What is a Colposcopy?
This is a detailed examination of the neck of the womb (cervix). You have been referred to the Colposcopy Clinic because the smear that they had taken from your cervix has shown abnormal cells. This does not mean that you have cancer.
Occasionally your GP or clinic doctor may request an appointment for you so that your cervix can be examined in more detail.
About your Cervical Smear
The purpose of a cervical smear test is to detect any abnormal or pre-cancerous changes in the skin on the neck of the womb (cervix) many years before they can cause any serious problems.
We do know that some of these cell changes can return to normal without treatment. We also know that some cell changes, if untreated over a period of years, may develop into a cancer. Detecting these cell changes early, enables preventative treatment to be given.
Abnormal smears are very common. About one in twelve women will have an abnormal smear. Cervical cancer is very uncommon.
Causes of an abnormal smear
Cervical Intra-epithelial Neoplasia, more commonly referred to as CIN, is the medical term for the cell changes. The exact cause of cell changes on the cervix (CIN) is still unknown. However, we know that that it is related to sexual activity and a specific virus known as the Human Papilloma Virus (HPV).
It is believed that most women, who have been sexually active, will be exposed to the virus in their lifetime and a small butm significant number will be at risk of developing an abnormality on their cervix.
Women who smoke are known to be at greater risk of developing CIN than non-smokers. This is because once the chemicals produced by smoking have been inhaled they enter the bloodstream and travel to every part of the body.
These risk factors are not applicable to every woman who has an abnormality. However, to help prevent these changes occurring it would be advisable to:
- Give up smoking. We can provide advice if you wish.
- Use barrier methods of contraception, such as condoms, in the early stages of a relationship
- Limit the number of sexual partners.
Mr A Shah
Mrs L Karamura
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Additional nursing staff who will be present in the clinic:
Health Care Assistant (HCA)
A Colposcopy is done as an outpatient procedure, which takes approximately 10 – 20 minutes. However, allow one hour for the visit. The Colposcopist will explain the results of your smear test with you in more detail before you are examined.
The first part of the examination is very much like having a smear test. A nurse will accompany you at all times. The nurse will help you to position yourself on the colposcopy examination chair.
This chair will move to ensure you are in a comfortable position for the examination.
Menstruation (periods) does not prevent you from attending a colposcopy examination, unless your period is particularly heavy.
Pregnancy does not prevent you from attending a colposcopy appointment, as a colposcopy examination will not harm a pregnancy in any way. If you have been invited for a colposcopy and you are pregnant you are advised to attend.
If you have a coil, please use alternative methods of contraception (eg. condoms), or abstain from intercourse for 7 -10 days before your appointment as it may be necessary to remove the coil before treatment.
If other methods of contraception have not been used, your treatment may be delayed, as the coil cannot be removed, due to the slight risk of pregnancy occurring.
As with the smear test, the colposcopist will gently insert an instrument (speculum) into your vagina.
The colposcope is like a magnifying glass, which never actually touches or goes inside you, and is focused through the speculum onto the cervix. While examining your cervix the colposcopist will apply one or both of two solutions (very dilute acetic acid and iodine). This will help to identify and highlight various types of cells.
If everything appears normal, you will be advised to attend for a follow up smear at your GP’s surgery.
If a minor abnormality is detected, a small sample of tissue (biopsy) will be taken from the surface of the cervix. You may or may not feel a slight discomfort when the biopsy is taken.
However, most women are surprised how little they feel. You will be sent the results of the biopsy in the post and any further appointments as required. This process usually takes approximately 4 weeks.
If a biopsy is taken, you are likely to have a slight discharge from the area on the neck of the womb from where the biopsy was taken. This is normal and should gradually clear itself. We recommend that you refrain from sexual intercourse for two to three days to allow the biopsy site to heal.
A sanitary pad will be provided or you may wish to bring your own. Suitable underwear should be worn to accommodate this. (ie. thongs are not advisable).
If a definite abnormality is present treatment will be offered. If treatment is required then it is simple and virtually 100 per cent successful. The aim/benefit of treatment is to destroy or remove the abnormal cells allowing healthy cells to replace them.
Remember, you are very unlikely to have cancer.
Treatment is often done as an outpatient in the Colposcopy Clinic on your first appointment. You may wish to bring someone with you who may, if you wish, stay with you whilst treatment is performed. You may wish to plan a quiet day in case you are offered treatment.
Occasionally a short day-case procedure under general anaesthetic is required.
The loop excision or Lletz (Large Loop Excision of Transformation Zone) is the most common treatment. This treatment involves using an electric current; it is therefore necessary to remove piercing, such as navel or vulval rings. It would be helpful if these were removed before your visit to the clinic.
A local anaesthetic is used to numb the cervix. The abnormal cells are then lifted off the cervix using a wire loop there may be some bleeding following this procedure. The bleeding is controlled/stopped by cauterising/sealing the area with a diathermy ball. This process takes approximately 10 minutes.
The abnormal area removed is then sent to the laboratory for examination. The results of the laboratory examination will be sent to you by post when they are available. This usually takes approximately four to six weeks.
The risks and complications associated with a Lletz procedure are known only to affect a very small percentage of women.
The main complication during treatment is that of haemorrhage or heavy bleeding. In most cases the bleeding can be well controlled by the Colposcopist. Further measures, such as admission to a ward occurs in less than two per cent of patients.
Following treatment, haemorrhage can occur at any time for up to 14 days and is usually the result of a minor infection in the wound. The likelihood of this occurring is one to two per cent of all treated patients.
Information will be handed to you at the clinic following your treatment advising you of what to do if this occurs.
Cervical stenosis or narrowing of the birth canal also affects one to two per cent of women after treatment; however, this complication is more likely to occur in postmenopausal women.
Fertility is not known to be affected by one single treatment. However, if you have had multiple treatments then you may be at risk of miscarrying a future pregnancy.
When you are happy with the explanation of the treatment, it’s risks and benefits; your verbal consent will be required.
Before any doctor, nurse or therapist examines or treats you they must have your consent or permission. Consent ranges from allowing a doctor to take your blood pressure (rolling up your sleeve and presenting your arm is implied consent) to signing a form saying you agree to the treatment or operation.
It is important before giving permission that you understand what you are agreeing to. If you do not understand – ask.
Research has suggested that pain and discomfort following a treatment is thought to be uncommon. However, some women experience period like cramps; taking painkillers such as Paracetemol or Ibuprofen will relieve this.
You can expect some bleeding/vaginal discharge after treatment. This may not start straight away but may continue for up to ten days. The discharge may range from spotting to a flow, like an average period.
It should not be excessive or have an offensive smell. If it does become offensive or heavy, please contact your GP or the nurse Colposcopist via the Colposcopy Clinic 01935 384 622.
We would advise you not to use tampons during this time to reduce the risk of infection and allow your cervix to heal as quickly as possible. Sanitary pads should be worn in preference.
It is recommended that you refrain from sexual intercourse for four weeks after treatment to allow your cervix to heal and reduce the risk of infection.
We would advise you to avoid public swimming pools, spas and Jacuzzis until the discharge has stopped. We suggest that you avoid any strenuous exercise and heavy lifting for two to three weeks.
If travelling abroad following treatment, overseas medical attention for complications arising from the treatment may not be covered by medical insurance.
Otherwise you may continue with your normal everyday activities as usual.
Monday to Thursday, 8am to 5pm. Answer phone messages may be left outside these hours.
Contact: 01935 384 622
We hope this information is helpful. If you require any further advice regarding any aspect of your care please do not hesitate to ask the clinic staff at your appointment.
It is important for your own health and wellbeing that you do attend the clinic if this has been advised.
If you are unable to attend a clinic or wish to change your appointment or have any other queries please telephone the Colposcopy appointments Office Monday – Thursday between the hours of 8am to 5pm on 01935 384622 Ext.4622. Outside of these times you can leave an answer phone message.
If you feel your condition is urgent, seek advice from your GP or go to A&E.
Colposcopist Doctor or Nurse Specialist who performs the Examination
Cauterize To seal/burn wound using an electric current
Diathermy Ball Tool used to control bleeding and seal the wound using an electric current.
Lletz Procedure Large Loop Excision of Transformation Zone. The procedure that is performed to remove abnormal cells that has been detected at a colposcopy examination.
Post-Menopausal The time following the cessation of menstruation (periods)
- Luesley D, Leeson S (2010) Colposcopy and Programme
Management Guidelines for the NHS Cervical Screening
Programme. NHSCSP. Sheffield
- Luesley D, Shafi M, Jordan J, (2002) Handbook of Colposcopy
Chapman and Hall.
- The British Society for Colposcopy and Cervical Pathology
- Goldsmith M, Bankhead C, Austoker J, (2006) Improving the
quality of the written information sent to women about
cervical screening. NHSCSP. Sheffield.