests in primary care: a cohort study within the TOMBOLA trial

Seonaidh Cotton*, Linda Sharp, Claire Cochran, Nicola Gray, Maggie Cruickshank, Louise Smart, Alison Jane Thornton, Julian Little, The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group, Alison Jane Thornton

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)


Background: Although it is recognised that some women experience pain or bleeding during a cervical cytology test, few studies have quantified physical after-effects of these tests.

Aim: To investigate the frequency, severity, and duration of after-effects in women undergoing follow-up cervical cytology tests, and to identify subgroups with higher frequencies in Grampian, Tayside, and Nottingham.

Design: Cohort study nested with a multi-centre individually randomised controlled trial.

Method: The cohort included 1120 women, aged 20-59 years, with low-grade abnormal cervical cytology who completed a baseline sociodemographic questionnaire and had a follow-up cervical cytology test in primary care 6 months later. Six weeks after this test, women completed a postal questionnaire on pain, bleeding, and discharge experienced after the test, including duration and severity. The adjusted prevalence of each after-effect was computed using logistic regression.

Results: A total of 884 women (79%) completed the after-effects questionnaire; 30% of women experienced one or more after-effect: 15% reported pain, 16% bleeding, and 7% discharge. The duration of discharge was =2 days for 66%, 3-6 days for 22%, and =7 days for 11% of women. Pain or bleeding lasted =2 days in more than 80% of women. Severe after-effects were reported by <1% of women. The prevalence of pain decreased with increasing age. Bleeding was more frequent among nulliparous women. Discharge was more common among oral contraceptive users.

Conclusion: Pain, bleeding, and discharge are not uncommon in women having follow-up cervical cytology tests. Informing women about possible after-effects could better prepare them and provide reassurance, thereby minimising potential non-adherence with follow-up or non-participation with screening in the future.

Original languageEnglish
Pages (from-to)e333-e339
Number of pages7
JournalThe British Journal of General Practice
Issue number587
Early online date31 May 2011
Publication statusPublished - Jun 2011


  • after-effects
  • bleeding
  • complications
  • cervical smears
  • cytology
  • pain
  • primary care
  • vaginal discharge
  • PAP-smear
  • cancer
  • population
  • knowledge
  • attitudes
  • barriers
  • beliefs


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