Colposcopy after cervical dysplasia: psychological aspects

The aim of this thesis was to conduct a prospective investigation of anxiety and its long-term effects on women referred for colposcopy after an abnormal cervical smear. The thesis comprises four articles, all based on a study of the current life situation, anxiety (Spielberger's state-trait anxiety inventory, STAI), depression (Montogomery Isberg Depression Rating Scale self-rate), psychosexuality, and quality of life (Health Survey Short Form-36) in 100 women referred for colposcopy and at follow-up six months and two years later. Upon referral for colposcopy, women exhibited high state anxiety levels and 52% feared they had cancer. By the time of the six-month follow-up visit, anxiety levels were comparable to the reference group. Women with high initial depression scores had a nine-fold risk of high state anxiety. At the end of two years, those with the highest initial depression scores still scored high on state anxiety and depression. At their first baseline visit, women scored low on all health-related mental subscales of QoL; two years later, vitality was still lower than normative data. The physical subscales, however, were comparable to normative data at all three visits. Two years after referral for colposcopy, women still reported experiencing a negative impact on their sexual functioning i.e., lower "spontaenous interest" in sex and a decrease in "frequency of intercourse". In conclusion, the most important risk factor for high state anxiety upon referral for colposcopy was a depressive mood. Treatment with LWWP had no effect on either anxiety, depression, sexual functioning, or quality of life. After two years, women with an initially depressed mood still had state anxiety levels and depression scores significantly higher than normal, and low levels on the assessment of their mental quality of life.