Mr Paul Carter is a highly-experienced consultant gynaecologist, currently consulting at several prestigious clinics in the London area, and St George's, which is a teaching hospital. At St George's, he also holds the title of Lead Clinician for Colposcopy & Vulval Disorders, and runs a specialist clinic for the treatment of vulval disorders offering expert treatment across a multi-disciplinary team. As an expert in colposcopy, Mr Carter sees over 4000 women a year in the specialised colposcopy unit. Before colposcopy, many women wonder why the test is performed, and how it is done. Here, Mr Carter answers some of the most frequently asked questions surrounding the colposcopy procedure, and tells us what you should keep in before going to your appointment.
What is colposcopy?
Colposcopy is a procedure which allows the cervix (the neck of the womb) to be examined, using a device called a colposcope, which illuminates and magnifies the area. The procedure is actually similar to that of a cervical smear, however it takes longer, as the colposcopy looks for any abnormalities through the application of various solutions to the cervix. Colposcopes can also be used to examine the vagina and vulva.
Why is colposcopy performed?
Colposcopy is most commonly performed after a cervical smear which has shown some presence of abnormal cells. A cervical smear is a routine procedure offered to women between 25 and 65 years of age, during which a cell sample is taken from the cervix, and is later examined, in order to detect any changes in the cervix and if any abnormal cells are present.
Colposcopy may also be performed if smear results are consistently inadequate, or for other reasons, such as bleeding between periods (inter-menstrual), bleeding experienced after sexual intercourse, or an abnormal or unusual appearance of the cervix.
If the investigation is for abnormal cells, they are generally regarded as being pre-cancerous, which means if they are left untreated, they could become cancerous in the future. However, if the abnormal cells are found at this early stage, the chances of cancer actually developing are very small indeed. They may develop, but usually over a number of years, so they can be treated quickly and easily. Therefore it is important for women to be reassured that there is little need to worry, and in 90% of cases, the pre-cancerous condition is eliminated.
How is colposcopy performed?
A colposcopy examination is very similar to that of a cervical smear test. A colposcopist inserts a speculum into the vagina, which dilates it and allows for examination both in the vagina and cervix.
Usually when the colposcopy is performed because of abnormal smear results, the colposcopist will apply a small amount of acetic acid (vinegar) to the cervix using cotton wool. This solution allows them to see any changes in the epithelium, the skin covering the cervix, more clearly. This can be a little uncomfortable, as it may sting, but it should not be more so than a regular smear test.
Occasionally, the colposcopist may wish to take a biopsy (a small sample of tissue) from the cervix, which is usually the size of a grape pip. When the biopsy is taken, it may cause a small amount of bleeding, but this can be controlled by applying silver nitrate to the affected area. This can also cause slight stinging. Once the bleeding has stopped, the examination is over. The biopsy is then sent to be tested and analysed by the pathologist. The procedure usually takes about 15 minutes, so it is not long.
When can I expect results?
During the test itself, the colposcopist may discuss any changes they might see with you. If you have a biopsy taken, lab tests usually take several days to come back. The doctor will advise you on how long you have to wait.
Before the test:
- Avoid having sexual intercourse the day before your colposcopy
- Do not put anything into your vagina (tampons, medicines, creams) in the 24 hours leading up to the test
- Schedule the test for when you are not due on your period
- Some prefer to wear a panty-liner as they may experience slight bleeding or discharge after the colposcopy
- Contact the clinic if you are pregnant – colposcopy is safe during pregnancy, but biopsy and treatment are usually delayed until after birth