Colposcopy

A colposcopy is an examination of the cervix (the entrance to the womb from the vagina) using a binocular microscope called a colposcope. It’s a routine and painless procedure that’s carried out by a specialist doctor or nurse, usually to check for signs of cervical cancer.

The first step in checking for cervical cancer is a cervical smear test — a way to examine the health of the cells in your cervix. In 1 in 20 women, a cervical smear test may show abnormal cells that need to be investigated or removed in case they become cancerous.

During a colposcopy, if your doctor has found abnormal cells, they may be able to treat them immediately.

Your doctor will recommend you have a colposcopy if:

• You’ve had a cervical smear test that has shown abnormal cells
• You’ve had several cervical smear tests without a clear result
• On examining your cervix during your smear test, your doctor or nurse thought that your cervix didn’t look completely healthy

You may also need a colposcopy if you have:

• Genital warts on the cervix
• Inflammation of the cervix
• Polyps and cysts ie benign (non-cancerous) growths
• Tested positive for human papillomavirus (HPV)
• Unexplained vaginal bleeding eg after sex

You will need to abstain from having sex and stop using vaginal creams, lubricants, medications, menstrual cups or tampons for at least 24 hours before your colposcopy. You can eat and drink normally. 

On the day of your colposcopy, bring a panty liner — you may experience some light bleeding or vaginal discharge after your procedure. You can also bring a friend or family member along for moral support. 

You should contact your healthcare team before your colposcopy if you think you may have your period on the day of your colposcopy. In most cases, you will still be able to go ahead with the procedure but in some cases, it may be postponed. 

You should also contact your healthcare team if you're pregnant during the time of your colposcopy. The procedure is safe during pregnancy but collecting a tissue sample (biopsy) or subsequent treatment will likely be postponed until after you've given birth. 

If you want your colposcopy performed by a female doctor or nurse, you will need to inform your healthcare team in advance. 

Before your colposcopy, you will be asked to undress from the waist down. If you’re wearing a loose skirt, you may not need to remove it. You will then lie down in a special chair with padded leg supports.

Your doctor will then gently insert a plastic or metal instrument (called a speculum) into your vagina to expose your cervix (neck of the womb). They’ll use a microscope with a light (a colposcope) to look at your cervix — the colposcope will not enter your vagina. Some colposcopes have a camera attached, which sends images to a screen so you can see inside your cervix.

Special solutions may be applied to your cervix to help identify any abnormal tissue. This may be enough for your doctor to determine whether your smear test was correct and there is abnormal tissue that needs to be removed. However, in some cases, they may need to take a biopsy (sample of cells or tissue) to send to the lab for further analysis.

Your doctor may be able to treat you immediately by removing any abnormal cells. There are a number of procedures to remove abnormal cervical cells. It is most often done using loop excision under local anaesthetic (so your cervix is numb). This involves using a loop of wire with an electrical current passing through it to remove abnormal cells.

Other methods to remove abnormal cells in your cervix include heating, freezing or laser treatment. Your doctor will discuss these options with you if further treatment is needed.

If you feel uncomfortable during your colposcopy, let your doctor know. They may be able to reduce your discomfort or can stop the procedure.

A colposcopy usually takes 15 to 20 minutes.

A cervical biopsy involves removing a sample of tissue or cells from your cervix, which is sent to a lab to identify abnormal cells. This can give you a clear diagnosis of cancer or precancerous tissue, while a colposcopy can only suggest that abnormal tissue is present.

You will only need a biopsy if during your colposcopy, your doctor identifies tissue that doesn't look normal. If they find more than one area of abnormal tissue, they will take biopsies from these areas too.

Your cervical biopsy will be performed immediately after your colposcopy using a sharp tool to collect the sample of cells or tissue. This is uncomfortable but not painful. It is often described as a feeling of pressure or mild cramps.

After your colposcopy, you can go home as soon as you feel ready, which is usually immediately after your procedure finishes. You may want to rest for the remainder of the day, however, you can return to your normal activities, such as working and driving. 

You may have brownish vaginal discharge or light vaginal bleeding after your colposcopy. Avoid swimming, sex and using vaginal creams, lubricants, medications, menstrual cups or tampons until your vaginal discharge or bleeding has stopped. This should clear up after two weeks but may last for up to six weeks.

Healing is usually very rapid. The small area left behind after the abnormal cells are removed fills up quickly and normal tissue grows over.

You may find that your first period following the procedure is heavier or more prolonged than usual and that your periods are irregular for a couple of months.

Your doctor may be able to tell you about your cells during the procedure. However, if you had a biopsy, we will send your results to the doctor who requested your test in 1–2 weeks. We will try to get your results back to you as soon as possible, as less waiting means less worrying.

You will receive one of two results: normal or abnormal.

Around 4 in 10 women will have a normal result. This means no abnormal cells were found in your cervix and you do not need any treatment. However, you'll still need to keep up with your regular cervical smear tests, as abnormal cells may develop later. The frequency of your cervical smear tests will depend on your age but is usually every three or five years.

Around 6 in 10 women will have an abnormal result. This means abnormal cells were found in your cervix. This is usually due to cervical intra-epithelial neoplasia (CIN) or cervical glandular intra-epithelial neoplasia (CGIN). CIN and CGIN are not cancer but could develop into cancer later.

A biopsy is needed to find out the likelihood of CIN cells becoming cancerous and consequently, whether you need treatment to remove them. CIN is graded according to the likelihood of cancer developing, as follows: 

• CIN 1 — the cells are unlikely to become cancerous and may go away by themselves; treatment is not needed but you will need a cervical smear test in 12 months to check the cells have gone away
• CIN 2 — the likelihood of the cells becoming cancerous is moderate and the cells should be removed
• CIN 3 — the cells are highly likely to become cancerous and the cells should be removed

CGIN cells are highly likely to become cancerous and you will need to have them removed.

In rare cases, an abnormal result is due to cervical cancer. In these cases, you will be referred to a specialist cancer care team for treatment. Cervical cancer detected as a result of a smear test and colposcopy is usually in an early stage. This makes treatment much more effective, which is why it’s important to keep up with your regular cervical smear tests.

Treatment to remove abnormal cells

If all the abnormal cells in your cervix were removed during your biopsy, you may not need further treatment. However, if they weren't all removed you may need one of the following treatments to prevent cervical cancer: 

• Cone biopsy — a cone-shaped piece of cervical tissue is removed to get rid of any cancerous or precancerous cells
• Cryotherapy — liquid gas is used to freeze and destroy abnormal cells in  your cervix
• Loop Electrosurgical Excision Procedure (LEEP) — abnormal cells are removed with a wire loop through which an electric current is passed

After your colposcopy, you may experience vaginal bleeding, similar to a light period and/or vaginal discharge. You should therefore avoid swimming, sex and using tampons, menstrual cups or vaginal medications, lubricants and creams until any discharge or bleeding has cleared.

On rare occasions, complications following a colposcopy can occur. If you experience any of the symptoms listed below, seek medical attention immediately:

• Fever or high temperature
• Heavy vaginal bleeding
• Pain that lasts more than 48 hours
• Severe pain
• Stomach ache
• Vaginal discharge that smells unpleasant

We’ll talk to you about the possible risks and complications of having this procedure and how they apply to you.

At Spire Healthcare, we’re careful to weigh up the benefits and risks of any ­­­­procedure and discuss it with you if you have any concerns.