When is a colposcopy performed?
A colposcopy becomes necessary when a cervical screening has shown the presence of high-risk HPV or abnormal cells in the neck of the womb (cervix). Sometimes a colposcopy is also performed when there is bleeding after sex (postcoital bleeding), or your cervix looks abnormal on examination.
What is high risk HPV?
In the UK, the primary screening for cervical cancer is done by testing cells taken from the neck of the womb for hight risk Human Papilloma Virus (HPV). This is a virus that can cause cell changes leading to cervical cancer over many years. Most patients manage to clear the virus over 1-2 years. A colposcopy can examine if the HPV has caused any cell changes.
What is done during a colposcopy?
During a colposcopy a speculum is inserted into the vagina and the cervix is inspected with a colposcope, a type of magnifying glass with a strong light source.
Who performs a colposcopy?
Colposcopies are performed by doctors or nurses with special training in colposcopy. They are usually members of the British Society of Colposcopy and Cervical Pathology (BSCCP), have passed an exam to prove their knowledge and expertise and are re-certified every three years to make sure they keep up their skills.
Usually, the woman will be sitting on a special gynaecological chair, which helps to bring the cervix in position so it can be seen easier.
A speculum is inserted into the vagina so that there is direct view onto the neck of the womb. The colposcope stays outside of the vagina all the time.
During the colposcopy the cervix can be viewed with different levels of enlargement. A camera can be attached to the colposcope to take pictures of the cervix. This is helpful if you want to compare examinations later. You can also see your own cervix during the examination. To diagnose an actual cancer during a colposcopy is very rare.
Two different fluids (weak medical vinegar and medical iodine) are brought onto the cervix and help to identify the site of abnormal cells. These abnormal areas can then be biopsied better. The biopsy is done with a very small set of tweezers to take a small bit of tissue of 2-3 mm, which will then be examined under a microscope. Most women prefer to have the biopsy taken without local numbing agent (anaesthetic), but some prefer to have it so that it does not hurt at all. Small bleeding from the biopsy is usually stopped with a medication which is applied directly onto the area.
Can I continue my routine work after the colposcopy?
A colposcopy only takes 5-10 minutes and after the procedure you can just continue your normal daily routine. If you had a biopsy, we advise not to do any sports after the procedure to make sure the bleeding does not restart. For optimal healing you should not have intercourse and avoid swimming, tampons and long baths for 5 days.
What happens after the colposcopy?
If a biopsy was taken during the colposcopy, this is sent to the lab to be examined under the microscope.
A biopsy of the cervix can show normal tissue, minor changes (CIN1) or major changes (CIN2 or CIN3).
Your doctor will discuss the result with you. Often only a further check-up in 12 months is necessary, because most patients clear the HPV by themselves without any treatment.
If treatment is recommended
Some patients might need treatment. This is usually done in a small outpatient procedure called LLETZ (Large Loop Excision of Transformation Zone) where the abnormal cells are removed with a small electric loop. The procedure takes approximately 15 minutes and is performed under local anaesthetic. You can go home after the procedure straight away. After a LLETZ procedure we recommend avoiding sports, sex, tampons, bathing, and swimming for 4 weeks to allow time for healing
What patients say about a colposcopy
Most patients tolerate a colposcopy very well. Some patients report, that the weak vinegar can cause a mild stinging. Usually this stops quite soon after the colposcopy is finished. We will make sure, that any remaining vinegar is dabbed away, so will you feel better quite soon. Some patients report that the speculum is uncomfortable. Just let us know, how you feel. Often the doctor can gently ease the two blades of the speculum or simply use a smaller speculum.
If you have had an abnormal smear and have been recommended for colposcopy then don’t be scared, this does not mean that you have cancer of the cervix. Come and see us and our expert colposcopist we will help you in a kind, sensitive and efficient fashion.