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 called a colposcope. It allows the doctor, or specialist nurse, to see the extent of the abnormal cells and the degree of change in the cells. Treatment of abnormal cervical cells (if needed), can be carried out at colposcopy.
Note: the information below is a general guide only. The arrangements, and the way tests are performed, may vary between different hospitals. Always follow the instructions given by your doctor or local hospital.
What is colposcopy?
Colposcopy is a detailed examination of the neck of the womb (cervix). It is usually carried out in a colposcopy clinic by a doctor or specialist nurse who has specific training and experience in colposcopy. The doctor or nurse uses a special microscope, called a colposcope, to look at the cells of the cervix in detail.
A liquid is painted on to the cervix to show up any abnormal cells. 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.
What is the difference between colposcopy and cervical screening?
A cervical screening test is offered regularly to all women to prevent cancer of the neck of the womb (cervical cancer). The cervical screening test is looking for early changes (or abnormalities) in the cervical cells, that, if left untreated, would have the potential to develop into cancer in the future. (See separate leaflet called Cervical Screening Test for more information.)
About 1 cervical screening test in 20 is abnormal. Abnormal changes in the cells are found in some women. These abnormal changes are known as dyskaryosis. In the vast majority of cases, an abnormal result does not mean cervical cancer. However, the presence of dyskaryosis indicates that cancer may develop at some time in the future (often many years away).
A cervical screening test shows if abnormal cells are present but does not show enough detail about the cells. Colposcopy allows a closer and more detailed look at these abnormal cells.
During colposcopy, the extent of the area where the abnormal cells are present is shown. This is done by applying a special liquid to your cervix, which stains the abnormal cells. Colposcopy also allows a sample of tissue (a biopsy) to be taken. This sample is then sent to the laboratory for further tests. This means that the exact type of abnormality in the cells can be identified.
A cervical screening test can be performed more quickly and needs less training than colposcopy. This means that it is a more suitable test to look for changes in the cervix in large groups of people. Cervical screening has been proven to reduce the number of cases of cervical cancer. This is why there is a National Screening Programme throughout the UK.
Why do I need a colposcopy?
The usual reason for having a colposcopy is because you have had an abnormal cervical screening test result. This happens quite commonly, so you should try not to be too alarmed. Remember that in most cases, an abnormal cervical screening test does not mean you have cancer of the neck of the womb (cervical cancer). It is rare for cervical cancer to be diagnosed this way.
Sometimes you can be referred for a colposcopy because you have had a number of inadequate cervical screening tests in a row. This can happen if there was too much blood or mucus present around your cervix at the time of your cervical screening test, or because too few cells were removed during the procedure. Because of this, not enough cells could be seen clearly under the microscope.
You might also be referred for a colposcopy if you have had a borderline or mildly abnormal smear which was then tested for human papillomavirus (HPV). This is a type of wart virus that can be passed on by having sex. It is involved in the development of most cases of cervical cancer. However 9 in 10 infections with HPV will clear completely from the body within two years. This means that most women who are infected with HPV do not develop cancer.
Rarely, you can be referred for a colposcopy because the doctor or nurse carrying out your cervical screening test is worried about infection, inflammation or a non-cancerous growth (a polyp) around the cervix.
How will I know if I need a colposcopy?
When you have your cervical screening test, you should be told when (and how) to expect your results. You will generally be informed directly, by letter, of your results. Your GP will also receive a copy of your results.
In each case, the laboratory advises what action is needed for each cervical screening result. Some women will have a degree of abnormality that means a colposcopy is needed. You will often be sent this information in the post. In some areas, women who have an abnormal cervical screening test will be referred directly to a colposcopy clinic. In other areas, the GP has to make this referral. If this is the case, your GP should inform you of the referral. You do not need to do anything - BUT speak with your GP if you are worried or there is something you do not understand AND contact your GP if you know you are waiting for a colposcopy appointment but have not heard anything after a few weeks.
Before your colposcopy
You should receive written information about the procedure in advance of your appointment. If there is anything you don't understand you can either ring the clinic directly or discuss this with your GP. There are some things that you should think about before your 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 your 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 or pessaries for 24 hours before your colposcopy. This includes lubricants, thrush treatments, douches and spermicides.
- Some people find the colposcopy examination a little uncomfortable. For this reason, you may choose to take some paracetamol about an hour before your appointment.
- 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).
What should I expect when I have my colposcopy?
The whole procedure normally takes about 15-20 minutes. It may be longer if you have treatment at the same time (see below). It is best to allow an hour for the whole visit:
- The doctor or nurse will usually start by asking you some questions. These may include information about your periods, the date of your last period, what contraception you use and your general health.
- You will then be asked to remove your clothing from the waist down. (You can usually keep a loose skirt on.)
- You will be asked to lie in a reclining chair, or on a couch, in the same position as during a cervical screening test. This is with your knees bent and your legs apart. In some clinics your legs may be placed apart in padded supports called stirrups.
- An instrument called a speculum (the same instrument that is used during a cervical screening test) will be inserted into your vagina. It is gently opened to bring the neck of the womb (cervix), at the top of the vagina, into view.
- The doctor or nurse will then look through the colposcope to get a good view of your cervix. The colposcope itself does not go inside your vagina. It is essentially like a big pair of binoculars on a stand that can be moved around. There is also a light to help see inside your vagina. Sometimes, the colposcope can be attached to video equipment so that the examination can be viewed more clearly on a TV screen. This means that you have the opportunity to watch too (but only if you would like to!).
- A long swab (like a fat cotton bud) is used to apply liquids to the cervix. These liquids stain any abnormal cells that may be present. Two different liquids are normally used - acetic acid (like vinegar) and iodine.
- A small sample of tissue (a biopsy) from your cervix may also be taken. This will be sent to the laboratory for further examination. The biopsy is only about the size of a pinhead, but taking it can be slightly uncomfortable. If this is anticipated, local anaesthetic is usually used to numb your cervix first.
- Sometimes it is suggested that you have treatment at your first colposcopy visit (see below). However, often, you may be asked to return for treatment once the biopsy results are back.
- It is worth bringing a sanitary towel or panty liner with you, to use after your colposcopy. It is unlikely you would have much bleeding, but you might have some discharge or staining from the iodine used in the examination. There is more likely to be discharge or bleeding if you have had a biopsy or treatment. You should not use a tampon, but don't worry if you forget sanitary protection - the clinic will give you a pad (but it might be thicker and more bulky than the usual products you prefer).
After your colposcopy
After your colposcopy you can usually return to work or carry on with your normal day. You are likely to have a small amount of bleeding, especially if you have had a sample of tissue taken (a biopsy). This can last for 3 to 5 days and you should wear a sanitary pad. Do not use tampons. You should not have sex or use vaginal creams or pessaries until the bleeding has stopped. Generally you should wait for five days.
You may notice a dark fluid-like material on the pad. It is sometimes green or looks like coffee granules. This is normal and is the liquid that is painted on to the neck of your womb (cervix) during the examination.
What are the risks or complications of colposcopy?
Colposcopy is generally a safe procedure. Some women find that is it a little uncomfortable. Rarely, complications can occur. These can include heavy bleeding and infection. If you experience any heavy bleeding, smelly vaginal discharge or severe lower abdominal pain, you should see a doctor as soon as possible.
The biopsy results
When a small sample of tissue (a biopsy) has been taken, it is sent to the laboratory for further examination under a microscope. The cell abnormality that can be seen is called cervical intra-epithelial neoplasia (CIN). There is a scale from 1 to 3 according to the number of cells in the biopsy sample affected by CIN. In CIN1, only a few (1 in 3) cells are abnormal. In CIN3, all of the cells are abnormal. Rarely, a biopsy can show changes in your cells that have already developed into cancer. About 7 in 10 cases of CIN1 return to normal without treatment, but 1 in 10 progresses to CIN3. Only 1 in 100 cases of CIN1 becomes cancer (and this is over a long time).
CIN2 and 3 still mean it is very unlikely you have or will develop cervical cancer. However, these changes are much less likely than CIN1 to get better on their own, without treatment. So, if CIN2 or 3 were found on your biopsy, you are likely to need treatment of these abnormal cells on the neck of your womb (cervix).
Remember that the whole point of cervical screening (and subsequent examination/treatment of abnormal cells at colposcopy) is to prevent cervical cancer. This is by detection and treatment of early changes in the cells, which, if left untreated or unchecked for some years, could develop into cancer.
How will I know if I need any treatment?
The results of your colposcopy and small sample of tissue (biopsy) will show if you need any treatment. Sometimes, the doctor or nurse may suggest that you have treatment at your first visit for colposcopy. However, they may suggest that they wait for the results of your biopsy before you have any treatment. This just depends on the clinic that you attend. It can take a few weeks for the biopsy results.
Not everyone who has a colposcopy needs treatment. If the doctor or nurse feels that you only have a mild abnormality, they may just suggest that you have a repeat colposcopy in 6 to 12 months. The changes in your cervix may return to normal by themselves and they may just need monitoring.
What are the treatment options available?
There are a number of different treatments available for CIN. The aim of the treatment is to destroy or remove all of the abnormal cells on the neck of your womb (cervix) without affecting too much normal tissue. Most treatments can be done as an outpatient, at colposcopy. The treatment may cause a little discomfort, perhaps similar to a period pain.
The treatment that you have will depend on the extent of your abnormality as well as what treatment the clinic has available and the preference of the doctor or nurse. Treatment options include:
- Loop diathermy: a thin wire loop cuts through and removes the abnormal area of cells. This is also known as a large loop excision of the transformation zone (LLETZ). It is the most common form of treatment used in the UK.
- Cryotherapy: freezing the affected area of the cervix, which destroys the abnormal cells.
- Laser treatment: this destroys or cuts away abnormal cells.
- Cold coagulation: a heat source is used to burn away and remove the abnormal cells.
A local anaesthetic is usually given before any treatment, to numb the cervix. The treatment is normally very straightforward and quick. There is a small risk of bleeding at the time of treatment.
Occasionally, the doctor or nurse may suggest that you have a cone biopsy (described later) or, very rarely, a hysterectomy (removal of your womb (uterus) and cervix) as a treatment for CIN. If this is the case, you will need to be admitted to hospital.
What should I expect after my treatment?
You may have some mild discomfort, like a period pain, after your treatment. Painkillers such as paracetamol may help to ease the pain.
You are likely to have some bloody vaginal discharge. This can last up to six weeks. It is like the blood loss during a period. If you are worried that it is too heavy, or if it becomes smelly, then see your usual doctor. You should use sanitary pads and not tampons. You should avoid sex and not do any heavy exercise until the discharge has stopped.
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 GP surgery. You will usually be advised to have a cervical screening test every year for a number of years (often 10 years if you had CIN2 or 3). If you have any further abnormal cervical screening test results you may need to have another colposcopy examination.
What is the outlook (prognosis) if I need treatment?
Treatment of CIN is usually almost 100% effective. In the vast majority of women, it is unlikely that CIN will come back.
What is a cone biopsy?
Sometimes, all of the abnormal cells cannot be seen during colposcopy because the cells go further up into the neck of the womb (cervix). If this happens, the doctor or nurse will usually suggest that you have a minor operation called a cone biopsy. This is when a cone-shaped piece of tissue is removed from your cervix so that it can be examined under the microscope in the laboratory.
You will be given a separate appointment to come back for your cone biopsy. You are usually admitted to hospital overnight. A general anaesthetic that puts you to sleep is usually given.
What happens after a cone biopsy?
After your cone biopsy, you may have some gauze packed into your vagina to help control any bleeding. Some women also have a tube to drain urine (a catheter) inserted into their bladder at the time of the operation. This is because the gauze can sometimes press on the bladder and stop it from emptying properly. The gauze and the catheter will be removed before you leave hospital.
Most women notice a bloody discharge for up to four weeks after a cone biopsy. You should wear sanitary pads and not tampons. If you are worried that the bleeding is too heavy, if it becomes smelly, or if you develop abdominal pain, you should see your usual doctor.
After your cone biopsy you should rest for a few days. You should not have sex or do any heavy exercise for 4 to 6 weeks.
If all the abnormal cells are removed during your cone biopsy and there is no sign of any cancer, you do not usually need any more treatment. However, you will need to have regular cervical screening tests to make sure that no more abnormal cells develop.
Colposcopy and pregnancy
If you are pregnant, you should discuss this with the doctor or nurse before you have a colposcopy. Colposcopy can, however, be done safely in pregnancy. Treatments (if needed) are usually delayed until after having the baby - unless the abnormality is very severe and it is thought to be dangerous to wait until after the baby is born. Colposcopy in pregnancy does not affect the delivery of your child; nor does it affect your future fertility.
Dr Tim Kenny
Dr Louise Newson
Dr Hannah Gronow