Colposcopy is a special lighted magnifying device that looks like a pair of binoculars used to look at the vulva, vagina, and cervix to see problems that would be missed by the naked eye. Vinegar (acetic acid) and sometimes iodine (Lugol’s solution) is applied on the vagina and cervix with a cotton swab or cotton ball to see problem areas more clearly. If a problem is seen during colposcopy, a small sample of tissue (biopsy) may be taken from the cervix or from inside the opening of the cervix (endo-cervical canal). The sample is looked at under a microscope.
Colposcopy is done to:
- Look at the cervix for problem areas when a Pap test was abnormal. If an area of abnormal tissue is found during colposcopy, a cervical biopsy or a biopsy from inside the opening of the cervix (endo-cervical canal) is usually done. Most abnormal Pap tests are caused by viral infections, such as human papillomavirus (HPV) infection, or other types of infection, such as those caused by bacteria, fungi (yeast), or protozoa (Trichomonas). Natural cervical cell changes (atrophic vaginitis) related to menopause can also cause an abnormal Pap test. In some cases, untreated cervical cell changes that cause abnormal Pap tests may progress to precancerous or cancerous changes.
- Check a sore or other problem (such as genital warts) found on or around the vagina and cervix.
- Follow up on abnormal areas seen on a previous colposcopy. Colposcopy can also be done to see if treatment for a problem has worked.
- Look at the cervix for problem areas if an HPV test shows a high-risk type of HPV is present.
How To Prepare
Tell me if you:
- Are or might be pregnant. Colposcopy is safe during pregnancy. If a cervical biopsy is needed during a colposcopy, the chance of any harm to the pregnancy (such as miscarriage) is very small. But you may have more bleeding from the biopsy. A colposcopy may be repeated about 6 weeks after delivery.
- Are taking any medicines.
- Are allergic to any medicines or Iodine.
- Have had bleeding problems or take blood thinners, such as aspirin or warfarin (such as Coumadin).
- Have been treated for a vaginal, cervical, or pelvic infection.
Do not have sexual intercourse or put anything into your vagina for 24 hours before a colposcopy. This includes douches, tampons, and vaginal medicines. You need to empty your bladder just before your colposcopy.
You may want to take a pain reliever, such as Panadol and Neurofen, 30 to 60 minutes before having a colposcopy, especially if a biopsy may be done.
Schedule your colposcopy for when you are not having your period. Heavy bleeding makes it harder to see the cervix. The best time to schedule a colposcopy is during the early part of your menstrual cycle, 8 to 12 days after the start of your last menstrual period.
How It Is Done
Colposcopy is done by a gynaecologist who has been trained to do the test. Colposcopy can be done in the office. Having a colposcopy is similar to having a Pap smear but will take about 15 minutes.
- You will be asked to take off your clothes below the waist. You will be given a covering to drape around your waist. You will then lie on your back on an examination table with your feet raised and supported by footrests.
- A lubricated speculum like the one used while having the Pap smear will be inserted into the vagina. The speculum gently spreads apart the vaginal walls so the inside the vagina and the cervix can be seen.
- A repeated Pap smear is taken if your recent Pap smear was done over 12 weeks prior to colposcopy.
- The colposcope is placed near the entrance of the vagina. The colposcope magnifies the cervix 15-30 times.
- A weak vinegar solution is then applied to the cervix. When the cervix is painted like this, areas where there are changes in the cells turn white. Healthy cells stay pink.
- Sometimes Iodine (Lugol’s solution) brown solution is applied to view your cervix under different light. During this examination healthy cells turn brown. This brown solution contains iodine, and may produce a brown discharge for a few days after the procedure.
- If areas of abnormal tissue are found on the cervix, a small sample(s) (cervical biopsy) of the tissue will be taken. Biopsies generally are not painful. The sample(s) are sent to a laboratory to be looked at by a pathologist under a microscope for changes in the cells that if left untreated may develop into cancer.
- If a sample of tissue is needed from inside the opening of the cervix (the endo-cervical canal), a test called endo-cervical curettage (ECC) will be done. Since the endo-cervical canal cannot be seen by the colposcope, a small sharp-edged tool called a curette is gently put into the endo-cervical canal to take a sample. ECC takes less than a minute to do and may cause mild cramping. An ECC is not done during pregnancy.
- If bleeding occurs from the biopsy site, a silver nitrate swab may be used to stop the bleeding.
How It Feels
You may feel discomfort when the vaginal speculum is inserted. You may feel a pinch and have some cramping if a biopsy sample is taken.
In rare cases, a cervical biopsy can cause an infection or bleeding. Infection can be treated with a course of antibiotics. Bleeding can usually be stopped by using the silver nitrate swab.
After the test
If you have a biopsy, you may feel some soreness in the vagina for a day or two. Some vaginal bleeding or discharge is normal for up to a week after a biopsy. You can use a sanitary pad for the bleeding. Do not douche, have sex, or use tampons for one week, to allow time for your cervix to heal. Do not exercise for 1 day after your colposcopy.
You need medical attention if you have:
- Heavy vaginal bleeding (more than a normal menstrual period).
- A fever.
- Belly pain.
- Bad-smelling vaginal discharge.
The finding at the colposcopy will be explained to you just after the procedure. However, It is important that you attend the follow up visit; at this visit the results of the biopsy(s) will be available and explained to you.
- Colposcopy: The vinegar or iodine does not show any areas of abnormal tissue. The vagina and cervix look normal.
- Cervical biopsy: A biopsy sample does not show any abnormal cells.
- Colposcopy: The vinegar or iodine shows areas of abnormal tissue. Sores or other problems, such as genital warts or an infection, are found in or around the vagina or cervix.
- Cervical biopsy: A biopsy sample shows abnormal cells. This may mean cervical cancer is present or likely to develop.
Depending on your results and after discussing the result with you, the recommendation might be:
- More frequent Pap smears.
- Repeating the colposcopy for follow-up.
- Other treatment. Your treatment will depend on whether an abnormality was detected and if so, the type of abnormality detected. Changes in the cells are treated by removing them.
Common types of treatment
- LLETZ (Large Loop Excision of the Transformation Zone). This treatment uses a wire loop to remove the abnormal cells, usually done in hospital under general anaesthetic
- Cone Biopsy is where a small cone shaped area of the cervix containing the abnormal cells is removed surgically in hospital under general anaesthetic
- Less common treatments are Laser or Diathermy and Cryosurgery, which use heat or cold to remove abnormal cells.
What Affects the Test
Reasons you may not be able to have the colposcopy or why the results may not be helpful include:
- If you have sexual intercourse 24 hours before the colposcopy.
- The use of douches, tampons, or vaginal creams or medicines 24 hours before the colposcopy.
- If you are having a menstrual period at the time of the colposcopy.
- If a vaginal or cervical infection is present.
- If you have gone through menopause. Hormonal changes may make it hard to see the cervical canal clearly.
What should I do after the procedure?
- You may want to wear a pad for a few days to prevent staining of your underwear by the iodine solution.
- It is best to avoid heavy physical exercise for 24 hours after a biopsy and it is best not to have penetrative sexual intercourse for about a week. To prevent infections avoid swimming, bathing and spas for 3 days.
- If a biopsy is taken, some extra discomfort may be experienced for a short time. In general, you will not need time off work after a colposcopy. You can take regular simple analgesia for few days (Panadol or Neurofen)
- These precautions are to reduce the risk of bleeding or infection. You need medical attention if you have any heavy bleeding, fever or offensive vaginal discharge.
- Taking time to look after yourself includes a healthy diet, doing some exercise, getting enough sleep and not smoking. These basic lifestyle modifications are the best way to stay healthy and helps your body eradicate the virus.
Your queries are best answered over the phone, our friendly reception staff would be happy to assist you with your enquiry, contact us on +02 8824 4998