Colposcopy

Depending on the grade of abnormality detected on a smear test some women can be referred for colposcopy; this enables a doctor to examine the cervix and if required advise further treatment.

What is colposcopy?

What is the purpose of colposcopy?

Where is colposcopy done?

Can I have colposcopy if I am pregnant?

Is colposcopy a treatment?

What happens during colposcopy?

How is a diagnosis made?

What if abnormalities are diagnosed during colposcopy?

What should I be aware of after colposcopy?

What is colposcopy?

Colposcopy is a diagnostic procedure used in the prevention of cervcial cancer and involves the use of a magnifying device called a colposcope to examine an illuminated, magnified view of the cervix, the tissue of the vagina, and vulva. The enlarged view provided by the colposcope allows the colposcopist to visually distinguish normal from abnormal appearing tissue and to take directed biopsies for further histology.

What is the purpose of colposcopy?

The purpose of colposcopy is the prevention of cervical cancer through the early detection and treatment of pre-cancerous lesions (CIN). The procedure was developed by the German physician, Dr.Hans Hinselmann in 1925. Women who receive abnormal smear results can be referred for colposcopy, which is used to identify and grade the abnormality.

Where is colposcopy done?

Colposcopy is usually done in colposcopy/gynaecology out-patient clinics by consultants and nurse specialists in colposcopy. If you are referred for colposcopy it is important that you note your period date as the procedure will not carried out if you have your period. You will be admitted as an out-patient and it is advisable to bring a sanitary towel as a small amount of bleeding is not uncommon after colposcopy, particularly if biopsies have been taken. The use of tampons is not advised immediately after colposcopy. The procedure usually takes between ten and fifteen minutes and should be painless. However, some women experience more discomfort than others so DO inform a member of your team if you experience any problems during colposcopy.

Can I have colposcopy if I am pregnant?

Colposcopy can be done safely during pregnancy, although treatment is usually advised to be left until after delivery.

Is colposcopy a treatment?

Colposcopy is not a treatment, but instead a diagnostic procedure which is used to more accurately assesses the significance of an abnormal smear and to plan any treatment if necessary. However, treatment can take place at your colposcopy appointment and the advised procedure will be discussed fully with you beforehand.

What happens during colposcopy?

When you arrive for your appointment at the colposcopy clinic a member of the dedicated staff will take a medical history, including as much information as possible about your previous smear results, cervical procedures, allergies, last period, pregnancies,contraception use, the possibility of being pregnant, (a pregnancy test may be done) whether you smoke, and any medications currently being taken or taken previously for other medical conditions. The procedure will then be explained and you should ask as many as questions as it takes for you to fully understand what is going to happen. When you are, you will be asked to sign a consent form.

The colposcope is the most important piece of equipment used during a colposcopy. It functions as a lighted binocular microscope, which magnifies the view of the cervix, vagina and vulvar surface and enables the colposcopist to identify areas on the surface that show abnormalities. Two chemicals; acetic acid and iodine solutions are used in colposcopy to improve the visualisation of abnormal areas.

You will be asked to remove your underwear and to lie with your bottom close to the lower edge of a purpose-built table. For your comfort your feet will be placed in stirrups or braces, which take your weight during the procedure. A further smear test may be carried out at colposcopy. Your vulva will be examined for any suspicious lesions and then a speculum (used in smear tests) is gently placed in your vagina. The transformation zone is the area on the cervix where many pre-cancerous and cancerous lesions develop so this area is swabbed lightly with acetic acid to remove the mucous that covers the surface, and to highlight abnormal areas.

The colposcope is then positioned at the opening of the vagina, and the area is thoroughly examined. Areas of the cervix which turn white after the application of acetic acid or have an abnormal pattern are often considered for biopsy. If no lesions are visible, an iodine solution may be applied (The Schiller Test) to the cervix to help highlight areas of abnormality. Mature, normal cells will stain a dark-brown colour whereas abnormal cells will not stain and biopsies may be taken from these non-staining areas.

After a complete examination, the colposcopist determines the areas with the highest degree of visible abnormality and a small sample of the tissue will be removed (biopsy) using small biopsy forceps. Many samples may be taken, depending on the size of the area.

Some colposcopy clinics have video equipment so that the colposcopist can view the examination on a screen. You will be able to watch this too, if you want to.

How is a diagnosis made?

A combination of acetic acid and iodine tests are used by most colposcopists to determine if an abnormality is likely to be pre-cancerous or not. A diagnosis will be made by:

• how white the tissue goes after using acetic acid
• how quickly the tissue turns white
• how smooth or irregular the surface is
• the different patterns of the blood vessels under the surface of the cervix

All biopsies taken are sent to a laboratory for histology and you should receive the results within one week.

What if abnormalities are diagnosed during colposcopy?

Depending on the type and grade of abnormality diagnosed a variety of treatments can be advised during colposcopy. Most involve the abnormal area being excised/removed from the cervix by procedures called laser or diathermy treatment.

Borderline or mild abnormalities (CIN1) may be treated or left to see if they return to normal spontaneously and some 50% do. Treatment is advised if the abnormality (CIN2 or CIN3) is proven by biopsy. Treatment can take place at your colposcopy appointment - the advised procedure will be discussed fully with you beforehand or if you prefer a further appointment will be made.

What should I be aware of after colposcopy?

Following a colposcopy examination some women experience a heavier and sometimes more painful period than usual while others comment that their cycle has been interrupted and that their periods begin earlier, or are delayed. There is no medical explanation for this as the uterus is not ‘treated’ during colposcopy but it may be due to the proximity of the cervix to the uterus. Usually these symptoms settle down quickly without medical attention.

The cervix can take a week to ten days to heal completely after colposcopy. There is usually very little bleeding immediately after colposcopy but some women experience some bleeding/discharge in the following days. The use of sanitary towels instead of tampons is advised after colposcopy and they are useful in monitoring any evident bleeding or discharge. 

Signs and symptoms to be aware of after colposcopy and/or treatment include:

If biopsies or treatments have been performed during colposcopy then the cervix can take between one to six weeks to heal completely, depending on the size of the biopsy taken.

• Heavy bleeding with clots or bright red bleeding - this could indicate that the wound is not healing

• Offensive discharge or greenish/yellow discharge, which could indicate infection

• If you experience any of these symptoms you should either make an appointment with your GP or contact the clinic, where you had the colposcopy as you may require a medical review

Last Updated: 23 Feb 2007