Women's health: how to prepare for your colposcopy

The UK’s cervical screening program started in 1988 and has reduced deaths from cervical cancer by almost 4,000 per year. If a cervical smear test returns as abnormal, you will be required to have a colposcopy to further investigate the changes that were detected on the test. We spoke to Dr Shahla Ahmed, one of our top London gynaecologists, about the procedure from when it is necessary to have a colposcopy and what happens depending on your results.

When is a colposcopy necessary?

Cervical smear tests detect high-risk HPV, which causes abnormal changes in cells of the cervix. These changes may, if ignored, develop into cervical cancer over a period of several years. Low-risk HPV types may also be present in the cervix but do not cause cervical cancer, which is why the test only reports the presence of high-risk HPV. 

If high-risk HPV is detected, your sample will be further analysed for cellular abnormalities. You will be referred for colposcopy if (1) you carry high-risk HPV and have abnormal cells or (2) you persistently carry high-risk HPV for two years or longer, even though the cells are normal. 

A single high-risk HPV result on its own does not require a referral, as it may clear itself.
 

How is colposcopy different from a smear test?

Colposcopy means an examination of the cervix with a special instrument called a colposcope and is usually done by a gynaecologist. 

A smear test, usually performed by your GP or practice nurse, collects cells from the cervix, which are then analysed for HPV and abnormalities of the cells.

Cervical screening alone is not enough to make an accurate diagnosis of the level of cellular abnormality, which is why colposcopy is needed to further assess the changes detected on the smear test.
 

What is colposcopy?

During a colposcopy, an instrument called a colposcope - which is essentially a large microscope – is used to look at your cervix under magnification, in order to identify any changes. Just as during a smear test, you will be asked to lie on a special couch with your legs in stirrups, and the doctor will insert a speculum. Special stains will be applied to your cervix using cotton wool, and your cervix will be examined using the colposcope. 

If all appears normal, nothing further will be required. If the doctor sees an area of abnormality, a small tissue sample (biopsy) will be taken. 

Colposcopy also lets us identify and potentially treat polyps or warts on the cervix and/or vagina. In addition, it is used to check the cervix after treatment to remove abnormal cells from the cervix. 

A colposcope remains outside of your body.
 

How should I prepare for my colposcopy?

No preparation is required. However, if your colposcopy appointment falls on a heavy day of your period, it is best to defer the procedure until after your period has finished.
 

Is the procedure painful?

The colposcopy procedure itself is not painful. However, having a speculum inserted can be uncomfortable, as much as it is for a smear test. If a biopsy is taken, you may feel a short-lived pain or a dull ache like a period cramp, which may last for a few minutes.

How long do I have to wait for the results?

The biopsy is sent to the laboratory for analysis. It can take up to two weeks to get the results.
 

What happens if the results come back as abnormal?

This will depend on the type and grade of abnormality, and how long it has been present.

If your results show low-grade abnormalities (CIN 1), you will be kept under follow-up for up to two years, and if the CIN 1 persists, then treatment is advised. 

If your results show high-grade abnormality (CION 2 or CIN 3), you will be offered treatment. 

However, if the result shows CIN 2, and the area of abnormality appears small, you may be offered the option of follow-up in 4-6 months’ time to see if the abnormality is improving, persisting, or progressing.

A decision for treatment can then be made based upon these findings.
 

What does treatment entail?

Treatment means removing the area of abnormal cells from the cervix, called loop excision of the transformation zone (LETZ). This is usually done in the colposcopy clinic using local anaesthesia. We start with the colposcopy examination, inject a local anaesthetic to numb the cervix, and then remove the abnormal area with a small, fine wire loop.

The entire procedure takes about 15 minutes, but the treatment itself takes less than five minutes, and you go home as you would after a normal colposcopy. You will be asked to return for a colposcopy, cervical smear test and HPV screen 6 months after the treatment to check that the cervix has healed well and that abnormal area has been completely removed.



You can book an appointment to see Dr Ahmed via her Top Doctor's profile here if you would like to discuss any of your gynaecological concerns.