What happens after a colposcopy test?

Written by: Mr Paul Carter
Published:
Edited by: Emily Lawrenson

A colposcopic examination is performed after a cervical smear has shown presence of abnormal cells, which are regarded as being pre-cancerous. After the colposcopy itself, the doctor/nurse-specialist will be able to describe to you what they have seen and whether it is consistent with the smear result. If a confirmatory biopsy is taken, it will take at least a week to receive the result. When the biopsy result is available, it may be reported as as ‘normal’, which means no abnormal cells were found in the sample, and no treatment is needed, at the present time.  However, it will be necessary to remain under the care of a specialist until the situation has been proven to have resolved. This means that the cervical smear will need to be normal and negative for the Human Papilloma Virus (HPV) and the colposcopic examination will need to be normal. However, what happens when results come back as ‘abnormal’?

Abnormal colposcopy test results

If a biopsy shows the presence of abnormal (pre-cancerous) cells, this will confirm that there are pre-cancerous changes in the cervix. These changes are called Cervical Intra-epithelial Neoplasia, (CIN). CIN 1 indicates a mild change, CIN 2 a moderate change, and CIN 3 severe changes.

Approximately 40-50% of CIN 1 cases will revert to normal, spontaneously, such that no treatment is required. If the results return as CIN 1, a woman can choose to be kept under review, meaning they attend colposcopies on a 6 – 9 monthly basis until the situation resolves itself or, over time, advances to a moderate change. Women can also choose to undergo treatment if they so wish. Women with CIN 2 & 3, generally, do not revert to normal, over time, and treatment is generally advised.

Rarely, biopsies and colposcopies find the presence of cervical cancer. In such cases a specialist, and specialist team, will become involved.

What is the treatment for abnormal cells like?

Treatment may involve ablation (destroying cells through various methods such as laser, coagulation, freezing, or diathermy), but the majority of treatments use excision to cut tissue away from the cervix. The procedure uses a wire loop to cut a cone-shaped section from the cervix, and is called Loop Excision of the Transformation Zone (LETZ). The tissue is sent away to be analysed by a pathologist.

The procedure is performed under local anaesthetic, which is injected into the cervix in order that the procedure is pain-free. When the anaesthetic is injected, it is likely some discomfort will be felt, similar to that of an anaesthetic injection in the gum when visiting the dentist. The cone of tissue is then excised, and the area is cauterised, to stop any bleeding. The procedure takes around ten minutes. In some cases it is performed under general anaesthetic, but even in cases like this, the patient is discharged the very same day.

What can I expect after treatment?

After both ablative and excisional treatments, there will be no pain. After 48 hours there will be some discharge, normally reddish brown in colour, which is entirely expected as the cervix heals. Nothing should be inserted into the vagina during this healing process, for example, no sanitary products, and sexual intercourse should be avoided. The discharge is usually no heavier than a regular period, but it can last up to four weeks, depending on the size of the area which needs to heal.

Sometimes, around 10-14 days after treatment, heavier bleeding may occur, due to the separation of clots on the healing area. If this bleeding is heavier than a regular period, or if you are changing sanitary pads every couple of hours, advice should be sought from the clinic or doctor who performed the procedure initially.

Does the treatment have any lasting consequences?

Many women worry that future conception and pregnancies will be affected by the treatment, but based on studies conducted so far, it is extremely unlikely that this will be the case.

There are possible long-term consequences to the treatment, but risk rates are low at about 1-2% rate of occurrence. The consequences are:

Cervical stenosis – a narrowing of the entrance to the cervix, which can cause periods to be painful, and make future cervical smear tests more difficult to perform. Occasionally, during labour, the cervix does not dilate because of the cervical scarring, which means delivery is performed via Caesarean section.

Cervical incompetence – the cervix may be weakened by the removal of a cone of tissue, which can (but rarely) result in miscarriages at around 16-24 weeks of pregnancy, as the cervix is not strong enough to hold the pregnancy.

Over 90% of women are cured through a single treatment, so the success rate is high. Your doctor will always talk you through the risks and potential outcomes when explaining the treatment process to you.

After treatment, a cervical smear (and HPV test) with or without repeat colposcopy should be taken around 6-12 months later. Each clinic has their own guidelines to follow, but these will be clearly highlighted and explained after treatment has been carried out. Following treatment, a normal smear result is encouraging but being negative for the HPV is even more reassuring that the treatment has been successful. After successful treatment, women are advised to return to the national screening guidelines, which means smear tests should be taken every 3 years until the age of 50, and every 5 until 65. 

By Mr Paul Carter
Obstetrics & gynaecology

Mr Paul Carter is an experienced consultant gynaecologist with over 20 years' experience, in the role of consultant at St George’s which is a London teaching hospital. He also consults at several prestigious clinics in the London area. His specialist interests include colposcopy, vulval disorders, complex benign surgery, and oncology. Mr Carter holds the titles of Unit Cancer Surgeon, Lead Clinician for Colposcopy & Vulval Disorders at St George's Hospital. He leads a specialist clinic, for vulval disorders, which offers expert treatment from a multi-disciplinary team, including a dermatologist and a genito-urinary medicine physician. His colposcopy unit sees over 4,000 women per year, and he runs a weekly clinic for suspected cancers of the lower genital tract. Having trained as a cancer surgeon, he is also skilled in taking on the surgery for the more complex cases of benign disease. Mr Carter also holds specialised clinics at the Portland Hospital and the Parkside Hospital. He is a member of several associations, including the British Society for Colposcopy & Cervical Pathology and the British Gynaecological Cancer Society. He also has a senior position, at St George’s, University of London as the Head of Anatomical Science and lectures, extensively, on human anatomy.

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