Colposcopy

What is colposcopy?

What is the difference between colposcopy and a cervical screening test?

A cervical screening test is offered regularly to all women to look at the chance of you developing cervical cancer (cancer of the cervix). A sample of cells is taken from your cervix using a brush or a wooden instrument called a spatula. The sample is then sent to the laboratory so that the cells can be examined under a microscope.

Abnormal changes in the cells are found in some women. These abnormal changes are known as dyskaryosis. In the vast majority of cases, an abnormal result does not mean cervical cancer. However, the presence of dyskaryosis indicates that cancer may develop at some time in the future. The abnormal cells are essentially 'pre-cancer' cells.

A cervical screening test shows if abnormal cells are present but does not show enough detail about the cells. Colposcopy allows a closer and more detailed look at these abnormal cells.

During colposcopy, the extent of the area where the abnormal cells are present is shown. This is done by applying a special solution to your cervix that 'stains' the abnormal cells. Colposcopy also allows a biopsy (a sample of tissue) to be taken. This sample is then sent to the laboratory for further tests. This means that the exact type of abnormality in the cells can be identified.

A cervical screening test can be performed more quickly and needs less training than colposcopy. This means that it is a more suitable test to look for pre-cancer changes in the cervix in large groups of people. There is a separate leaflet on the Cervical Screening Test.

Why do I need a colposcopy?

The usual reason for having a colposcopy is because you have had an abnormal cervical screening test result. This is not something unusual. About one in ten cervical screening tests are abnormal.

Sometimes you can be referred for a colposcopy because you have had a number of 'inadequate' cervical screening tests in a row. This can happen if there was too much blood or too much mucus present around your cervix at the time of your cervical screening test. Because of this, the cells could not be seen clearly under the microscope.

Rarely, you can be referred for a colposcopy because the doctor or nurse carrying out your cervical screening test is worried about infection, inflammation or a polyp (a non-cancerous growth) around the neck of your womb.

Before your colposcopy

There are some things that you should think about before your colposcopy that can help you prepare:

• You should not have a colposcopy if you have your period. If this is the case, you should call the clinic and re-arrange the appointment.
• You should avoid sex and not wear a tampon for 24 hours before your colposcopy.
• You should not use any vaginal creams or pessaries for 24 hours before your colposcopy.
• Some people find the colposcopy examination a little uncomfortable. For this reason, you may choose to take some paracetamol about an hour before your appointment.
• You may want to wear a skirt on the day of your colposcopy so that you do not have to remove all of your lower clothing.

What should I expect when I have my colposcopy?

The whole colposcopy procedure normally takes about 15-20 minutes. This may be longer if you have treatment at the same time (see below).

1. The doctor or nurse will usually start by asking you some questions. These may include information about your periods, the date of your last period, what contraception you use and your general health.
2. You will then be asked to remove your clothing from the waist down. (You can usually keep a loose skirt on.)
3. You will usually be asked to lie in a reclining chair, or on a couch, in the same position as during a cervical screening test. This is with your knees bent and your legs apart. In some clinics your legs may be placed apart in padded supports called stirrups.
4. The doctor or nurse will insert an instrument called a speculum (the same instrument that is used during a cervical screening test) into your vagina. This gently opens the vagina and means that the doctor or nurse is able to see the cervix at the top of the vagina.
5. The doctor or nurse will then look through the colposcope to get a good view of your cervix. The colposcope itself does not go inside your vagina. It is essentially like a big pair of binoculars on a stand that can be moved around. There is also a light to help the doctor or nurse see inside your vagina. Sometimes, the colposcope can be attached to video equipment so that the doctor or nurse (and you if you would like) can view your examination on a screen.
6. The doctor or nurse will then use a long cotton bud to apply a special solution to your cervix. This solution stains any abnormal cells that may be present. Two different solutions are normally applied to your cervix. These solutions are called acetic acid and iodine.
7. The doctor or nurse may also take a biopsy (a small sample of tissue) from your cervix. This will be sent to the laboratory for further examination. This may be slightly uncomfortable. The biopsy is only about the size of a pinhead. Some doctors and nurses inject a local anaesthetic into your cervix before they take a biopsy.
8. Sometimes the doctor or nurse may suggest that you have treatment at the same time as your colposcopy (see below). However, often, you may be asked to return for the treatment.

After your colposcopy

After your colposcopy you can usually return to work or carry on with your normal day. You are likely to have a small amount of bleeding, especially if you have had a biopsy. This can last for three to five days and you should wear a sanitary pad. Do not use tampons. You should not have sex or use vaginal creams or pessaries until the bleeding has stopped. Generally you should wait for five days.

You may notice a dark fluid-like material on the pad. It is sometimes green or looks like coffee granules. This is normal and is the fluid that is painted onto your cervix during the examination.

What are the risks or complications of colposcopy?

Colposcopy is generally a safe procedure. Some women find that is it a little uncomfortable. Rarely, complications can occur. These can include heavy bleeding and infection. If you experience any heavy bleeding, smelly vaginal discharge or severe lower abdominal pain, you should see a doctor as soon as possible.

If you are pregnant, you should discuss this with the doctor or nurse before you have a colposcopy.

The biopsy results

When a biopsy is taken, the sample of tissue is sent to the laboratory for further examination under a microscope. The cell abnormality that can be seen is called cervical intra-epithelial neoplasia, or CIN. There is a scale from 1 to 3 according to the number of cells in the biopsy sample affected by CIN. In CIN 1, only a few cells are abnormal. In CIN 3, all of the cells are abnormal. Very rarely, a biopsy can show changes in your cells that have already developed into cancer.

How will I know if I need any treatment?

The results of your colposcopy and biopsy will show if you need any treatment. Sometimes the doctor or nurse may suggest that you have treatment at your first visit for colposcopy. However, they may suggest that they wait for the results of your biopsy before you have any treatment. This just depends on the clinic that you attend. It can take a few weeks for the biopsy results.

Not everyone who has a colposcopy needs treatment. If the doctor or nurse feel that you only have a mild abnormality, they may just suggest that you have a repeat colposcopy in 6 to 12 months. The changes in your cervix may return to normal by themselves and they may just need monitoring.

What are the treatment options available?

There are a number of different treatments available for CIN. The aim of the treatment is to destroy or remove all of the abnormal cells on your cervix without affecting too much normal tissue. Most treatments can be done as an out-patient. The treatment may cause a little discomfort, perhaps similar to a period pain.

The treatment that you have will depend on the extent of your abnormality as well as what treatment the clinic has available and the preference of the doctor or nurse. Treatment options include:

• Cryotherapy: freezing the affected area of the cervix which destroys the abnormal cells.
• Laser treatment: this destroys or cuts away abnormal cells.
• Loop diathermy: a thin wire loop cuts through and removes the abnormal area of cells. This is also known as a Large Loop Excision of the Transformation Zone (or LLETZ). It is the most common form of treatment used in the UK.
• Cold coagulation: a heat source is used to burn away and remove the abnormal cells.

A local anaesthetic is usually given before any treatment. The treatment is normally very straightforward and quick. There is a small risk of bleeding at the time of treatment.

Occasionally the doctor or nurse may suggest that you have a cone biopsy (described later) or, very rarely, a hysterectomy (removal of your uterus and cervix) as a treatment for CIN. If this is the case, you will need to be admitted to hospital.

What should I expect after my treatment?

You may have some mild discomfort, like a period pain, after your treatment. Painkillers such as paracetamol may help to ease the pain.

You are likely to have some bloody vaginal discharge. This can last for up to six weeks. It is similar to the blood loss during your period. If you are worried that it is too heavy, or if it becomes smelly, you should see your usual doctor. You should use sanitary pads and not tampons. You should avoid sex and not do any heavy exercise until the discharge has stopped.

Will I need any follow-up?

This depends on the results of your colposcopy and whether you needed any treatment. Some women may need a follow-up colposcopy examination. Other women may just need a follow-up cervical screening test, usually after about four months. The doctor or nurse who performs your colposcopy will advise what follow-up you will need. Most colposcopy clinics will see you again four to six months after your first examination or treatment.

If all is well at your follow-up appointment, you will be given advice about when you should have your next cervical screening test. This test can be carried out by your usual clinic or GP surgery. You will usually be advised to have a cervical screening test every year for a number of years. If you have any further abnormal cervical screening test results you may need to have another colposcopy examination.

What is the prognosis (outlook) if I need treatment?

Treatment of CIN is usually almost 100% effective. In the vast majority of women, it is unlikely that CIN will come back.

Cone biopsy

What is a cone biopsy?

Sometimes all of the abnormal cells cannot be seen during colposcopy because the cells go further up into the cervix. If this happens, the doctor or nurse will usually suggest that you have a minor operation called a cone biopsy. This is when a cone shaped piece of tissue is removed from your cervix so that it can be examined under the microscope in the laboratory.

You will be given a separate appointment to come back for your cone biopsy. You are usually admitted to hospital overnight. A general anaesthetic that puts you to sleep is usually given.

What happens after a cone biopsy?

After your cone biopsy, you may have some gauze packed into your vagina to help control any bleeding. Some women also have a catheter (a tube to drain urine) inserted into their bladder at the time of the operation. This is because the gauze can sometimes press on the bladder and stop it from emptying properly. The gauze and the catheter will be removed before you leave hospital.

Most women notice a bloody discharge for up to four weeks after a cone biopsy. You should wear sanitary pads and not tampons. If you are worried that the bleeding is too heavy, if it becomes smelly, or if you develop abdominal pain, you should see your usual doctor.

After your cone biopsy you should rest for a few days. You should not have sex or do any heavy exercise for 4 to 6 weeks.

If all of the abnormal cells are removed during your cone biopsy and there is no sign of any cancer, you do not usually need any more treatment. However, you will need to have regular cervical screening tests to make sure that no more abnormal cells develop.