Physical after-effects of colposcopy and related procedures and their inter-relationship with psychological distress: a longitudinal survey

OBJECTIVES: To estimate prevalence of post-colposcopy physical after-effects and investigate associations between these and subsequent psychological distress. DESIGN: Longitudinal survey. SETTING: Two hospital-based colposcopy clinics. POPULATION: Women with abnormal cytology who underwent colposcopy (+/- related procedures). METHODS: Questionnaires were mailed to women 4-, 8- and 12-months post-colposcopy. Details of physical after-effects (pain, bleeding and discharge) experienced post-colposcopy were collected at 4-months. Colposcopy-specific distress was measured using the Process Outcome Specific Measure at all time-points. Linear mixed effects regression was used to identify associations between physical after-effects and distress over 12-months, adjusting for socio-demographic and clinical variables. MAIN OUTCOME MEASURES: Prevalence of post-colposcopy physical after-effects. Associations between presence of any physical after-effects, awareness of after-effects and number of after-effects and distress. RESULTS: 584 women were recruited (response rate=73%, 59% and 52% at 4, 8 and 12-months, respectively). 82% of women reported one or more physical after-effect(s). Multiple physical after-effects were common (two after-effects=25%; three after-effects=25%). Psychological distress scores declined significantly over time. In adjusted analyses, women who experienced all three physical after-effects had on average a 4.58 (95% CI 1.10 to 8.05) higher distress scored than those who experienced no after-effects. Women who were unaware of the possibility of experiencing after-effects scored significantly higher for distress during follow-up. CONCLUSIONS: Prevalence of physical after-effects of colposcopy and related procedures is high. The novel findings of inter-relationships between awareness of the possibility of after-effects, and experiencing multiple after-effects, and post-colposcopy distress may be relevant to the development of interventions to alleviate post-colposcopy distress