Colposcopy
A colposcopy is a procedure during which the surface of the cervix is closely examined using a magnifying instrument called a colposcope.
A specialist, called a colposcopist, performs the procedure to check the cells on the surface of the cervix for abnormalities.
Why do I need a colposcopy?
A colposcopy is usually carried out when the results of a cervical screening test (smear test) indicate there are abnormal changes in the cells of the cervix.
A colposcopy may also be used to investigate things such as unexplained vaginal bleeding (such as after sex), an inflamed cervix, and unexplained pelvic pain.
What happens?
During a colposcopy, you lie down in a special type of chair which has padded supports to rest your legs on. A device called a speculum is gently inserted into your vagina and opened to allow your colposcopist to see your cervix (the same as when you have a cervical smear test).
Your cervix is then examined with a colposcope. A colposcope is an instrument with a light and magnifying lens that stays outside your body and allows your colposcopist to see any abnormalities.
A small sample of tissue may also be removed for further testing during a process known as a biopsy.
The examination lasts about 20 minutes, but the whole appointment can take about an hour.
It is usually a painless procedure, although some women do find it uncomfortable. If you are concerned, you could take a painkiller, such as paracetamol, beforehand. However, do not take aspirin or ibuprofen as they may increase your chance of bleeding afterwards.
Results and treatment
The colposcopist can usually determine straight away if there are any cell abnormalities and whether treatment is required, although it may take a few weeks to get the results of a biopsy.
The extent of the abnormal cells will be graded on a scale of one to three, with three indicating the highest level of abnormality.Mild abnormalities do not always need to be treated, as they can improve without it.
If treatment is required, the aim is to remove abnormal cells, while preserving as much normal tissue as possible.
The most common treatment is large loop excision of the transformation zone (LLETZ). This is a quick procedure that involves using a heated loop of wire to remove the abnormal cells. This procedure usually only lasts a few minutes and can be done during a colposcopy.
The removal of abnormal cervical cells is almost always 100% successful and it is unlikely that any cell changes will occur in the future.
You may require treatment if the results of your colposcopy indicate abnormal cells in your cervix.
Treatment typically aims to remove the area of abnormal cells. This usually involves removing an area of the cervix about the size of a finger-tip.
The specific type of treatment recommended will depend on the number of abnormal cells in your cervix and how advanced the abnormalities are.
The aim of treatment is to remove the abnormal cells while minimizing damage to healthy tissue. Treatment is nearly always 100% successful, and it is unlikely cell changes will occur again.
Timing of treatment
It is often possible to have treatment at the same time as your colposcopy. This may be more convenient for you than having to make another appointment for treatment at a later date.
Some women find waiting for treatment causes anxiety, and prefer to be treated as soon as possible. Others prefer time to think about their treatment and schedule it for another time.
Some more intensive treatments cannot be done on the same day as a colposcopy. Your colposcopist will advise about the best time for your treatment to be carried out. They will also be able to discuss treatment options with you, and what each type of treatment involves.
Some available treatments are discussed below.
Cone biopsy
It is not possible to carry out a cone biopsy at the same time as a colposcopy. A cone biopsy is a minor operation that may require an overnight stay in hospital. It is carried out less commonly than LLETZ and is only really used if a large area of tissue needs to be removed.
A cone biopsy is carried out under general anaesthetic. A cone-shaped piece of tissue is cut away from your cervix with a scalpel. The section of tissue removed may include the whole area of cervix where the abnormal cells are located. The tissue will be sent to a laboratory for closer examination.
Following a cone biopsy, a piece of gauze (a dressing made of absorbent material) may be placed in your vagina to help stop any bleeding. If you require a gauze pack, you may also need a catheter inserted (a thin tube that drains urine from your bladder) as the pack can sometimes press on your bladder. You may need to stay in hospital overnight – please ask your doctor or nurse for more advice.
It is normal to bleed for up to four weeks after having a cone biopsy. You may also have some period-like pain, although any discomfort should only last for a couple of hours. Painkillers can be used to help ease the pain.
Take plenty of rest during the first week after having a cone biopsy. You will not need to stay in bed, but you should avoid tasks such as heavy lifting. Also, avoid vigorous exercise and having sex during the first four to six weeks after the biopsy. After this time, the tissue in your cervix should have healed.
While recovering from your operation you may also find it useful to arrange for a relative or friend to stay with you for a few days to help with difficult tasks.
Other treatments
Abnormal cells can be treated in several other ways, without removing them. Your doctor can give you more information and advice about the procedures briefly outlined below and whether they are appropriate to your circumstances.
Cryotherapy
Cryotherapy is a form of treatment that involves freezing and destroying any abnormal cells. During the procedure, you will lie on a couch and a doctor will insert an instrument called a speculum into your vagina. They will then freeze and destroy any abnormal cells.
During cryotherapy, liquid carbon dioxide is passed through a probe and directed at the abnormal cells. The tissue will be frozen for two to three minutes, and the process may be repeated if necessary.
You may feel period-like pain during cryotherapy, and for a short time after the treatment has finished.
Laser treatment
Laser treatment involves the doctor using a laser to pinpoint and destroy any abnormal cells on your cervix. A local anaesthetic will be used to numb the area being treated.
The abnormal area will be burned away using a hot beam of light produced by the laser. There may be a burning smell during this procedure, but this is normal and nothing to be worried about.
You can return home as soon as the laser treatment is finished.
Cold coagulation
Cold coagulation involves applying a heat source to the cervix that burns away and removes the abnormal cells. You may feel period-like pain during cold coagulation treatment, and for a short time afterwards.
Hysterectomy
A hysterectomy (surgical removal of your womb) will only be considered if abnormal cells on your cervix have been found more than once or if they are severely abnormal.
Removing your womb will usually only be an option if you have decided not to have any more children or you have had the menopause.
After treatment
Following treatment on your cervix, you are likely to be advised to avoid:
• using tampons for four weeks after your treatment
• having sexual intercourse for four weeks after your treatment
• going swimming for two weeks after your treatment
Ask your GP or call the clinic if you have any questions about the colposcopy examination, biopsy procedure, your results, or possible treatment options for abnormal cervical cells. Your GP or staff at the clinic will be able to answer any queries or discuss any of your concerns.
