Colposcopy

What is Colposcopy?

Colposcopy is a diagnostic procedure that allows a healthcare provider to examine the cervix and the surrounding area more closely. It is used to investigate abnormal cervical cells that are found during a routine Cervical screening test (CST) or Pap smear.


Colposcopy is not a screening test for cervical cancer but a follow-up test after an abnormal Cervical screening test or Pap smear. It is also important to follow the recommended cervical cancer screening guidelines and to have regular check-ups with Dr Crawford.


Common Names for Colposcopy

Colposcopy is the medical term for the procedure, but it may also be referred to by other names, such as:

  • Cervical Colposcopy: This name emphasises the focus of the examination on the cervix.
  • Vaginal Colposcopy: This name emphasises that the procedure is done through the vagina.
  • Genital Colposcopy: This name encompasses the examination of the whole genital area.


Who is Suitable for a Colposcopy?

Colposcopy is typically recommended for women with abnormal cervical cells found during a routine Cervical screening test or Pap smear. There are several reasons why a Pap smear may be abnormal, such as an infection, inflammation, or abnormal growths on the cervix.


Colposcopy is also recommended for women who have had a cervical biopsy that shows precancerous cells or cervical cancer.


You might need a colposcopy if you have the following:

  • abnormal results from a cervical screening test (CST) (which has replaced the old PAP smear)
  • unusual or unexplained bleeding, such as after intercourse
  • an abnormal lump or growth on your cervix or vagina


The procedure can help diagnose conditions such as:

  • cervical cancer or precancer
  • benign growths such as polyps
  • inflammation of the cervix
  • genital warts


Not all women with an abnormal Cervical screening test will require a colposcopy. Dr Crawford will consider the Cervical screening test  results, the patient's age, and other risk factors to determine if a colposcopy is necessary. 


What are the Benefits of Colposcopy?

Some of the potential benefits of colposcopy include the following:

  • Early detection of abnormal cervical cells: Colposcopy allows the healthcare provider to examine the cervix and surrounding area more closely, which can help to detect abnormal cervical cells that may be precancerous or cancerous. This can help to detect cervical cancer at an early stage when it is more likely to be treated successfully.
  • Identification of the specific area of abnormal cells: Colposcopy allows the healthcare provider to identify the specific area of abnormal cervical cells, which can help to determine the appropriate treatment.
  • Biopsy: Colposcopy can be used to take a small biopsy (tissue sample) of any abnormal cervical cells for further examination in the laboratory. This can help to confirm the diagnosis and determine the appropriate treatment.
  • Reduced need for repeat Cervical screening tests: Colposcopy can help identify the specific cause of an abnormal Pap smear, reducing the need for repeat Pap smears or other cervical cancer screening tests.
  • Emotional support: Colposcopy can give emotional support to women who may be worried about the results of an abnormal Cervical screening test . The procedure can give a more accurate diagnosis and help to address concerns.


What are the Types of Colposcopy?

Colposcopy is a diagnostic procedure that allows Dr Crawford to examine the cervix and the surrounding area more closely. Different types of colposcopy are used depending on the indication, the patient's preference, and the healthcare provider's expertise. These include:

  • Simple colposcopy: This is the most common type of colposcopy, and it is used to examine the cervix and the surrounding area for abnormal cells. The healthcare provider uses a colposcope (a magnifying device) to examine the cervix and surrounding area and may take a small biopsy (tissue sample) of any abnormal cervical cells for further examination in the laboratory.
  • Directed biopsy colposcopy: This type of colposcopy is used to biopsy a specific cervix area identified as abnormal during a previous examination. It is performed when the healthcare provider wants to confirm a diagnosis or determine the appropriate treatment.
  • Endocervical curettage (ECC) colposcopy: This type of colposcopy is used to take a sample of cells from the endocervical canal, which is the inner portion of the cervix that opens into the uterus. It is occasionally done in conjunction with a simple colposcopy and is used to identify abnormal cells that may not be visible on the surface of the cervix.
  • Large loop excision of transformation zone (LLETZ) or Loop electrosurgical excision procedure (LEEP) colposcopy: This type of colposcopy uses a thin wire loop that is heated with an electrical current to remove abnormal cervical cells. It is used to treat cervical precancer and cervical cancer in situ.


Colposcopy Procedure

How to Prepare for a Colposcopy?

Ask your gynaecologist to explain the benefits and risks of a colposcopy. Let them know if you are pregnant.


The procedure is usually done when you are not menstruating. For 24 to 48 hours beforehand, you should also not:

  • wear tampons
  • have sex
  • use vaginal medicines
  • douche


How Is The Colposcopy Procedure Done?

During a colposcopy, you will lie on your back with your feet raised, just as you do when you have a regular pelvic examination. A colposcopy takes 5-15 minutes to perform. Dr Crawford uses an instrument called a speculum to hold the walls of the vagina apart. Then the colposcope is placed at the opening of your vagina.


A cotton swab may apply a mild solution to the vagina and cervix. This allows abnormal areas to be seen easily.  Dr Crawford will look inside the vagina and cervix to locate any problems. If there are any abnormalities, Dr Crawford may take a small tissue sample called a biopsy.


You may feel a mild pinch or cramp while taking the biopsy sample. The tissue is then sent to a laboratory for further study.


What to Expect After a Colposcopy?

After a colposcopy without a biopsy, you can carry on normal activities right away.  You could have a brown discharge from the iodine that might stain your clothes, so we suggest you wear a liner.


If you also had a biopsy, you could have cramps for a day. If so, paracetamol can help. It is normal to have a slight vaginal discharge or to bleed for around 5 or 6 days.


Avoid sexual intercourse and heavy exercise, and do not use tampons for a couple of days. You can shower, but don’t have a bath or a swim.


Your future treatment will depend on what the biopsy shows. 

  • Often no further treatment is required, and you only need another CST in 12 months. 
  • Other possible treatments include an LLETZ, a cone biopsy or rarely a hysterectomy.


What are the Risks?

There is a minimal risk of infection or heavy bleeding. You should contact Dr Crawford if you have the following issues:

  • a high temperature
  • a bad-smelling vaginal discharge
  • severe pelvic pain
  • heavy bleeding that lasts longer than five days


Colposcopy Prognosis

The prognosis for colposcopy can vary depending on the procedure's results and the underlying cause of the abnormal cervical cells.


If abnormal cervical cells are found during colposcopy, a biopsy will be done, and the results will be used to determine the appropriate treatment. The treatment options will depend on the type and severity of the abnormal cervical cells and the patient's circumstances.


If the abnormal cervical cells are precancerous, they can usually be treated with cryotherapy, loop electrosurgical excision procedure (LEEP) or conisation. These procedures can remove abnormal cells and prevent cervical cancer from developing.


If the abnormal cervical cells are cancerous, the patient will be referred to a Subspecialist for further evaluation and treatment. Treatment options may include surgery, radiation therapy, or chemotherapy, depending on the cancer stage.


What if Colposcopy is Delayed?

If abnormal cervical cells are found during a routine Pap smear or other cervical cancer screening test, a colposcopy is usually recommended as the next step in the diagnostic process. If the colposcopy is delayed, it may take longer to confirm the diagnosis and determine the appropriate treatment. This can prolong the uncertainty and anxiety for the patient.


Additionally, if the abnormal cervical cells are precancerous, delaying the colposcopy increases the risk that the abnormal cells will progress to cervical cancer. Early detection and treatment can help to prevent cervical cancer from developing.


How Is An Abnormal Pap Smear Treated?

If the colposcopy results reveal a high-grade abnormality (CIN II or III), then an LLETZ (Large Loop Excision of the Transformation Zone) is performed. Dr Crawford will perform this as a Day Stay procedure. It involves removing abnormal cells from the tip of the cervix.


A cone biopsy is performed depending on the type and depth of the lesion.


This specimen is sent for histopathological examination. Complications are uncommon and include infection and bleeding. Most women will experience brown vaginal loss for about three weeks. It is advised that you avoid swimming, intercourse, baths and tampons for this time to minimise the risk of infection.



Abnormal Pap Smear During Pregnancy

A Pap smear during pregnancy is very safe. A colposcopy can be performed during pregnancy in case of an abnormal Pap smear. However, further treatments are delayed until the birth of the baby.

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