The Effects of Age and Number of Vaginal Births on the Adequacy of Colposcopic Examination: Implications for Cervical Cancer Prevention

The visualisation of the new squamocolumnar junction (SCJ) is critical for the screening, colposcopy and treatment of cervical pre-invasive disease. Several factors influence the visualisation. In this study, we assessed the effects of age and vaginal birth on the visibility of the SCJ. In this study, 9406 women aged 30–49 years had vaginal self-sampling, and the samples were tested for high-risk human papillomavirus (HPV) using the digene hybrid capture-2 (R) (HC2). The socio-demographic data of participants and all consenting HPV-positive women were triaged on colposcopy. The data were analysed using SPSS version 22. There were 1630 (17.3%) HPV-positive women, 1400 (85.6%) consented to colposcopy and 1392 (99.4%) had complete records. At colposcopy, SCJ was visible, partially visible and not visible in 61.6%, 8.5% and 29.9%, respectively. The SCJ was visible in 71.8% of women of age group 30–34 years, 67.9% of 35–39 years, 53.3% of 40–44 years and 45.2% of 45–49 years. The SCJ visibility was 41.9% in women with no previous VB, 61.7% with one VB, 66.1% with two VB, 67.2% with three VB and 69.5% and 64.7% with four and more than five VB, respectively. Multiple regression analysis showed significant effects of age and number of VB on SCJ visibility ( p = 0.000) for both (95% confidence interval). The relationship between SCJ visibility and advancing age was indirect, whereas it was direct with the number of VB up to the fourth. Both must be considered when selecting women for cervical cancer screening.