HPV and abnormal smear: screening, monitoring and treatment at the practice, in Paris 16th

Frequently asked questions

Your questions, our answers

I am HPV positive — should I worry?

Not in the sense of an emergency. HPV is very common and, most of the time, the body clears it on its own. A positive test means the cervix needs a closer look and monitoring over time: it is the persistence of the virus that leads to lesions.

Does colposcopy hurt?

The examination is like a slightly longer smear test: the speculum stays in place for a few minutes and the solutions sometimes sting. It is generally well tolerated. The biopsy causes a brief pinch; light bleeding over the following days is usual.

Do all lesions need treatment?

No. A low-grade lesion, confirmed by colposcopy, most often regresses on its own: we monitor it. High-grade lesions are treated, because over the years they can progress to cervical cancer: by conisation as a rule, or by laser vaporization at the practice when the lesion lends itself to it — small, fully visible at colposcopy, with no sign of severity on the biopsy.

Laser or conisation?

Laser destroys the lesion without removing tissue; it suits some lesions, fully visible at colposcopy and with no sign of severity on the biopsy. It spares the cervix more for a future pregnancy; close surveillance follows, because the lesion can come back slightly more often than after conisation. Conisation removes the lesion and allows it to be analyzed in full; it is chosen when the lesion extends into the cervical canal or when complete analysis of the tissue is needed. The choice is made with you, based on the images and the biopsy.

Can I still have children after a conisation?

Conisation preserves the uterus: pregnancy remains possible. Because the cervix is shortened, a subsequent pregnancy is monitored more closely. This point is discussed with you before the procedure, according to your plans, and the College's information sheet covers it in detail.

Should my partner be examined?

HPV circulates very widely: within a couple, both partners have most often shared it. There is no routine HPV screening for men; visible genital warts, on the other hand, should be shown to a doctor. Raise it at the consultation.

Is it covered by health insurance?

In part. Consultation, smear test, HPV test, colposcopy, biopsy and conisation are partly covered by the French health insurance (Assurance maladie). The practice applies direct billing to the French national health insurance (tiers payant): with an up-to-date carte Vitale, you do not pay that part upfront. What remains payable by you includes the excess fee (dépassement d'honoraires), which may be reimbursed by your complementary insurer (mutuelle), depending on your policy. For laser procedures, coverage depends on the indication; the quotation given at the consultation specifies it for your case. The full picture is in “Fees and reimbursement”, further down.

What is the recovery after a conisation?

You go home the same day. The CNGOF information sheet states that conisation causes no post-operative pain, at most passing discomfort like a painful period, and that bleeding remains possible for the 15 days that follow; continuous bleeding, or bleeding heavier than a period, means seeking advice straight away. Dr Gatri asks you to wait 4 weeks for a bath, the swimming pool and intercourse; the CNGOF sheet gives 20 days for demanding sport.

What happens if a cervical lesion is left untreated?

A low-grade lesion most often regresses on its own, and monitoring is enough. For a high-grade lesion the CNGOF information sheet is clear: left untreated, these lesions can develop over several years into cancer of the cervix, which is what justifies removing the affected portion of the cervix. Once treated, the lesion is gone, and the sheet states that progression to cancer becomes exceptional.

How do I book?

On Doctolib, with Dr Gatri: “Colposcopie” for an abnormal smear or a positive HPV test, “Consultation avec frottis” for screening, “Consultation pour conisation du col” when conisation has been proposed; laser sessions are scheduled afterwards. Or by telephone through the secretariat.