The Health Blog

Dysplastic changes. The smear test is a screening test. It gives an idea of what is likely to be going on at the cervix, but does not give a definitive diagnosis. It can’t, and no one expects it to. It is, however, good as a screening procedure, with a high rate of accuracy and low rate of failures.

The actual diagnosis of a cancerous or pre-cancerous change of the cervical cells requires another technique. A biopsy (a small piece of cervical tissue rather than a smear of cells) must be examined under the microscope to determine the extent of the problem. In general, all women whose smear tests show any degree of dysplasia will be referred for further investigation.

Having a biopsy taken from your cervix involves a procedure called a ‘colposcopy’. A gynaecologist can use a specialised magnifying instrument to examine the cervix more closely. You need to have a speculum inserted, as for a smear, but often the examination will take place on a chair-type couch designed especially for gynaecological examinations. There can be a little brief ‘stinging’ feeling when the biopsies are actually taken, but in general this is short lived and not too painful. The specimens are examined by pathologists to find out what degree of dysplasia there is, and how much of the cervix it affects. The treatment depends on the results. If treatment is required, it will usually be done on a subsequent visit.

To treat dysplasia one of two different techniques may be used, but they effectively do the same thing: they destroy the abnormal cells. Laser (a special light ray which destroys tissue) and diathermy (burning via an electric needle) both sound like pretty gruesome procedures. They are performed under anaesthetic, which may be general (the patient is asleep) or local (the cervix is made numb by an injection, like the gums are at the dentist). The abnormal tissue is replaced by

healthy tissue in a few weeks as new cells grow. A check up is performed using the colposcope to make sure everything is normal, usually three to six months after treatment. Depending on the degree of abnormality and the effectiveness of the treatment, further colposcopies and more regular smears are likely to be recommended, to closely monitor the cervix. This is because women who have had dysplasia appear to be at greater risk of developing a recurrence, and regular checking can prevent this developing into cancer. Fortunately, it usually works.

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This is a particularly clever little bug. Able to infect without causing symptoms, able gradually to cause damage to unsuspecting fallopian tubes, able to render women infertile without very much fuss at all, really.

Some commentators have referred to the ‘silent epidemic’ of chlamydia. Figures from the United States suggest a conservative estimate of three to four million new cases a year there. There are varying rates reported in Australia; between 1 and 4 per cent of women of reproductive age are thought to be infected. Identified risk factors include being under 25 years of age, and having had a new sexual partner within the last twelve months.

Diagnosis. A swab test specifically for chlamydia can be performed on both women and men. In women the swab is taken from the cervix, so it is similar to a pap smear and can be done at the same time as the pap smear. If there are symptoms of infection the doctor may test for other bugs, such as gonorrhoea, as they are similar in their symptom pattern, and can be transmitted together. A swab is used to test men, too. A very fine swab is inserted into the tip of the penis.

Treatment. This infection must be treated with a full ten-day course of antibiotics. This is usually doxycycline 100 milligrams, twice a day, for ten days. The course must be finished to ensure the infection is treated, and intercourse should be avoided until both partners are fully treated. If a person is unable to take doxycycline (because of allergy, breast-feeding or pregnancy), erythromycin may be prescribed. (Remember that taking antibiotics can interfere with the absorption of the oral contraceptive pill. If you are taking the pill, extra precautions are needed during the course of antibiotics, and for at least seven hormone tablets after the course is finished.)

Because no test is 100 per cent accurate, and the consequences of infection are so significant, it is usual to treat all the people who have had recent sexual contact with a person who has a proven infection, regardless of the test results of those people. This ensures that the bug does not have the chance to spread further, or back to the person who has just been treated, as one infection does not give you immunity. Being a ‘silent infection’ means that you can’t rely on the symptoms to know if you are infected. It is better to treat every potentially infected person to be on the safe side.

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Sex is generally about feeling excited and aroused, wanting to be intimate and physically close to someone, and to share those feelings. The someone may be of the same sex or the opposite sex to you.

It is not uncommon, in fact the people in the lab coats tell us that it is almost the rule, that at some stage in our lives we will be sexually attracted to someone of the same sex. We may act on it, and share sexual experiences with people of the same sex. This often happens during our childhood and teens, and is now seen as part of a normal sexual development. The attraction may persist into, or recur in, adult life and may co-exist with an attraction to the opposite sex.

The name given to sexual involvement and attraction towards someone of the same sex as yourself is homosexuality (also known as being ‘gay’, particularly when referring to homosexual men, and ‘lesbian’, specifically referring to homosexual women). If someone is attracted to both sexes the term used is bisexuality. Attraction exclusively to the opposite sex is heterosexuality. None of these ‘-alities’ is right or wrong. Certainly the heterosexual relationship is the one best designed to make babies.

Homosexuality can be a problem for some people. Fear, guilt and insensitivity are responsible for a lot of suffering. The person who realizes that she or he is homosexual or bisexual may cope well with that, or may not. The greatest problem is usually the reactions and prejudices of other people. Society has a tendency to alienate any individual or group which does not appear to fit in with preconceived perceptions of how to behave. Many people find the concept of homosexuality frightening, often through ignorance or their own insecurities perhaps. Because of this ‘minority group’ identity, some homosexual people find it useful to band together for support. AIDS, for example, has focused attention on gay men as an identifiable group in our society. The networks and lobby groups in the gay community have become more vocal and visible over the years.

Although we feel it would be difficult to obtain accurate statistics, it has been said that about 10 per cent of the adult (male and female) population are homosexual. There are no identifying marks and characteristics universal to homosexuals. They do not all fit a stereotyped image any more than heterosexuals do. There is the same diversity of personalities, lifestyles, talents, careers, and aspirations as within the heterosexual population. It is simply that when it comes to forming relationships and having sex about 10 per cent of the population will choose a person of the same sex as themselves.

There is no reason why homosexual relationships should be any less intense, important or enjoyable than heterosexual relationships. Our society is moving a little closer to accepting this. Instead of locking up homosexual people (as the law in some states of Australia still allows), homosexuality is gradually becoming much less of a thorny issue, and people are being allowed to get on with their lives.

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