Colposcopy

 

 

Introduction

A colposcopy is a procedure where the lining of the cervix (the neck of the womb) is closely examined. It is carried out by a colposcopist (a specially trained doctor or nurse) who uses a magnifying instrument called a colposcope to check the cells that line the cervix for abnormalities.

When is a colposcopy performed?

A colposcopy is carried out when the results of a cervical screening test indicate that there are abnormal changes in the cells of the cervix. 

Modern colposcopy clinics are fitted with video equipment that allows the colposcopist to view the examination on a television monitor. The patient can also watch the procedure if they want to, which may help to reduce any nervousness and anxiety.

Outcome

After closer examination of the cervical cells, the colposcopist will be able to determine the extent of any cell abnormalities and whether any treatment is required.

If the colposcopy confirms that there are cervical cell abnormalities, a biopsy may be carried out. This involves removing a small sample of tissue for closer examination and testing. 

The treatment of abnormal cervical cells is almost always 100% successful. Following treatment, it is unlikely that any cell changes will occur in the future. 

Why a colposcopy is used

Cervical screening

A colposcopy is usually carried out after an abnormal cervical screening test result.

A cervical screening test is a routine test to check the health of a woman’s cervix (the neck of the womb). Sometimes, the cells that line the cervix start to change and become abnormal. In a very small number of cases, abnormal cervical cells can be an early sign of cervical cancer.

Regular cervical screening helps to ensure that any cell changes are picked up early, and treatment – if required – is started as soon as possible.

Around 9 out of 10 cervical screening tests do not reveal any cell abnormalities in the cervix. About 1 in 20 tests reveal mild cervical cell changes, most of which do not need treatment because they return to normal by themselves.

Approximately 1 in 100 cervical screening tests indicate moderate cell changes. One in 200 indicate severe cell changes. Both moderate and severe cell changes need further investigation and possibly treatment. Less than 1 in 1,000 tests reveal invasive cancer that requires immediate referral to a specialist.

Further investigation

Although abnormal cervical screening results rarely indicate cancer, it is important to fully investigate all moderate and severe abnormal cell changes so that conditions, such as cervical cancer, can be ruled out or diagnosed as soon as possible.

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

A colposcopy allows Dr. B C Shah 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.

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
• Unexplained 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 

How a colposcopy is performed

Preparing for a colposcopy

If your cervical screening test reveals that you have cervical cell changes, Dr. B C Shah will refer you for a colposcopy examination.

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 whether it will need to be rescheduled. A colposcopy can be performed during pregnancy.

If you feel nervous about having a colposcopy, it may be possible for a friend or relative to be present during the procedure 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)  

Before the colposcopy

Before having a colposcopy,Dr. B C Shah will explain the procedure to help put you at ease. He will ask you questions about your:

• Periods
• The type of contraception that 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 skirt that can be lifted up without having to take it off.

Do not feel embarrassed about having a colposcopy. 

During the colposcopy

A nurse will help you into position on a special type of couch, 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, Dr. B C Shah 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 Dr. B C Shah to access your cervix. He 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 him to examine the cells inside your cervix.

Dr. B C Shah  may put some liquids 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 Dr. B C Shah 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 (medication to numb the area). 

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 allowed to go home 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 yDr. B C Shah 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.

Check-ups

Following a colposcopy, you will usually need to attend a check-up appointment to ensure that the 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 to have a cervical screening test (where a sample of cells is taken from your cervix) or you may need to have another colposcopy. You may also need to have a further check-up appointment six months later.

Results of a colposcopy 

After doing a colposcopy, Dr. B C Shah will know straight away whether you have abnormal cells on the lining of your cervix (the neck of the womb).

Biopsy results

In some cases, it may be possible the abnormal cells to be treated during your colposcopy. Or you may have to wait for the results of a biopsy (where a sample of cells is taken for analysis) before treatment is given.

If you have had a biopsy during your colposcopy, the tissue sample will be sent to a laboratory for testing. Testing will help to determine the extent of the cell changes in your cervix. You usually have to wait one or two 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, but CIN cells can sometimes develop into cancerous cells.

CIN scale

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. Dr. B C Shah will be able to advise you about the best course of treatment. In some cases, no treatment may be recommended because the cells sometimes return to normal without treatment.

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 treatment to help any abnormal cells return to normal.

CIN 3

CIN 3 cells indicate that all of the cells in the affected area of your cervix are abnormal. If this is the case, you will need treatment to help the cells return to normal.

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 Dr. B C Shah will arrange any necessary treatment as soon as possible.

Repeat colposcopy

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

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

Treating abnormal cells in the cervix 

You may require treatment if the results of your colposcopy indicate that you have abnormal cells in your cervix.

The 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 any damage to healthy tissue. Treatment is nearly always 100% successful, and it is unlikely that any cell changes will occur again.

Timing of treatment

It may be possible for you 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 that waiting for treatment causes anxiety, and they prefer to be treated as soon as possible. Others prefer to have time to think about their treatment and schedule it for another time.

Some types of treatment that are more intensive cannot be done on the same day as a colposcopy. Dr. B C Shah will advise about the best time for your treatment to be carried out. He will also be able to discuss the treatment options with you, and what each type of treatment involves.

Some of the available treatments are discussed below.

Large loop excision of the transformation zone (LLETZ)

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

LLETZ usually takes 5-10 minutes. It is often carried out under local anaesthetic (medication that numbs the area). The procedure is not usually painful, although you may feel some pain that is 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 (where you are put to sleep).

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 after LLETZ (use sanitary pads instead)
• Having sexual intercourse for four weeks following LLETZ
• Heavy exercise

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

Diathermy is a treatment similar to LLETZ. It also uses an electric current to destroy abnormal cervical cells.

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 usually requires an overnight stay in hospital.

A cone biopsy is carried out under general anaesthetic. A cone-shaped piece of tissue is cut away from your cervix. The section of tissue that is taken may include the whole area of cervix where the abnormal cells are located. The tissue will be sent to a laboratory for closer examination under a microscope.

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 to have a catheter inserted (a thin tube that drains urine from your bladder) as the pack can sometimes press on your bladder.

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 out with any difficult tasks.

Other treatments

Abnormal cells can be removed from your cervix in several other ways. Your doctor can give you more information and advice about the procedures that are briefly outlined below.

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 Dr. B C Shah will insert an instrument called a speculum into your vagina. He 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 that is 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 (surgically removing 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 also only be an option if you have decided not to have any more children and 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 Dr. B C Shah  if you have any questions about the colposcopy examination, biopsy procedure, your results or possible treatment options for abnormal cervical cells. Dr. B C Shah will be able to answer any queries or discuss any of your concerns.