Colposcopy

Before your colposcopy, you may have had one or more smear tests. If this test picked up abnormal cells or your tests showed the presence of HPV, you will have been invited to have a colposcopy. It is essential to discuss your medical history with your gynaecologist to ensure a safe and practical examination.

When you schedule your appointment, you should avoid a date when you may be on your period.

A chaperone is available for all intimate examinations. If you would prefer one to be present, please let us know when booking your appointment. The chaperone will be a female nurse or trained female staff member.

From two days before, you should also not have vaginal intercourse, use tampons or use any vaginal medications or creams. Inform your doctor about any vaginal infections before the procedure, as this may affect the steps of the examination.

Your doctor will start by explaining the procedure and answering any questions you may have. Once you’re ready, you will need to undress from the waist down. The doctor will lock the door to prevent people from entering, draw a privacy curtain, and wait on the other side until you are ready. A chaperone will also be present in the room at this point to help you feel comfortable.

Your doctor will then ask you to lie on your back on a couch and place your feet in stirrups, with your knees up.

Next, your gynaecologist will place a device called a speculum (which is a tube-shaped tool) into your vagina. Once in place, the speculum opens to allow a clear view of your cervix. The doctor will then position an instrument called a colposcope (which is a magnifying instrument with a light) a few inches away from your vulva. This will allow the doctor to examine the cervix and vagina. The colposcope will not touch you. Special filters on the colposcope help highlight any unusual blood vessels or patterns. The colposcope also aids in identifying any visible lesions that may require further investigation. To examine the cells more closely, your gynaecologist will also gently swab your cervix and vagina with a cotton bud to remove any mucus and may also apply a vinegar-based solution, which will highlight areas that need further investigation. This vinegar-based solution (acetic acid) helps make abnormal cells more visible. This may cause a burning or tingling sensation.

If your doctor sees tissue they are unsure about, they may use a small tool to gently remove a tiny sample of tissue (called a biopsy) for further examination. Multiple small samples may be taken from different areas.

Some issues can be treated during your colposcopy. For example, if your gynaecologist sees a small area of abnormal cells, this could be removed during your colposcopy. This is done with a ‘Large Loop Excision of the Transformation Zone’ (LLETZ), also known as a loop excision or loop biopsy. An LLETZ takes 5-10 minutes and involves using a heated wire to remove abnormal cells. This is done under local anaesthetic, so the area being treated is numb.

The examination takes 10-15 minutes. You can expect your entire appointment to take 20 to 30 minutes, including preparation time.

Before you leave your appointment, your doctor will let you know when you can expect your biopsy results, so you can book a follow-up appointment before going home.

After a colposcopy, and particularly if you also had a biopsy or treatment, we would recommend taking a taxi home or asking someone to drive you if you don’t feel well afterwards.

It’s a good idea to have some pain relief, pads and a hot water bottle ready at home to help with pain, cramps or discomfort.

After a colposcopy, it’s normal to experience some mild cramping or spotting for the next day or two. You may also experience discomfort similar to period pain and light bleeding that typically stops within 3 to 5 days.

If you also had a biopsy, you may experience:

• Pain over the next two days
• Light bleeding for one or two days
• Dark vaginal discharge

You should also not use tampons or have vaginal intercourse for one week after, or for as long as your doctor recommends.

If you had an LLETZ, you will bleed after the procedure, and you may have some light bleeding for a few weeks after. After an LLETZ, you shouldn’t use tampons and avoid sex for four weeks. Do not exercise for two weeks, or while there’s still some bleeding or discharge.

Results

The results of a colposcopy can be expected, abnormal, or inconclusive. Here’s what each result means:

• Normal result – if your colposcopy results are expected, it means that your cervix and vagina appear healthy, and there are no signs of abnormal cell growth. No further testing or treatment is usually needed.
• Abnormal result – if abnormal cells are detected, it means that there are changes in the cells of your cervix that may require further investigation or treatment. Your gynaecologist may recommend a biopsy to determine the extent of the abnormal cell growth.
• Inconclusive result – sometimes, the results of a colposcopy may be inconclusive, meaning that it’s unclear whether abnormal cells are present. In such cases, further testing or follow-up appointments may be necessary to determine the presence of abnormal cells.

It’s essential to follow up with your gynaecologist to discuss the results of your colposcopy and any further testing or treatment that may be necessary. Early detection and treatment of abnormal cells are crucial in preventing cervical cancer and ensuring your long-term health.

Further treatment

Depending on your biopsy results, your doctor may recommend further treatment.

This could involve:

• Cryotherapy – where abnormal cells are destroyed by freezing.
• Laser ablation – using a laser to pinpoint and destroy the cells.
• Cone biopsy – a minor operation that involves surgically removing the affected area of your cervix.
• Cauterisation – destroying abnormal cells by burning or chemically damaging the tissue.
• Total hysterectomy – the surgical removal of the uterus. This is only ever considered if abnormal cells on your cervix have been found more than once or if they’re severely abnormal.

If you have had any treatment, you should have a smear test six months after to check everything is ok.

Possible risks and complications

Colposcopy is a generally safe procedure, but like any medical test, it carries some potential risks. It’s common to experience light bleeding or spotting for a few days afterwards, and some patients may feel discomfort or pain during the procedure, especially if a biopsy is taken. Though rare, there is a small risk of infection.