Colposcopy – Everything You Need to Know
05 April 2019 by - Dr Pandelis Athanasias
A colposcopy is a simple examination which is carried out to examine the cervix in more detail. People are referred for a colposcopy when they are found to have abnormal cells, as a result of a routine cervical screening (sometimes referred to as a smear test).
In most cases, abnormal cells are not harmful and will normally disappear on their own, but, it is important to examine them further to minimise the risk of the cells developing into cervical cancer down the line. A colposcopy is, therefore, essential in helping confirm whether the cervical cells are abnormal and require treatment to remove them.
Why are colposcopies carried out?
A doctor may refer a patient for a colposcopy for the following reasons:
- The cells taken in their cervical screening have come back abnormal
- The nurse or doctor who has carried out the cervical screening thought the patient’s cervix did not look as healthy as it should have
- The cervical screening did not give a clear test result
In some circumstances, patients may also be referred for a colposcopy when they are experiencing abnormal vaginal bleeding, for instance, bleeding after intercourse.
What happens when a patient goes for a colposcopy?
If you have received an abnormal cervical screening result (abnormal smear), or a nurse or doctor has visibly seen changes on your cervix, then you will most likely be invited to attend a colposcopy. This is carried out to take a more detailed look at the cervix, using a special microscope that allows the practitioner to view any cell changes in greater detail.
Colposcopies are normally carried out at a hospital or colposcopy clinic and they will last about 15-20 minutes. No longer stay is necessary, and patients can go home afterwards. A colposcopist – a nurse or doctor who is trained specifically to undertake colposcopies – will carry out the procedure.
The procedure is quick and should cause any pain. First, the patient is required to undress from the waist down, though if a loose fitting dress or skirt is worn, it may not need to come off. The patient then lies down on a padded chair which supports the legs and a speculum is inserted and opened (this is the same device used when taking the initial cervical screen test at a clinic). The colposcopist then uses a microscope with a light attached to look at the cervix in better detail. This instrument will not enter the patient’s body – only the speculum will. Several liquid solutions will be applied to the cervix in order to test for abnormal cell changes.
In some cases, a small sample of tissue (biopsy) will be taken from the cervix for later examination at a laboratory. The results of this sample will determine whether treatment is necessary.
Sometimes, the colposcopist is able to tell a patient right away that treatment is needed, in which case, they may be able to receive the treatment to remove the abnormal cells on the same clinic visit.
If the results are not clear, the patient may need to wait until the biopsy results come back.
How do patients prepare for a colposcopy?
Patients are advised to avoid sexual intercourse or using tampons, creams or lubricants in the vagina for at least 24 hours prior to the appointment. Eating or drinking beforehand is okay.
Bringing a pad with you to the clinic is recommended, since patients typically experience some bleeding or discharge afterwards.
It is important to contact the clinic performing the colonoscopy if you are pregnant, because taking a biopsy or receiving treatment should be delayed until after the baby is born (usually a few months). Undergoing the colposcopy itself is safe while pregnant.
Moreover, if you think your period will be due when your appointment takes place, it might be worthwhile to postpone it, though this is not usually necessary.
Patients are welcome to bring a friend or family member with them to the clinic if it will help them relax.
Is there a recovery period?
A colposcopy is carried out quickly and should not be painful. Patients are able to go home afterwards, as long as they feel up to it. There is no downtime needed after a colposcopy and patients are able to return to normal day-to-day activities immediately, though many people choose to rest for a day or two afterwards.
A light, brownish discharge or light bleeding is normal for 3-5 days for those who have had a biopsy taken. It is important to wait until the bleeding stops before using tampons again or having sexual intercourse, or using any vaginal lubricants.
Does the colposcopy procedure carry any risks?
This procedure is undertaken frequently and is very safe. There are no serious risks associated with it, although in some cases patients might experience a little discomfort or pain, vaginal discharge or light bleeding.
If you experience persistent bleeding, or bleeding that is heavier than normal, smelly discharge or abdominal pain, you must contact your doctor immediately.
What are the results of a colposcopy? If a biopsy is performed, patients may need to wait for their results, which can take up to 4-8 weeks and results will typically be sent via post.
The result of a colposcopy and/or biopsy will be one of two things:
- Normal – There were no abnormal cells found and no immediate action is required. About 4 in 10 women receives this result. However, patients with no abnormal cells should still keep attending their cervical screening within the normal timeframes – every three years if aged 25-49; every five years if aged 50-64.
- Abnormal – Treatment may be necessary to remove the abnormal cells. About 6 in 10 women will have abnormal cervical cells (CIN). If you receive this result, it does not mean you have cancer, but there is a risk that cancer could develop if left untreated.
What are CIN grades?
When discussing the result of a colposcopy and/or biopsy, the doctor or nurse may use the term CIN. This is the medical terminology used to describe abnormal cells. CIN stands for Cervical Intra-epithelial Neoplasia and is followed by a numerical digit, for, CIN 1. The higher the number, the higher the risk of the abnormal cells developing into cancer if they are not removed.
What treatments are carried out to remove abnormal cells?
Patients may be referred for treatment to remove the abnormal cells if there is a moderate or high chance of them developing into cancer if they are left untreated. Removing these cells means they will not be able to develop into cancer.
There are several treatment options, but the two most common forms are:
- Large loop excision of the transformation zone (LLETZ) – This is a straightforward procedure which involves using a thin heated wire loop to remove the abnormal cervical cells, whilst preserving as much of the healthy cervix as possible. A LLETZ procedure may be carried out straight after a colposcopy if it is extremely clear that the patient has abnormal cells that need to be removed. Patients are awake, but their cervix is numbed, and they can usually go home on the same day.
- Cone biopsy – This is less common than LLETZ and is usually only carried out where a larger area of tissue requires removal. It involves using a cone-shaped piece of tissue to capture the abnormal cells, then cutting it out from the cervix. This is normally carried out under general anaesthetic and patients will need to stay overnight at the hospital. Patients will need to come back for this treatment as it is not carried out after a colposcopy.
What happens after treatment?
It is recommended that patients rest after the treatment is complete, though many people will feel they are well enough to return to work and normal activities the following day.
Patients are advised to avoid using tampons (use pads instead) and having sex for four weeks afterwards. Exercise and swimming is best avoided for at least two weeks, or at least while there is still discharge or bleeding taking place.
Patients should not drive for at least 24 hours after the procedure, especially if they have had general anaesthetic. It is better to have someone pick you up from the clinic.
It is important to undergo another cervical screening six months after the treatment. This will check that the abnormal cells have gone, as well as checking for HPV. If HPV or significant cell changes are discovered, the patient should undergo another colposcopy. If HPV is not found, then a cervical screening will not be necessary for another three years, as normal.