Colposcopy – with or without treatment

  • Reference Number: HEY-367/2018
  • Departments: Gynaecology

Introduction

This leaflet has been produced to give you general information about your treatment. Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion.   If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is a Colposcopy?

Colposcopy is an examination performed by a doctor or specialist nurse who specifically deals with problems related to cervical cytology (smears).  It is used to identify any important changes on the cervix that may require more frequent or closer follow-up and to determine any significant changes that may require a treatment to be performed. The examination is similar to when you have a cervical smear taken but usually takes a little longer (about 10 – 15 minutes).

The examination is performed in the colposcopy suite located within the Gynaecology Outpatient department. During the examination a solution (acetic acid) will be applied to the cervix to help identify any abnormal cells which may be causing the smear result that you have received.  Occasionally iodine solution may also be applied to your cervix during the examination; the iodine may stain your underwear. Occasionally you may experience a slight ‘stinging’ sensation but on the whole the procedure is extremely similar in nature to a routine smear test and relatively painless.

The colposcope is attached to a TV monitor which means that you may watch the examination if you so wish. This can help the doctor or specialist nurse to describe the findings of the examination to enable you to have a better understanding of your smear result and the possible causes.

What is a colposcope?

This is an instrument used to magnify the cervix and allow the doctor or specialist nurse to have a closer look at the cervix. In simple terms the colposcope looks very much like a pair of binoculars on a stand. The colposcope does not enter the vagina it is simply used to look more closely at the neck of your womb.

Why do I need a Colonoscopy?

Your cervical screening test (smear) which was taken at your doctor’s surgery or clinic has been reported as abnormal, which may be due to either:

  • An inadequate sample of cells (not enough cells obtained at the time of your screening test to ensure adequate assessment)
  • The detection of a virus (HPV) on your sample
  • Changes to the cells on your cervix (dyskaryosis)

Your doctor or practice nurse may have simply had difficulty in obtaining your cervical screening test, or they may be concerned regarding the appearance of your cervix. In certain cases the colposcopy clinic is the best place to have these symptoms checked.

Alternatively you may have been referred because you have been experiencing symptoms (for example bleeding between periods, bleeding after intercourse) which may be related to the health of your cervix.

This means that your cervix needs to be examined more closely and in more detail by an instrument known as a colposcope.

What is dyskaryosis?

When your cervical screening test finds abnormal changes in the cells of the cervix then these abnormal changes are called dyskaryosis. Dyskaryosis refers to abnormal changes in the cells of the cervix which act as an early ‘warning’ signal that cervical cancer might develop in the future if these changes are ignored. It is extremely rare for these abnormal cells to be cancer at the time of your referral to colposcopy. It is however important for you to attend your appointment in order to monitor or treat these changes when necessary.

The abnormal cervical screening result which is referred to as borderline or mild dyskaryosis are early and low-grade changes in cells which in many cases may return to normal by themselves. Although examination with the colposcope is necessary, in the majority of cases it is safe just to monitor the changes. Any immediate treatment is usually unnecessary, although a small biopsy may sometimes be taken at the time of the colposcopy examination.

The abnormal cervical screening result which is referred to as moderate or severe dyskaryosis are also precancerous in nature with the majority of cases not leading to cancer of the cervix in the future. These changes however are less likely to return to normal by themselves. They tend to be persistent and may worsen with time; an outpatient treatment may be performed so that the cervix can change back to normal. This simple treatment may be performed at the same time as your colposcopy examination.

Alternatively a small biopsy may be performed to confirm these changes and a further appointment for a treatment may be given at a later date once the biopsy results are available.

Please remember that it is extremely rare for these abnormal cells detected on your cervical screening to be cancer at the time of your referral to colposcopy.

What is a biopsy?

A biopsy is the removal of a small piece of tissue from the neck of the womb. This biopsy is sent to the pathology laboratory for testing to confirm any changes in the cells which may have been seen at the time of the colposcopy examination.

The biopsy may cause a small amount of discomfort (like a period type pain) and the doctor may need to use a special solution to stop any minor bleeding from the biopsy site.  If the pain continues then you can take mild pain relief medication but please do not take more than the recommended dose. If a biopsy is performed then you will need to use sanitary protection for a day or two after the procedure as you may get a brown or red vaginal discharge. It is advisable to avoid sexual intercourse and not to go swimming for 2 to 3 days afterwards to ensure that healing of the area has finished.

What is HPV?

Human papillomavirus (HPV) is a virus transmitted mainly by sexual skin-to-skin contact which means that penetration is not required to contract the virus. HPV is a very common virus and some types of HPV affect both males and females causing conditions like genital warts. Other types of HPV are potentially associated with the development of cervical cancer but most women with high risk type HPV will never get cervical cancer.

High risk type HPV usually has no symptoms so most women (and men) are unaware of the presence of the virus and a woman may have been infected for many years before the virus has been detected. It is therefore not recommended that you confront or blame your current or previous partner.

Although high-risk type HPV is potentially associated with the future development of cervical cancer the majority of women do not get cervical cancer as a result of the infection.

Because there are no symptoms and some types of HPV are linked to the development of cervical cancer then regular cervical screening is essential for detecting any abnormal changes caused by HPV.  Detection of a HPV virus that is regarded as a high-risk type is associated with the development of cervical cancer.  This means that you may be referred for a colposcopy examination to ensure that the neck of the womb is otherwise normal.

Can there be any complications or risks of colposcopy?

There are no health risks with this procedure. The colposcopy examination itself feels similar to having a routine smear test. It is always advisable to have something to eat or drink before you come to colposcopy as very occasionally some women feel faint or lightheaded.

Can there be any complications or risks of loop biopsy?

There is some risk associated with most procedures, for loop biopsy they include:

  • Infection, 5 out of every 100 women may develop an infection. If the vaginal discharge becomes smelly and you develop a raised temperature and a fever, you should contact your doctor
  • There is a small but significant risk of increase in the incidence of early labour following treatment
  • Narrowing of the entrance to the cervix (cervical stenosis). This may lead to difficulties in doing smear tests
  • Difficulties in labour (very rare)

How do I prepare for a colposcopy?

Please read the information leaflet.  Share the information it contains with your partner and family (if you wish) so that they can be of help and support.  There may be information they need to know, especially if they are taking care of you following this examination.

What if I am having a period when my appointment is due?

It is not normally possible to do a colposcopy examination if you are having a period and you may need to telephone to change your appointment. If this is the case the telephone number to contact is: (01482) 624035. 

If you have infrequent or irregular periods then please keep your original appointment.

If you feel uncomfortable about having the examination whilst you are having your period then please call us to rearrange the appointment.

What if I am pregnant?

If you are pregnant then please keep any appointment that has been arranged for you. A colposcopy examination will not harm your baby and if you need any treatment then this can usually wait until you have delivered your baby.

What will happen?

What can I expect when I attend the clinic?

On arrival at the clinic one of the nursing staff will welcome you and check your personal details

  • We will aim to see you as close to your appointment as possible, but please be patient with us as sometimes unforeseen delays may occur
  • You will have the opportunity to talk to the colposcopist (doctor or specialist nurse) before getting undressed for the examination
  • The doctor or nurse specialist will ask you some general questions about your health and some more specific questions about your past smears and any previous treatment to your cervix
  • It would be extremely helpful if you could provide the date of your last menstrual period, what contraception method you use, details of any allergies, and the names of any medication that you are taking
  • You will be asked to remove your clothes from the waist down and to cover yourself with a sheet that will be provided. You will be asked to undress in a separate and private room and not in front of any medical or nursing staff
  • You will be asked to lie on a special couch which has supports for your legs and the doctor or nurse specialist will gently insert a speculum into the vagina which is the same instrument used to perform your cervical screening
  • During the colposcopy examination the doctor or specialist nurse may need to take a further cervical screening test
  • During the colposcopy the doctor or specialist nurse may need to take a small biopsy (remove a small piece of tissue from the neck of the womb)
  • Sometimes (if appropriate) the doctor or specialist nurse may offer to perform a treatment at your first colposcopy appointment.  Alternatively a treatment can be arranged at a later date following for example the result of any biopsy taken confirming the cell changes on your cervix.  Treatment at the first visit is entirely optional and this will be discussed with you by the doctor or nurse specialist at your appointment

Although there are male and female doctors in the clinic you will have a female nurse/ healthcare assistant with you at all times. You may wish to bring a friend or a partner with you for further support, particularly if you are having a treatment.

What happens if I need treatment?

The aim of treatment is to remove any abnormal cells and allow healthy cells to replace them. The doctor or specialist nurse may decide at your first visit that some treatment to the cervix is required and this treatment can sometimes be performed at the first visit if you wish. However, it is not always possible to decide if treatment is necessary and a cervical screening test or a biopsy, as previously described, may be taken. If this is the case, the doctor may describe to you what may happen next and write to you at home to confirm these plans once they have seen the screening and biopsy results.

You will usually receive your letter within 6 weeks after your clinic visit. If you need treatment this is usually in the form of a loop biopsy.

What is a loop biopsy?

A loop biopsy is a treatment used to remove a small area of tissue (loop) from the neck of your womb. This treatment uses an electric current to remove abnormal tissue from the neck of the womb and a local anaesthetic is used to perform the procedure. This is a very effective form of treatment for the condition. This treatment usually takes between 10 – 15 minutes and is very similar to the colposcopy examination.

The procedure is very straightforward. You may experience some discomfort during or after the procedure which most women describe as feeling like a period type pain. You may need to rest for a further 15 minutes or so after the treatment or you may feel well enough to leave straightaway. Please allow approximately 40 – 50 minutes for your clinic visit. Some bleeding may occur after treatment and you may prefer to bring your own sanitary pad but not a towel. It is advisable to have a restful day and if possible not return to work after the treatment.

Following treatment you will be asked:

  • not to use any tampons, use pads for the next 4 weeks to allow the neck of the womb to heal
  • not to have sexual intercourse for the next 4 weeks
  • not to go swimming for 4 weeks

If you have a coil (IUCD) the doctor will take it out at the time of treatment. You should use an additional method of contraception (condoms) as well as the coil for 7 days before the appointment.

If for some reason this is problematic at the time of your treatment appointment (for example you are going on holiday) then please contact us to rearrange your appointment.  The telephone number to call is (01482) 624035. 

What happens afterwards?

What normally happens following treatment?

You may expect some bleeding or brown discharge for up to 4 weeks as the cervix takes some time to heal

  • Your next period may also be heavier than usual
  • As with the colposcopy you may need to take mild pain relief medication, but please do not exceed the recommended dose
  • For 4 weeks after treatment it is advisable not to use tampons but to use sanitary pads and not to have sexual intercourse. It is also advisable to avoid swimming
  • Occasionally very heavy bleeding may occur, in which case you may need to contact your doctor or the hospital. This bleeding may occur immediately after the treatment or within the first few weeks. If this occurs then it is possible that you may need another examination
  • Occasionally an infection may occur causing a raised temperature, discomfort and an offensive discharge. If this occurs then you may need to contact your doctor or the hospital. You may need to have a further examination and swabs taken. Antibiotics may also be prescribed

Will having a treatment affect my fertility or sex life?

Having treatment will not have any effect upon your fertility

  • Having treatment will have no long-term effect upon your sex life
  • Some treatments may have an effect upon future pregnancy outcomes where recent evidence has suggested a potential increase in the risk of pre-term delivery (delivery of a premature baby). We will be able to discuss this further with you when you attend for your appointment

Will I need further follow-up?

If you have a treatment performed then you will need further cervical screening in 6 months. This is to ensure that everything has returned to normal. This test may be performed by either your doctor or in the colposcopy clinic. We will send you a letter after your treatment confirming your results and informing you where you will need to go for your repeat screening test.

It is very important to attend for your follow-up as this allows us to check that your cervix stays healthy.

 You may also contact your doctor for further advice. Information may also be obtained from the BSCCP (The British Society for Colposcopy & Cervical Cytology) Website: www.bsccp.or.uk

 Should you require further advice about the issues contained in this leaflet, please do not hesitate to contact the following areas:

Colposcopy Secretary (01482) 624035

Gynaecology Outpatients

Women and Children’s Hospital (01482) 607893

Women’s Health Outpatients

Castle Hill Hospital (01482) 624045

Ward 30

Women and Children’s Hospital (01482) 382739 / 604387

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.