{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T06:41:20Z","timestamp":1787380880140,"version":"build-2736575974"},"reference-count":24,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2009,7,7]],"date-time":"2009-07-07T00:00:00Z","timestamp":1246924800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2009,10]]},"abstract":"<jats:p><jats:bold>Objective\u2002<\/jats:bold> Few studies have investigated physical after\u2010effects of colposcopy. We compared post\u2010colposcopy self\u2010reported pain, bleeding, discharge and menstrual changes in women who underwent: colposcopic examination only; cervical punch biopsies; and large loop excision of the transformation zone (LLETZ).<\/jats:p><jats:p><jats:bold>Design\u2002<\/jats:bold> Observational study nested within a randomised controlled trial.<\/jats:p><jats:p><jats:bold>Setting\u2002<\/jats:bold> Grampian, Tayside and Nottingham.<\/jats:p><jats:p><jats:bold>Population\u2002<\/jats:bold> Nine hundred\u2010and\u2010twenty\u2010nine women, aged 20\u201359, with low\u2010grade cytology, who had completed their initial colposcopic management.<\/jats:p><jats:p><jats:bold>Methods\u2002<\/jats:bold> Women completed questionnaires on after\u2010effects at approximately 6\u2010weeks, and on menstruation at 4\u2010months, post\u2010colposcopy.<\/jats:p><jats:p><jats:bold>Main outcome measures\u2002<\/jats:bold> Frequency of pain, bleeding, discharge; changes to first menstrual period post\u2010colposcopy.<\/jats:p><jats:p><jats:bold>Results\u2002<\/jats:bold> Seven hundred\u2010and\u2010fifty\u2010one women (80%) completed the 6\u2010week questionnaire. Of women who had only a colposcopic examination, 14\u201318% reported pain, bleeding or discharge. Around half of women who had biopsies only and two\u2010thirds treated by LLETZ reported pain or discharge (biopsies: 53% pain, 46% discharge; LLETZ: 67% pain, 63% discharge). The frequency of bleeding was similar in the biopsy (79%) and LLETZ groups (87%). Women treated by LLETZ reported bleeding and discharge of significantly longer duration than other women. The duration of pain was similar across management groups. Forty\u2010three percent of women managed by biopsies and 71% managed by LLETZ reported some change to their first period post\u2010colposcopy, as did 29% who only had a colposcopic examination.<\/jats:p><jats:p><jats:bold>Conclusions\u2002<\/jats:bold> Cervical punch biopsies and, especially, LLETZ carry a substantial risk of after\u2010effects. After\u2010effects are also reported by women managed solely by colposcopic examination. Ensuring that women are fully informed about after\u2010effects may help to alleviate anxiety and provide reassurance, thereby minimising the harms of screening.<\/jats:p>","DOI":"10.1111\/j.1471-0528.2009.02263.x","type":"journal-article","created":{"date-parts":[[2009,7,8]],"date-time":"2009-07-08T02:28:25Z","timestamp":1247020105000},"page":"1506-1514","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":85,"title":["After\u2010effects reported by women following colposcopy, cervical biopsies and LLETZ: results from the TOMBOLA trial"],"prefix":"10.1111","volume":"116","author":[{"family":"The TOMBOLA (Trial Of Management of Borderline and Other Low","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2009,9,16]]},"reference":[{"key":"e_1_2_10_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.lgt.0000192695.93172.75"},{"key":"e_1_2_10_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2006.01160.x"},{"key":"e_1_2_10_4_2","article-title":"Biopsy and selective recall is as effective as immediate LLETZ in the management of women with low\u2010grade cervical smears referred for colposcopy","author":"The TOMBOLA Group","journal-title":"BMJ"},{"key":"e_1_2_10_5_2","first-page":"28","article-title":"Cone biopsy: a review of 112 cases","volume":"85","author":"Moore EJ","year":"1992","journal-title":"Ir Med J"},{"key":"e_1_2_10_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(74)90189-6"},{"key":"e_1_2_10_7_2","first-page":"701","article-title":"Healing experiences after cervical cryosurgery","volume":"49","author":"Harper DM","year":"2000","journal-title":"J Fam Pract"},{"key":"e_1_2_10_8_2","doi-asserted-by":"publisher","DOI":"10.3109\/01443619409004075"},{"key":"e_1_2_10_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1992.tb13714.x"},{"key":"e_1_2_10_10_2","doi-asserted-by":"publisher","DOI":"10.1080\/01443610410001648278"},{"key":"e_1_2_10_11_2","first-page":"76","article-title":"Complications of outpatient LLETZ procedures","volume":"49","author":"Dunn T","year":"2004","journal-title":"J Reprod Med"},{"key":"e_1_2_10_12_2","first-page":"731","article-title":"The use of large\u2010loop excision of the transformation zone in an inner\u2010city population","volume":"82","author":"Spitzer M","year":"1993","journal-title":"Obstet Gynecol"},{"key":"e_1_2_10_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/0029-7844(95)00453-X"},{"key":"e_1_2_10_14_2","doi-asserted-by":"publisher","DOI":"10.1006\/gyno.1994.1009"},{"key":"e_1_2_10_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(04)01712-7"},{"key":"e_1_2_10_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006250-200206000-00009"},{"key":"e_1_2_10_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2006.04.001"},{"key":"e_1_2_10_18_2","volume-title":"EORTC Quality of Life Group Guidelines for Developing Questionnaire Modules","author":"Blazeby J","year":"2002"},{"key":"e_1_2_10_19_2","volume-title":"Applied Logistic Regression","author":"Hosmer DW","year":"1989"},{"key":"e_1_2_10_20_2","unstructured":"StataCorpLP. Stata Statistical Software. Release version 10. College Station TX:StatCorp 2008."},{"key":"e_1_2_10_21_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000220505.18525.85"},{"key":"e_1_2_10_22_2","unstructured":"PaavonenP. Colposcopy Performance. Proceedings of the EUROGIN Conference; 2008 November 12\u201315; Nice. Paris:EUROGIN Scientific Secretariat 2008."},{"key":"e_1_2_10_23_2","unstructured":"The Information Centre for Health and Social Care. Cervical Screening Programme England 2007\/8. London:NHS 2009[http:\/\/www.ic.nhs.uk\/statistics\u2010and\u2010data\u2010collections\/screening\/cervical\u2010cancer\/cervical\u2010screening\u2010programme\u20102007\u201008\u2010%5Bns%5D]. Accessed 4 March 2009."},{"key":"e_1_2_10_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2004.11.021"},{"key":"e_1_2_10_25_2","unstructured":"NHS Cancer Screening Programmes.Cervical Screening: The Colposcopy Examination. 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