Abstract

Colposcopy is a relatively common invasive outpatient medical procedure performed to detect and treat cervical dysplasia. The aims of this study were to describe women’s physical and psychological symptom experience during and following colposcopy and to explore sociodemographic and psychological predictors of symptom experience. Seventy women were recruited from a colposcopy clinic. Participants were predominantly single, Caucasian, and employed but uninsured. The sample had a mean age of 30 years and an average educational level of 12 years. Prior to the procedure, participants completed a demographic questionnaire and measures of general psychological distress, cancer-specific distress, coping style, and perceived cervical cancer risk. Following colposcopy, participants rated their levels of discomfort, pain, and anxiety during and after the procedure. Women reported moderate levels of discomfort, pain, and anxiety which decreased significantly post-colposcopy. Older age and being an ethnic minority correlated with significantly lower ratings of discomfort, pain, and anxiety. Regarding psychological measures, higher baseline general and cancer-specific distress predicted higher ratings of anxiety and pain following colposcopy. Also, elevated perceived cervical cancer risk correlated with higher ratings of discomfort and anxiety during and following colposcopy. Overall, results suggest women experience significant levels of anxiety, pain, and discomfort during colposcopy but symptoms decline relatively rapidly postprocedure. Interestingly, distress and perceived cancer susceptibility were risk factors for a more dramatic symptom profile. Future research will examine predictors of adherence to recommended clinical follow-up.

Introduction

Study Aims

• The primary aim of the current investigation is to describe women’s physical and psychological symptom experience during and following colposcopy.
  
• The secondary aim is to explore sociodemographic and psychological predictors of the symptom experience.
  

Method

Study Design

• Sample (n=70)

• Women presenting to University of Louisville Colposcopy Clinic for a colposcopy procedure
• Pre-colposcopy questionnaire
• Sociodemographic variables
• Psychosocial instruments
• Post-colposcopy questionnaire
• Symptom experience during colposcopy
• Symptom experience following colposcopy

Sample Description

Age: Mean = 29.61 yrs (SD = 9.95)

Education: Mean = 11.90 yrs. (SD = 1.66)

Race
Caucasian: 43 (61.4%)
African-American: 25 (35.7%)
Hispanic: 1 (1.4%)
Asian: 1 (1.4%)

Marital status
Partner: 13 (18.6%)
No Partner: 56 (80.0%)
Other: 1 (1.4%)

Children
No: 19 (27.1%)
Yes: 51 (72.9%)

Household income
$10,000 or less: 31 (44.3%)
$10,001-20,000: 22 (31.4%)
$20,001-30,000: 6 (8.6%)
$30,001-40,000: 5 (7.1%)
$40,001-50,000: 4 (5.7%)
$50,001-60,000: 0
over $60,000: 1 (1.4%)
Missing values: 1 (1.4%)

Job status
Employed: 46 (65.7%)
Unemployed: 24 (34.3%)

Insurance type
Medicare: 3 (4.3%)
Medicaid: 6 (8.7%)
Private: 5 (7.2%)
HMO/PPO: 8 (11.6%)
None: 47 (68.1%)

Variables/Measures

Independent Variables

• Sociodemographic characteristics
  
• Psychological Measures
  
• POMS-SF (General Psychological Distress)
  
• Impact of Events Scale (Cancer-specific Distress)
  
• MBSS-SF (Information Coping Style)
  
• Perceived Cervical Cancer Risk (Perceived Risk)

• Discomfort during and after colposcopy
  
• Pain during and after colposcopy
  
• Anxiety during and after colposcopy
  
• Overall satisfaction with Colposcopy

Analyses

• Paired t-test analysis of symptom ratings during and after colposcopy
  
• Bivariate correlations of demographic, psychological and social predictors with symptom ratings and satisfaction with colposcopy
  

Results

Reported Symptoms During and Post-colposcopy (average rating on a scale of 0-10)

Discomfort
During: 4.64
Post: 3.58

Pain
During: 4.27
Post: 3.34

Anxiety
During: 4.61
Post: 2.79

* p <.001 for differences in all reported symptoms “during colposcopy” and “post-colposcopy”

Significant Correlations (Pearson’s) Showing Predictors of Symptoms During and Post-Colposcopy

Age
Discomfort During: -.309 (p<.05)
Discomfort Post:  -.282 (p<.05)
Pain During: -.275 (p<.05)
Pain Post: -.036 (p<.05)
Anxiety During: -.297 (p<.05)
Anxiety Post: -.331 (p<.01)

Minority
Discomfort Post: -.240 (p<.06)
Anxiety Post: -.279 (p<.05)

IESAVOID
Pain Post: .247 (p<.05)
Anxiety During: .309 (p<.05)
Anxiety Post: .321 (p<.01)

IESTOT
Pain Post: .252 (p<.05)
Anxiety During: .291 (p<.05)
Anxiety Post: .286 (p<.05)

POMSAD
Discomfort Post: .239 (p<.06)
Pain Post: .260 (p<.05)
Anxiety Post: .245 (p<.05)

POMSAC
Anxiety Post: .254 (p<.05)

Perceived  Cervical Cancer Risk %
Discomfort Post: .327 (p<.01)
Anxiety Post: .237 (p<.06)

Conclusions

• Older age and being an ethnic minority correlated with significantly lower ratings of discomfort, pain, and anxiety.
• Higher baseline general and cancer-specific distress predicted higher ratings of anxiety and pain following colposcopy.
  

Limitations

• The sample size of 70 women may have been too small to detect subtle predictors of anxiety, pain, and discomfort.
• Women were questioned retrospectively with regard to the symptoms of pain, anxiety, and discomfort that they experienced during colposcopy. Retrospective report of symptoms may not correspond to the true symptoms experienced during the procedure.