What is colposcopy?
Colposcopy is a simple examination of your cervix. The examination allows the colposcopist to confirm the presence of abnormal cells and allows an assessment of the severity of the changes so that, if needed, appropriate treatment can be offered. The instrument used is called a colposcope. This is a special type of microscope that magnifies the cervix so that it can be closely examined and any abnormalities can be detected. A speculum, the instrument used to take a cervical smear, is placed into the vagina while the colposcope remains outside of the body. For most women the colposcopy examination is painless, but some may find it a little bit uncomfortable. Colposcopy examination can be done safely during pregnancy and will not affect the delivery of your baby, nor will it affect your ability to become pregnant in the future. However, any treatment would usually be postponed until the delivery of your baby.
Why do I need a colposcopy examination?
In the majority of cases, you have been asked to come for a further examination because your smear test has shown that you have come into contact with the Human Papilloma Virus, which may in turn cause abnormal cells on your cervix. This is not unusual, about one in 12 smears is abnormal. These abnormal cells are not cancer, but if left, may develop into this in the future. These changes take many years to develop, therefore if you have regular smear tests any abnormality can be detected at an early stage and treated. The smear test and colposcopy examination are performed to help prevent these changes progressing. Most abnormal cells will return to normal by themselves, but if required, treatment can be undertaken; the colposcopy examination will determine this. It is important to remember that it is extremely rare indeed for these abnormalities to be cancer.
There are several reasons why you may have been asked to come for a colposcopy examination:
- Abnormal cells:
Abnormal cells on the cervix (neck of the womb) are very common. About 1 in 20 screening samples are abnormal. An abnormal result usually means that small changes have been found in the cells on the cervix. These abnormal changes are known as ‘dyskaryosis’ and act as early warning signals that cervical cancer might develop in the future. It is important to remember that it is very rare for these abnormalities to be cancer.It has been found that the main cause for abnormal cells is a virus called Human Papilloma Virus (HPV), although other factors, especially smoking, can also increase the risk of cell abnormality. There are around 100 different types of HPV and approximately 30 can be transmitted through intimate sexual contact to the genital tract. Most people will come into contact with the virus at some point in their life as it is very common. HPV detection does not indicate that your partner has been unfaithful. At present there is no treatment for HPV and it normally takes up to two years for it to clear on its own. For some women the abnormal cell changes in the cervix return to normal by themselves. Other women will need some simple outpatient treatment which is successful in about 95% of cases.
- B) Inadequate results following your cervical screening:
This means that the sample taken of your cervical cells could not be analysed properly. There may not be enough cells collected, or the cells may have been hidden by blood or mucus. If you have had three consecutive inadequate results from your screening tests, you will be referred to colposcopy so that a colposcopist can check your cervix.
- C) Other signs and symptoms
Rarely you may have had a normal screening result, but there are other clinical signs and/or symptoms that indicate colposcopy would be advisable.
Is there anything I can do before the examination?
No formal preparation is required. However, we suggest that you bring a sanitary pad with you as you may bleed very lightly following the procedure. It may be helpful for you to take a mild pain relieving medication (similar to what you might take for period pain) one hour before the examination to help prevent/ reduce any crampy pain that may occur following the procedure
You are welcome to bring with you a relative or friend to your colposcopy appointment and if you wish they can stay with you during the examination. If you have a period on the day of your appointment this is usually not a problem unless it is very heavy. If you feel particularly awkward about being examined with a period, please contact us to make another appointment. The actual examination only takes about 15 minutes, but allow at least half an hour for the whole visit.
First you will be invited into the consultation room by the colposcopist who will ask you some questions. These questions relate to your periods, the type of contraception you use, and any operations or illnesses you have had in the past, among others. You will then be taken into the examination room where you will be asked to undress from the waist down (if you wear a skirt, this does not need to be removed). You will be given privacy and time for this.
What exactly happens during the examination?
The nurse will ask you to take a seat on the examination couch, and provide you with a modesty sheet. The couch has padded supports on it where you rest your legs. When you are lying comfortably, the colposcopist will gently insert a speculum into the vagina, which is the same instrument used when you have a smear test. Sometimes another sample of cervical cells is taken. After this the colposcopist will look at your cervix using the colposcope (microscope). The colposcopist will dab different liquids onto the cervix to help identify and highlight any areas of abnormal cells. Abnormal areas will appear white. If any abnormal area is identified, a small sample of tissue (a biopsy) will be taken from the surface of the cervix. A biopsy is about the size of a pinhead. You may feel a slight stinging, but it should not be painful. After the examination has taken place the colposcopy nurse will ask you to get up and dressed in your own time, giving you privacy to do so.
What happens after the examination?
After you have dressed, the colposcopist may be able to tell you if anything is wrong and what treatment, if any, is needed. But often (especially if you have a biopsy) you will not be given a definite diagnosis immediately after the examination. We will contact you with the result of the biopsy as soon as we receive it. After the examination you should feel well enough to continue with your usual routine. If you have had a biopsy, you may well have a light blood stained discharge for a few days following the procedure. We will provide you with a panty liner just in case. This is normal and it should clear itself, however, it is best to avoid intercourse for up to five days to allow the biopsy site to heal and avoid infection.
What will the examination show?
Colposcopy defines the type and extent of the abnormal area on the cervix. The results show if you need treatment and if so, what sort. The results of the biopsy show how abnormal the area is. It may also indicate if further treatment is needed. The technical term used to refer to cell changes confirmed by a biopsy is cervical intra-epithelial neoplasia (CIN). It is these changes which, in some women, may develop into cancer if the cells are not treated. CIN is mainly caused by certain types of HPV. HPV is a group of more than 100 viruses, and certain types of it are associated with around 95% of all cases of cervical cancer. However, most HPV infections have no symptoms and will disappear without any need for treatment.
Even women with ‘high risk’ HPV’s (the type which can cause abnormalities of the cervix) rarely go on to develop cancer. CIN changes are described using a scale of 1 to 3, according to how deeply the abnormal cells are found in the surface layer of the cervix. CIN 1 means that only 1/3rd of the thickness of the surface layer of the cervix is affected. These cells may be left to return to normal or may be treated, depending on your doctor’s opinion. CIN 2 means that up to 2/3rds of the thickness of the surface layer contains abnormal cells. Treatment will usually be needed to return the cells to normal. CIN 3 means that the cells throughout the thickness of the surface layer are abnormal. Treatment will be needed to return the cells to normal. Only very rarely will a biopsy show cell changes that have already developed into cancer. Surgery and more extensive treatments are generally used to treat cervical cancer.
What if I need treatment and what type of treatment is available?
Following examination and the biopsy results, you may be offered treatment visit under local anaesthetic. The aim of the treatment is to destroy or remove all the cells affected by CIN with the minimum of disruption to normal tissue. If you prefer to come back for treatment at a later date, this is your choice and you will be given another appointment in due course. The methods of treatment used in this clinic are loop diathermy, cold coagulation and cryocautery. The clinician will suggest the most suitable treatment (if this is necessary) and this will be discussed with you.
What about pregnancy?
Colposcopy can be performed safely during pregnancy and it will not affect your ability to become pregnant in the future. Treatment, however, if required, is usually postponed until after your baby is born.
** Colposcopy should not be undertaken by any gynaecologist. Τhe performance of the Colposcopic examination by non-specialized gynaecologists involves two main risks. The first is not to detect an existing lesion and therefore to expose the woman to the risk of developing cancer. The second concerns the possibility for the gynaecologist to misdiagnose the existence of the disease in completely healthy women and to subject them to unnecessary treatments with potential consequences for their health. Colposcopy is therefore a highly specialized medical procedure, which must be performed ONLY by doctors with the appropriate training and accreditation.
