Overview

Colposcopy
Colposcopy

A colposcopy is a simple procedure used to look at the cervix, the lower part of the womb at the top of the vagina. It's often done if cervical screening finds abnormal cells in your cervix.

These cells often go away on their own, but sometimes there's a risk they could eventually turn into cervical cancer if not treated.

A colposcopy can confirm whether cells in your cervix are abnormal and determine whether you need treatment to remove them.

When a colposcopy may be needed

You may be referred for a colposcopy within a few weeks of cervical screening if:

  • some of the cells in your screening sample are abnormal
  • the nurse or doctor who carried out the screening test thought your cervix did not look as healthy as it should
  • it was not possible to give you a clear result after several screening tests

A colposcopy can also be used to find out the cause of problems such as unusual vaginal bleeding (for example, bleeding after sex).

Try not to worry if you've been referred for a colposcopy. It's very unlikely you have cancer and any abnormal cells will not get worse while you're waiting for your appointment.

What happens during a colposcopy

A colposcopy is usually carried out in a hospital clinic. It takes about 15 to 20 minutes and you can go home the same day.

During the procedure:

  • you undress from the waist down (a loose skirt may not need to be removed) and lie down in a chair with padded supports for your legs
  • a device called a speculum is inserted into your vagina and gently opened
  • a microscope with a light is used to look at your cervix - this does not touch or enter your body
  • liquids are applied to your cervix to highlight any abnormal areas
  • a small sample of tissue (a biopsy) may be removed for closer examination in a laboratory - this may be a bit uncomfortable

If it's obvious that you have abnormal cells in your cervix, you may have treatment to remove the cells immediately. If this is not clear, you'll need to wait until you get your biopsy results.

Results of a colposcopy

It's often possible to tell you right away if there are any abnormal cells in your cervix. But if you had a biopsy, it may take 4 to 8 weeks to get your results in the post.

The result of your colposcopy and/or biopsy will be either:

  • normal - about 4 out of 10 people have no abnormal cells and are advised to continue attending cervical screening as usual
  • abnormal - about 6 out of 10 people have abnormal cells in their cervix and may need treatment to remove them

Your doctor or nurse may use the term CIN or CGIN when discussing your biopsy result. This is the medical name for abnormal cells.

It's followed by a number (for example, CIN 1) that shows the chances of the cells becoming cancerous. A higher number means a higher risk of cancer developing if the cells are nor removed.

Treatment to remove abnormal cells

Treatment to remove abnormal cells is recommended if there's a moderate  or high chance of the cells becoming cancerous if left untreated.

There are several simple and effective treatments that can be used to remove the abnormal cells, including:

  • large loop excision of the transformation zone (LLETZ) - a heated wire loop is used to remove the abnormal cells
  • a cone biopsy - a cone-shaped piece of tissue containing the abnormal cells is cut out from your cervix

LLETZ is usually carried out while you're awake but your cervix is numbed. You can go home the same day.

A cone biopsy is usually done under general anaesthetic (where you're asleep) and you may need to stay in hospital overnight.

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What happens?

A colposcopy is usually carried out in a hospital clinic. It takes around 15 to 20 minutes and you can go home soon afterwards.

Preparing for a colposcopy

  • for at least 24 hours before your appointment avoid having sex or using vaginal medicines, lubricants, creams, tampons or menstrual cups
  • bring a panty liner, as you may have some light bleeding or discharge afterwards
  • you can eat and drink as normal

Contact the clinic before your appointment if:

  • you think your period might arrive around the time of your appointment - you'll usually still be able to have the procedure, but in some cases you may be advised to postpone it
  • you're pregnant - a colposcopy is safe during pregnancy, but a biopsy (removing a tissue sample) and any treatment will usually be delayed until a few months after giving birth
  • you want the procedure to be done by a female doctor or nurse

You can bring a friend, partner or family member with you to the hospital if you think it will help you feel more at ease.

The colposcopy procedure

A colposcopy is carried out by a specialist called a colposcopist. This may be a doctor or a trained nurse.

During the procedure:

  • you undress from the waist down (a loose skirt may not need to be removed) and lie down in a chair with padded supports for your legs
  • a device called a speculum is inserted into your vagina and gently opened - similar to having a cervical screening test
  • a microscope with a light (a colposcope) is used to look at your cervix - this stays outside your vagina
  • liquids are applied to your cervix to highlight any abnormal areas - you may feel a mild tingling or burning sensation when these are applied
  • a small sample (a biopsy) may be removed for closer examination in a laboratory - this should not be painful, but you may feel a slight pinch of stinging sensation

If it's obvious that you have abnormal cells in your cervix, you may be offered treatment to remove the cells immediately. Otherwise, you'll need to wait until you get your biopsy result.

After a colposcopy

After having a colposcopy:

  • you'll be able to go home as soon as you feel ready, usually straight afterwards
  • you can return to your normal activities, including work and driving, immediately - although you may prefer to rest until the next day
  • you may have a brownish vaginal discharge, or light bleeding if you had a biopsy - this is normal and should stop after 3 to 5 days
  • wait until any bleeding stops before having sex or using tampons, menstrual cups, vaginal medicines, lubricants or creams

Your nurse or doctor may be able to tell you what they've found straight away.

If you have had a biopsy, it will be checked in a laboratory and you'll need to wait a few weeks to receive your result by post.

Risks and side effects of a colposcopy

A colposcopy is a very safe procedure that does not cause any serious problems.

You may have some side effects such as:

  • discomfort or pain - tell the colposcopist if you find the procedure painful so they can try to make you more comfortable
  • brown vaginal discharge - this is caused by the liquids used to highlight abnormal cells in the cervix and should pass quickly
  • light bleeding - this can occur if you have a biopsy and should pass within 3 to 5 days

Contact a GP if you have persistent bleeding, bleeding that's heavier than your usual period, smelly vaginal discharge or a stomach ache.

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Results

After a colposcopy, the doctor or nurse will often be able to tell you what they've found straight away.

If they take a biopsy (remove a small sample of tissue to be examined in a laboratory), you may need to wait 4 to 8 weeks to receive your result by post.

Normal result

About 4 in every 10 people who have a colposcopy have a normal result.

This means no abnormal cells were found in your cervix during the colposcopy and/or biopsy and you do not need any immediate treatment.

You'll be advised to continue with cervical screening as usual, in case abnormal cells develop later on.

Depending on your age, you'll be invited for a cervical screening appointment in 3 or 5 years.

Abnormal result

About 6 in every 10 people have abnormal cells in their cervix - known as cervical intra-epithelial neoplasia (CIN) or cervical glandular intra-epithelial neoplasia (CGIN).

This is not cancer, but there's a risk it could turn into cancer if untreated.

Abnormal cells may be detected while a colposcopy is carried out, but a biopsy will be needed to determine what the risk of these becoming cancerous is and whether treatment is needed.

The different types of abnormal biopsy result and what they mean are as follows:

  • CIN 1 - it's unlikely the cells will become cancerous and they may go away on their own; no treatment is needed and you'll be invited for a cervical screening test in 12 months to check they've gone
  • CIN 2 - there's a moderate chance the cells will become cancerous and treatment to remove them is usually recommended
  • CIN 3 - there's a high chance the cells will become cancerous and treatment to remove them is recommended
  • CGIN - there's a high chance the cells will become cancerous and treatment to remove them is recommended

In rare cases, a colposcopy and biopsy will find cervical cancer. If this happens, you'll be referred to a team of specialists to discuss treatment.

Jo's Cervical Cancer Trust has more information about biopsy results.

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Treatment

If a colposcopy finds abnormal calls in your cervix, treatment to remove these cells may be recommended.

There's sometimes a risk these cells could become cancerous if left untreated. Removing them means they will not be able to turn into cancer.

The aim of treatment is to remove the abnormal cells while minimising damage to healthy tissue. Usually an area about the size of a fingertip is removed.

When treatment is carried out

Treatment to remove abnormal cells from your cervix can be done at the same time as a colposcopy if it's obvious that some of the cells in your cervix are abnormal.

But sometimes treatment cannot be done on the same day.

For example, you may need to wait until you get your biopsy result a few weeks later if it's not immediately clear whether you have abnormal cells in your cervix.

Types of treatment

There are several ways abnormal cells can be removed from the cervix.

LLETZ

The most common treatment is large loop excision of the transformation zone (LLETZ). It:

  • involves removing the abnormal cells using a thin wire loop that's heated with an electric current
  • can be carried out at the same time as a colposcopy
  • is usually done while you're awake - local anaesthetic is injected into your cervix to numb it during the treatment
  • does not usually need an overnight stay in hospital

LLETZ is also called loop diathermy, loop cone, loop biopsy or loop excision.

Cone biopsy

A cone biopsy is done less often than LLETZ. It:

  • is a minor operation to cut out a cone-shaped piece of tissue containing the abnormal cells
  • only tends to be used if a large area of tissue needs to be removed
  • cannot be done at the same time as a colposcopy
  • is usually done under general anaesthetic (where you're asleep)
  • may require an overnight stay in hospital

Other treatments

Abnormal cells in the cervix can also be treated with:

  • cryotherapy - the abnormal cells are frozen and destroyed (this is only used to treat minor cell changes)
  • laser treatment - a laser is used to pinpoint and destroy abnormal cells on your cervix
  • cold coagulation - a heat source is applied to the cervix to burn away the abnormal cells
  • hysterectomy (removal of the womb) - this will only be considered if abnormal cells on your cervix have been found more than once, if they're severely abnormal, you're past childbearing age, or you do not want to have more children

After treatment

You can often go home to rest soon after the treatment is finished. Most people feel well enough to return to work and most normal activities the next day.

You'll usually be advised to avoid:

  • driving for at least 24 hours if you had a general anaesthetic - you can drive straight away if a local anaesthetic was used
  • using tampons or menstrual cups for 4 weeks (use sanitary pads instead)
  • having sex for 4 weeks
  • exercising, including swimming, for at least 2 weeks, or while there's still any bleeding or discharge

You'll also be advised to have another cervical screening test 6 months after treatment, to check for abnormal cells and the human papilloma virus (HPV).

If HPV is not found, you will need to be screened again for another 3 years. But if HPV or significant cell changes are found, you'll be referred for another colposcopy.

Risks and side effects

Common side effects of treatment include:

  • mild pain, similar to period pain - this should pass in a few hours and can be relieved with paracetamol or ibuprofen
  • light vaginal bleeding and brown, watery vaginal discharge - this may last up to 4 weeks

There's also a small risk of more serious complications, such as:

  • an infection - this can cause heavy or persistent bleeding, smelly vaginal discharge and persistent stomach aches; see a GP if you have these symptoms
  • a slightly increased risk of premature birth (before the 37th week of pregnancy) in future pregnancies - this is more likely if you need repeated treatments or a lot of tissue needs to be removed

In most cases, the benefit of treatment will outweigh these risks. Talk to a doctor or nurse if you have any concerns or would like to know more about the potential risks of treatment.

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The information on this page has been adapted by NHS Wales from original content supplied by NHS UK NHS website nhs.uk
Last Updated: 13/02/2020 10:38:32