The Colposcopy

Maybe one of the most frightening times in a woman's life is when the gynaecologist calls and says that the Pap smear results are abnormal.  Although women might think an abnormal Pap smear means cervical cancer, the fact is that the majority of abnormal Pap smears are not caused by cervical cancer but more likely is the result of inflammation or a vaginal infection.

Also, abnormal cervical smear test result usually means that changes have been found in the cells of your cervix. Abnormal cells found during cervical screening can be pre-cancerous. Again, this doesn’t mean cervical cancer. It means that some of the cells are a little abnormal and if left untreated, they could develop into cervical cancer in the future.

Because the Pap smear can only screen for potential problems, not diagnose them, the gynecologist may want to take a closer look at the cervix to determine the cause of the abnormal Pap smear results. He/she will perform an examination called a colposcopy.

The doctor may also recommend a colposcopy if there are symptoms such as bleeding in between periods or after sex, blood-stained vaginal discharge or pain in the pelvis. A colposcopy can help to show whether the symptoms are due to cervical cancer, or if they may be caused by something else.

So…what exactly is a Colposcopy?

Colposcopy is a procedure carried out after some abnormal cervical screening tests. It involves a detailed examination of the neck of the womb (cervix) using a special microscope that acts like a lighted magnifying glass that looks like a pair of binoculars, called a colposcope. A camera can be attached to the colposcope to take pictures or videos of the vagina and cervix.

A liquid ( vinegar - acetic acid and sometimes iodine solution) is painted on the vagina and cervix with a cotton swab or cotton balls to see problem areas more clearly.

During colposcopy a small piece of tissue will be taken from the cervix. This is known as a biopsy. The tissue is then examined in even closer detail in the laboratory to allow further assessment of the cells. Treatment for any abnormal cells can sometimes be given at the same time as the colposcopy examination.

Before the colposcopy

Every woman should receive clear information about the procedure in advance of the appointment. There are some things to think about before the colposcopy that can help you prepare:

*  Some clinics prefer not to perform colposcopy whilst a woman is having her period. This is because it can be difficult to get a good view of the neck of the womb (cervix) if there is a lot of blood. Also, some women may prefer not to have an intimate examination whilst bleeding. If your period starts and you anticipate you will still be bleeding when you have your appointment, it is probably best that you telephone the clinic for advice. In some cases the appointment may be rearranged. Do not feel embarrassed about this - it is completely out of your control, and colposcopy clinics are very used to this sort of thing.

* You should avoid sex and not wear a tampon for 24 hours before your colposcopy.

* You should not use any vaginal creams for 24 hours before your colposcopy. This includes lubricants, thrush treatments, douches and spermicides.

* You may want to wear a loose, full skirt on the day of your colposcopy so that you do not have to remove all of your lower clothing.

* It is often a good idea to bring someone with you who can take you home after your colposcopy. This is most important if the clinic has told you that you may have treatment at your first appointment. They do not have to come into the examination room with you (but if you do want a friend or relative with you during your examination this is also possible).

Tell your doctor if you:

- Are or might be pregnant. A blood or urine test may be done before the colposcopy to see whether you are pregnant. Colposcopy is safe during pregnancy. If a cervical biopsy is needed during a colposcopy, the chance of any harm to the pregnancy (such as miscarriage) is very small. But you may have more bleeding from the biopsy. A colposcopy may be repeated about 6 weeks after delivery.

- Are taking any medicines.

- Are allergic to any medicines.

- Have had bleeding problems or take blood thinners, such as aspirin, etc.

- Have been treated for a vaginal, cervical, or pelvic infection.

What happens during a colposcopy?

During a colposcopy, you lie down in a special type of chair which has padded supports for you to rest your legs on. A device called a speculum is gently inserted into your vagina and opened to allow your colposcopist to see your cervix (the same as when you have a cervical smear test).  Your cervix is then examined with a colposcope and a biopsy is taken, if needed. 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).

The examination lasts about 20 minutes, but the whole appointment can take about an hour.

It is usually a painless procedure, although some women find it uncomfortable. If you are concerned, you could take a painkiller, such as paracetamol, beforehand. However, do not take aspirin or ibuprofen as they may increase your chance of bleeding afterwards.

If your colposcopist is relatively certain abnormal cells are present on your cervix they may recommend treatment straight away rather than a biopsy.

After the colposcopy

You will usually be able to go home or work 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 your doctor  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.

It is usually recommended that you wait until any bleeding stops before having sex or using tampons, vaginal creams and pessaries.

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 4 to 6 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 the gynaecologist. 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.