title: After-effects reported by women having follow-up cervical cytology tests in primary care: a cohort study within the TOMBOLA trial.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  Cohort study nested with a multi-centre individually randomised controlled trial.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Institute of Applied Health Sciences, University of Aberdeen, Scotland, UK. s.c.cotton@abdn.ac.uk
authors.forename: Seonaidh
authors.initials: S
authors.lastname: Cotton
authors.forename: Linda
authors.initials: L
authors.lastname: Sharp
authors.forename: Claire
authors.initials: C
authors.lastname: Cochran
authors.forename: Nicola
authors.initials: N
authors.lastname: Gray
authors.forename: Maggie
authors.initials: M
authors.lastname: Cruickshank
authors.forename: Louise
authors.initials: L
authors.lastname: Smart
authors.forename: Alison
authors.initials: A
authors.lastname: Thornton
authors.forename: Julian
authors.initials: J
authors.lastname: Little
mesh_terms: D000328:Adult; D015331:Cohort Studies; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D010146:Pain / Q000209:etiology*; D016032:Randomized Controlled Trials as Topic; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*; D014592:Uterine Hemorrhage / Q000209:etiology*; D019522:Vaginal Discharge / Q000209:etiology*; D014626:Vaginal Smears / Q000009:adverse effects*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000517:prevention & control*