35 year old woman comes with postcoital bleeding. What is the next step?
Please note...this answer is given as Pap smear in most guides. Pap smear is a screening test and here the patient is symptomatic and hence a diagnostic test is warranted. Even so, the sensitivity of the paps smear is the sensitivity of the Pap test in detecting CIN 2 or 3 ranged from 47% to 62% and the specificity ranged from 60% to 95% Do read this from Novaks Gynecology: ... Vaginal bleeding is the most common symptom occurring in patients with cancer of the cervix. Most often, this is postcoital bleeding, but it may occur as irregular or postmenopausal bleeding. ... Initially, all women suspected of having cervical cancer should have a general physical examination performed to include evaluation of the supraclavicular, axillary, and inguinofemoral lymph nodes to exclude the presence of metastatic disease. On pelvic examination, a speculum is inseed into the vagina, and the cervix is inspected for suspicious area ...When obvious tumor growth is present, a cervical biopsy is usually sufficient for diagnosis. If gross disease is not present, a colposcopic examination with cervical biopsies and endocervical curettage is warranted
PAP smear
Conisation
Cryotherapy
Colposcopic cervical biopsy
Cervical Carcinoma