Colposcopy

A colposcopy is a procedure during which the surface of the cervix is closely examined using a magnifying instrument called a colposcope.

Contents

Introduction

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.

Read more about why colposcopy is used.

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.

Read more about what happens during a colposcopy.

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.

Read more about colposcopy results.

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.

Read more about colposcopy treatments.

Treatment

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 minimising 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.

Large loop excision of the transformation zone (LLETZ)

In the UK, large loop excision of the transformation zone (LLETZ) is the most common treatment for abnormal cervical cells. LLETZ is also known as loop diathermy, loop cone, loop biopsy, or loop excision.

LLETZ can sometimes be carried out at the same time as a colposcopy and involves cutting out the area of the cervix where abnormal cells have developed. This is done using a thin wire loop that is heated with an electric current. A small ball electrode is used to seal the wound.

LLETZ usually takes 5-10 minutes. A local anaesthetic is usually used to numb the area, this is injected into your cervix with a needle. The procedure is not usually painful, although you may feel some pain similar to period pain.

If a larger area of the cervix needs to be treated, the procedure will take longer and you may need a general anaesthetic.

You will need to bring a sanitary towel with you as you will bleed after having LLETZ. You may also have some light bleeding for several weeks after the procedure.

After having LLETZ, you should avoid:

  • using tampons for four weeks (use sanitary pads instead)
  • having sexual intercourse for four weeks
  • heavy exercise for two to three weeks

These all increase your risk of developing an infection after the procedure has been carried out.

There is some evidence to suggest women who are treated with the LLETZ procedure have an increased risk of premature birth in future pregnancies. However, in most cases, the benefits of treatment will greatly outweigh this small risk. Your doctor can advise further about this if necessary.

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 doctor 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 doctor or staff at the clinic will be able to answer any queries or discuss any of your concerns.

How it is performed

A colposcopy is usually a straightforward, safe and pain-free procedure.

Preparing for a colposcopy

If your cervical screening test reveals cervical cell changes, your doctor – or the laboratory that carried out the test – will refer you for a colposcopy examination. This will be carried out at your nearest colposcopy clinic, usually in the outpatients department of your local hospital.

You may not be able to have a colposcopy if you are on your period, because this may make it harder to accurately assess the cells in your cervix. If your period starts when you are due to have your colposcopy, ask the colposcopy clinic whether it will need to be rescheduled. A colposcopy can be performed during pregnancy.

If you are on a combined oral contraceptive pill (also called the pill) and a colposcopy is due to coincide with your period, then continue onto the next packet of pills without a break. This should mean you are free of bleeding for your appointment.

If you have an intrauterine contraceptive device fitted such as a coil, IUCD or IUS you should refrain from intercourse or use barrier methods, such as condoms, in addition for at least five days before your colposcopy appointment as it may occasionally be necessary to remove your device during your examination.

If you feel nervous about having a colposcopy, it may be possible for a friend or relative to be present to help you feel more at ease.

For at least 24 hours before your colposcopy you should avoid:

  • using a tampon
  • using vaginal creams or pessaries (medication that is inserted into the vagina)
  • having sexual intercourse
  • washing directly inside your vagina (douching)

You may receive some written information about the colposcopy procedure from your colposcopy unit before your appointment.

Before the colposcopy

Before having a colposcopy, your colposcopist (a specially trained doctor or nurse) will explain the procedure to help put you at ease. They will also ask you questions about your:

  • periods
  • the type of contraception you are using
  • your general health

You will be asked to undress from the waist down. If this makes you feel uncomfortable, you might want to wear a loose skirt that can be lifted up without having to take it off.

Try not to feel embarrassed about having a colposcopy. Although this type of procedure may make you feel self-conscious, it is important to remember your colposcopist and will be used to examining women in this way.

During the colposcopy

A nurse will help you into position on a special type of chair which has padded supports for your legs. During the procedure, you will lie on your back with your knees drawn up and your legs apart. If you are uncomfortable lying in this position, your colposcopist may be able to perform the procedure while you are lying on your side with your knees drawn up towards you.

An instrument called a speculum will be gently inserted into your vagina to hold it open and allow the colposcopist to access your cervix. They will then use a colposcope to examine your cervix.

A colposcope is a magnifying instrument that has a light source attached to it and looks similar to a pair of binoculars. The colposcope does not touch you or go inside you; it just allows the colposcopist to examine the cells inside your cervix. In some cases, photos of your cervix may be taken for your medical records.

Recently, the National Institute of Health and Care Excellence (NICE) announced a new type of colposcope could be used by the NHS. The new colposcope uses a sophisticated video camera held in place outside your body by a special type of speculum. This technology should help with a faster and more accurate diagnosis.

Your colposcopist may put liquid directly onto your cervix (using a cotton swab) to help them see any abnormal cells more clearly. Any abnormal cells will show up as a different colour. The solutions that may be used are:

  • acetic acid (a vinegar-like solution)
  • an iodine solution

You should tell the colposcopist if you have an allergy to iodine. When the liquid is applied to your cervix you may feel a slight tingling or burning sensation. This will only be mild, and most people do not feel any burning at all.

If abnormal cells are found, a small tissue sample (biopsy) may be taken from your cervix. This should not be painful, although you may feel a slight stinging sensation. If necessary, you may be given a local anaesthetic to numb the area. During a biopsy, tiny pieces of your cervix (about the size of a grain of rice) are removed and sent to a laboratory for testing.

If your colposcopist is relatively certain abnormal cells are present on your cervix they may recommend treatment straight away rather than a biopsy.

Read more about colposcopy treatment.

It usually takes around 20 minutes for your cervical investigation to be carried out, but allow about an hour for the whole visit.

After the colposcopy

You will usually be able to go home or back to work straight after having a colposcopy. Following the examination and for a few days afterwards you may have a slight brown or black vaginal discharge. You may want to bring a sanitary towel with you to use after the examination.

Seek advice from your doctor if, after having a colposcopy, you experience:

  • a high temperature (fever) of 38ºC (100.4ºF) or above
  • bright red heavy vaginal bleeding (where you need to use one sanitary pad or more an hour)
  • severe cramps and lower tummy pain
  • chills

These symptoms may indicate the presence of an infection.

It is usually recommended that you wait until any bleeding stops before having sex or using tampons, vaginal creams and pessaries.

Follow up appointments

Following a colposcopy, you will usually need to attend a check-up appointment to ensure cells in your cervix have returned to normal. You will usually have a check-up appointment four to six months after having a colposcopy.

As part of the check-up you may need a cervical smear test (where a sample of cells is taken from your cervix), a human papilloma virus (HPV) test, or you may need another colposcopy. You may also need a further check-up appointment six months later.

Results

After a colposcopy, the colposcopist will have an idea straight away whether you have abnormal cells in your cervix.

If they are unsure, a biopsy may need to be carried out.

In some cases, it may be possible for the abnormal cells to be treated during your colposcopy.

Biopsy results

If you have had a biopsy during your colposcopy, the tissue sample will be sent to a laboratory for testing. Testing will help determine the extent of the cell changes in your cervix. You usually have to wait several weeks for your biopsy results. You will then be asked to return to the clinic to discuss them.

The medical term for abnormal cervical cell change is cervical intra-epithelial neoplasia (CIN). CIN is not cancer, however, CIN cells can sometimes develop into cancerous cells.

In some cases, cell abnormalities are detected in the glandular cells found in the inside lining of the cervix. These abnormalities are known as cervical glandular intra-epithelial neoplasia (CGIN). CGIN is less common than CIN.

The detection of CIN or CGIN does not necessarily mean you have or will develop cancer.

Grading CIN and CGIN

CGIN is usually classed as either low grade or high grade. High grade CGIN is the equivalent on CIN 3 (see below).

Doctors use a CIN scale ranging from 1 to 3 to classify how many cervical cells are abnormal. The scale is described below.

CIN 1

CIN 1 cells indicate that up to a third of cells in the affected area of your cervix are abnormal. Your specialist will advise about the best course of treatment. Treatment is not always recommended for CIN 1 because the cells return to normal without treatment in about 60% of cases.

CIN 2

CIN 2 cells indicate that up to two thirds of cells in the affected area of your cervix are abnormal. If you have CIN 2 cells, you will usually need to have these removed.

CIN 3 or CGIN

CIN 3 or CGIN cells indicate that all of the cells in the affected area of your cervix are abnormal. If this is the case, these cells will need to be removed.

In rare cases, a biopsy will show that some of the abnormal cells in your cervix have become cancerous. If this is the case, you will need to have further tests and your specialist will arrange any necessary treatment as soon as possible.

Repeat colposcopy

Depending on your colposcopy or biopsy results, you may need treatment immediately or you may need a repeat colposcopy:

  • If you have CIN 1 cells, you will need a repeat colposcopy every six to 12 months to monitor the cells and see whether further treatment is required.
  • If you have CIN 2 or 3 cells, immediate treatment is usually recommended.

CIN and CGIN are treated in exactly the same way.

Read more about colposcopy treatment.

Why it is used

In most cases, a colposcopy is carried out after an abnormal cervical screening test result.

Cervical screening

A cervical screening test is a routine test to check the health of a woman’s cervix (the neck of the womb). Sometimes, cells on the surface of the cervix start to develop abnormally and may become cancerous months or years later. In a small number of cases, abnormal cervical cells can be an early sign of cervical cancer. In many cases, this abnormal cell development is caused by the human papilloma virus (HPV), a common sexually transmitted virus.

Regular cervical screening helps ensure any cell changes are picked up early, and treatment – if required – is started as soon as possible. Treatment at this stage, involving the removal of any abnormal cells, is highly successful in preventing cervical cancer from ever occurring.

Around nine out of 10 cervical screening tests do not reveal any cell abnormalities in the cervix.

About one in 20 tests reveal mild cervical cell changes, most of which do not need treatment because they return to normal by themselves. If your test shows only mild changes, the sample will be examined for HPV viruses that can be associated with a risk of developing cervical cancer. If high risk HPV is found, you will be referred for a colposcopy as a precaution. If high risk HPV is not found in your sample, you will usually not need a colposcopy.

Approximately one in 100 cervical screening tests indicate moderate cell changes and one in 200 indicate severe cell changes. If you have either moderate or severe cell changes, you will be referred for a colposcopy and you may need treatment.

Less than one in 1,000 tests reveal invasive cancer that requires immediate referral to a specialist.

Read more about cervical screening tests.

Further investigation

Although abnormal cervical screening results rarely indicate cancer, it is important to fully investigate all moderate and severe abnormal cell changes so any problems can be diagnosed and treated as soon as possible.

You may be referred for a colposcopy as a precaution if three consecutive samples from a cervical screening test have given insufficient information about changes in your cervical cells.

A colposcopy allows a colposcopist to look more closely at your cervix and the cells that line it. This will give them a much clearer idea of how advanced the cell changes are.

It is important to be aware that a colposcopy is not a treatment for cervical cell changes; it is simply a way of enabling cell changes to be examined in more detail. However, treatment is often performed at the same time if abnormal cells are detected.

Other reasons for a colposcopy

A colposcopy is sometimes used to investigate a problem or condition other than abnormal cervical cell changes. For example, a colposcopy may be used to investigate:

  • unexplained vaginal bleeding (such as after sex)
  • unexplained pelvic pain
  • an abnormal appearance of the cervix after an examination
  • an inflamed cervix (cervicitis)
  • benign (non-cancerous) growths, such as polyps
  • genital warts found on the cervix
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