Colposcopy

What is a Colposcopy?

Colposcopy serves as a detailed examination method that provides doctors with an enhanced view of a woman's reproductive tissues. This diagnostic procedure allows doctors to thoroughly inspect the cervix (the lower part of the uterus) and vaginal walls for any abnormal tissue changes that might require further investigation.

The colposcope is at the heart of this examination – a specialised instrument equipped with a powerful light and a magnifying lens. Unlike a standard visual examination, the colposcope magnifies the cervical and vaginal tissues multiple times, revealing details that would otherwise remain unnoticed to the naked eye. Doctors can identify subtle tissue changes that might indicate potential health concerns through this magnification.

The primary purpose of colposcopy centres on early detection. When a doctor performs this examination, they're specifically looking for:

• Cancerous or precancerous cells in the cervix, vagina, and external genitals (vulva)

• Cells that could potentially develop into cancer if left untreated (cervical dysplasia)

• Genital warts or other abnormal growths

• Noncancerous growths called polyps

Additionally, a colposcopy might be recommended to investigate specific symptoms such as:

• Abnormal vaginal bleeding

• Persistent vulvar itching

• Other concerning symptoms that require closer examination

Most commonly, doctors suggest colposcopy after receiving concerning results from a Pap test. This follow-up examination helps determine whether the abnormal cells detected during the initial screening require treatment or further monitoring.

When doctors observe any suspicious areas during the colposcopy, they can immediately collect tissue samples (biopsies) from these regions. Subsequently, these samples are sent to a laboratory, where specialists examine them under a microscope to confirm or rule out cancerous or precancerous cells.

One significant advantage of colposcopy is that it combines diagnostic and sampling capabilities in a single procedure. Rather than simply identifying potential issues, the examination allows for immediate tissue collection from precisely the areas showing abnormalities. This targeted approach increases the accuracy of diagnosis compared to random sampling methods.

Despite its technical nature, colposcopy remains an outpatient procedure. The examination generally requires 10-20 minutes to complete, making it a relatively quick diagnostic tool.

Why Would a Woman Need a Colposcopy?

Doctors recommend a colposcopy to investigate various reproductive health concerns. This diagnostic procedure primarily checks for cancer cells or cells that could develop into cancer if left untreated, a condition known as cervical dysplasia. 

The main reason is an abnormal cervical screening test, although there are multiple other situations where this examination becomes necessary. Abnormal screening results stand as the most common reason for colposcopy referrals. Doctors recommend this procedure when:

• Previous Pap test shows abnormal results

• HPV investigation comes back positive for high-risk strains

• Pelvic examination reveals concerning findings

• A woman experiences unexplained vaginal bleeding, especially after intercourse or following menopause

• Symptoms suggestive of cervical cancer (profuse foul-smelling vaginal discharge, abnormal vaginal bleeding)

• Postmenopausal bleeding (along with endometrial assessment)

• Suspected cervical cancer during naked-eye examination

• Follow-up after treatment of cervical precancer

• Evaluation of other lower genital tract abnormalities

• Persistent abnormal vaginal discharge or vulvar itching

The type of abnormal cell changes detected during screening often dictates how urgently colposcopy is needed. For example, high-grade squamous intraepithelial lesions (HSIL) and atypical squamous cells that cannot exclude high-grade lesions (ASC-H) require immediate colposcopy due to their stronger association with severe cervical dysplasia.

Conversely, less concerning results like low-grade squamous intraepithelial lesions (LSIL) or atypical squamous cells of undetermined significance (ASCUS) with negative HPV might not immediately lead to colposcopy. These cases often involve monitoring through repeat testing before colposcopy becomes necessary.

A colposcopy examination helps doctors diagnose several conditions:

• Genital warts

• Inflammation of the cervix (cervicitis)

• Noncancerous growths like polyps

• Precancerous changes in cervical, vaginal, or vulvar tissue

• Cancer of the cervix, vagina, or vulva

• Persistent HPV infection

Notably, a colposcopy referral doesn't automatically indicate cancer. Colposcopy continues the screening process, providing further evidence about observed changes in the cervix. The procedure enables doctors to examine tissue more closely and determine whether treatment is necessary.

Should I be Worried if I Need a Colposcopy?

Receiving a colposcopy referral can trigger concern for many women. Research shows that women experience high levels of anxiety at all stages of cervical screening, with colposcopy associated with particularly elevated stress levels. Studies reveal that anxiety before colposcopy can be even higher than pre-surgery anxiety and similar to the stress experienced after receiving abnormal foetal screening results.

The good news is that you don't need to worry excessively. Most colposcopy referrals don't result in cancer diagnoses. As doctors often emphasise, "The chances are good that you don't have cancer". Even if precancerous cells are detected, they're unlikely to become cancerous while you're waiting for your appointment. The primary purpose of colposcopy is early detection and prevention, allowing doctors to identify & address minor health issues before they translate into serious conditions.

Understanding why anxiety occurs can help manage these feelings. Women's concerns typically stem from multiple sources:

• Fear of cancer diagnosis

• Uncertainty about what the procedure involves

• Worry about pain or discomfort

• Concern about what happens after the examination

• Misconceptions about the purpose of screening

Many women mistakenly believe that cervical screening aims to detect existing cancer rather than prevent it. This misunderstanding can amplify anxiety unnecessarily. Colposcopy is crucial in women's preventative healthcare by enabling early intervention for precancerous changes.

High anxiety levels before and during colposcopy can have several negative consequences. These include experiencing increased pain and discomfort during the procedure, decreased ability to recall and follow medical advice, and higher rates of missed follow-up appointments. Consequently, managing anxiety becomes an integral part of the colposcopy experience.

Fortunately, various interventions can help reduce anxiety during colposcopic examination. Research indicates that playing music during the procedure or allowing women to view the examination on a monitor (video colposcopy) can significantly decrease stress levels. Additionally, clear information about what to expect helps many women feel more prepared and less anxious.

 If you're anxious about an upcoming colposcopy, consider discussing your concerns and apprehensions with your gynaecologist. Remember that the procedure primarily serves as a preventative measure to identify potential issues early when they are most treatable. Knowing what to expect during your colposcopy appointment often helps reduce anxiety and allows you to feel more comfortable throughout the process.

Test Details

The medical procedure of colposcopy involves several essential steps that patients should understand before their appointment. 

Procedure

This diagnostic procedure primarily involves closely inspecting the cervix using a special magnifying instrument called a colposcope, which remains outside the body throughout the examination. However, if your doctor identifies any suspicious areas during the colposcopy, they may perform a biopsy by removing a small tissue sample for laboratory testing.

While biopsies are technically considered minor surgical procedures, they're typically quick and minimally invasive. Most women can resume routine activities immediately after a colposcopy appointment, which takes ten to twenty minutes and doesn't require a hospital stay.

How do I Prepare For a Colposcopy?

Proper preparation helps ensure your colposcopy goes smoothly. Your doctor may recommend several steps before your appointment:

• Avoid colposcopy during your menstrual period, as blood can make it difficult for the doctor to see your cervix clearly

• Don't have vaginal intercourse for 24 to 48 hours before your appointment

• Avoid using tampons, vaginal creams, medicines or douches for at least two days before the procedure

• Consider taking a pain reliever like paracetamol or ibuprofen before your appointment to minimise discomfort

Importantly, inform your doctor if you're pregnant. Although colposcopy is safe during pregnancy, your doctor needs this information beforehand as it may affect how they perform certain aspects of the examination. 

What to Expect During Colposcopy?

The colposcopy procedure follows several standard steps. Firstly, you'll lie on an examining table with your feet in stirrups, similar to a regular pelvic examination. Your clinician will then insert a speculum into your vagina to gently open the walls and provide a clear view of your cervix.

At this point, the colposcope—which remains outside your body—is positioned near your vaginal opening. The instrument has a bright light and magnifying lens that allows your doctor to examine your cervical tissues in detail. Your doctor will then apply a vinegar solution (acetic acid) or iodine to your cervix. This solution might cause a mild tingling or burning sensation but helps abnormal areas become more visible.

If suspicious areas are identified, your doctor may perform a biopsy. This involves removing a tissue sample using a sharp biopsy instrument. You might feel a pinching sensation or mild cramps during this part of the procedure. If several areas of concern are present, multiple biopsies might be taken.

What Happens After the Colposcopy?

Afterwards, most women can immediately return to regular activities. However, if you had a biopsy, you might experience:

• Light vaginal bleeding or spotting that may last a few days

• A dark-coloured discharge (from the solution applied during the procedure)

• Mild cramping or soreness in your vaginal area

To manage these symptoms, use sanitary pads rather than tampons. Likewise, if a biopsy was taken, avoid vaginal penetration (including intercourse and tampons) for approximately one week or until your doctor advises it's safe. This gives your cervix proper time to heal.

Contact your clinician promptly if you experience heavy bleeding (soaking through pads hourly for two consecutive hours), severe pain unrelieved by over-the-counter pain medication or signs of infection such as fever or foul-smelling discharge.

Biopsy results take 1 to 2 weeks. Your doctor will discuss these findings with you and recommend any necessary follow-up care based on the results.

Results and Follow-Up

Understanding your colposcopy results helps determine your next steps and any treatment you might need. After the procedure, your doctor will document the findings using standardised terminology from the International Federation of Cervical Pathology and Colposcopy. This documentation includes a diagrammatic representation showing the location of any abnormalities observed during the examination.

The results from your colposcopy and any biopsies taken will determine if treatment is necessary. About 40% of people receive results showing no sign of abnormal cells, while approximately 60% need some form of treatment to address an abnormality. Your provider might use scoring systems like the Swede score to evaluate findings:

• Score 0-4: Likely normal or CIN1 (mild changes)

• Score 5-6: Possibly CIN2/CIN3 (moderate to severe changes)

• Score 7-10: Likely CIN3/cancer

Based on these findings, your doctor will make a provisional diagnosis, ranging from normal to various grades of abnormality. Depending on the results, doctors might recommend different treatment approaches. For mild abnormalities (like CIN1), your doctor may ask you to repeat Pap tests periodically, as these changes often resolve on their own.

For more advanced precancerous cells, treatments might include:

• Loop electrosurgical incision procedure (LEEP) - using an electricity-powered wire loop

• Cone biopsy - removing a cone-shaped tissue sample

• Cryotherapy - using cold chemicals to destroy abnormal cells

• Laser surgery - using a heated laser beam

The follow-up protocol after colposcopy is crucial, particularly if you received treatment. Everyone treated for cervical abnormalities should have a follow-up test six months after treatment. This "test of cure" involves HPV testing and helps determine your next steps.

Notably, individuals who have been treated remain at higher risk than the general population - treated individuals are between 2 and 5 times more likely to experience cervical cancer. Much of this increased risk stems from poor compliance with long-term follow-up, making adherence to recommended follow-up schedules essential.

You should call your doctor immediately if you experience severe pain in your pelvis or lower belly, heavy bleeding (more than during a typical period), or signs of infection such as foul-smelling discharge, fever and chills. Usually, biopsy results arrive within two to ten days after your procedure

When To Call the Doctor

Most patients recover without complications after a colposcopy procedure. Yet, certain symptoms demand immediate medical attention. Knowing when to call your doctor helps ensure your safety following this important diagnostic test.

Pain intensity serves as a primary indicator of potential problems. While mild discomfort commonly occurs after colposcopy, severe pain that persists or worsens requires prompt communication with your medical team. This pain might manifest in your lower abdomen, pelvic region, or back.

Bleeding patterns also provide crucial information about your recovery. Though light spotting remains normal after a colposcopy with biopsy, you should contact your doctor immediately if you experience:

• Heavy bleeding (soaking through a pad for 2 consecutive hours)

• Passing large blood clots (larger than a 10p coin)

• Bleeding that lasts longer than one week

• Bleeding that stops and then suddenly restarts heavily

• Infection 

• Foul-smelling vaginal discharge

• Fever above 38°C (100.4°F)

• Chills or sweats

• Increasing pelvic pain not relieved by over-the-counter pain medications

Indeed, call your doctor if you develop unusual symptoms like severe dizziness, fainting, chest pain, or shortness of breath following your procedure. These could indicate rare but serious complications that need immediate evaluation.

FAQs

1. How frequently should I have a colposcopy? 

   The frequency of colposcopy depends on your individual circumstances. After an initial colposcopy, most women need cervical screening every 12 months until two consecutive tests are negative. Following this, screening may be reduced to once every five years. However, always follow your doctor's specific recommendations.

2. What are the potential side effects after a colposcopy? 

   Common side effects after this procedure include mild vaginal or vulvar pain lasting one to two days, light vaginal bleeding or spotting for a few days, and a dark-coloured discharge. These symptoms are usually mild and resolve on their own. However, if you have abnormal bleeding, severe pain, or infection, contact your doctor immediately.

3. Why might my doctor recommend a colposcopy? 

   Your doctor may ask for a colposcopy for several reasons, including abnormal cervical screening results, symptoms suggestive of cervical cancer (such as unusual vaginal discharge or bleeding), or to investigate persistent HPV infections. It's a diagnostic tool used to examine the cervix and detect any potential abnormalities closely.

4. How long does recovery take after a colposcopy? 

   Recovery time after a colposcopy is typically short. You may experience mild pain, similar to menstrual cramps, for a few days. If a biopsy was taken, you might have light bleeding or discharge for up to a week. Most women can return to their normal activities immediately after the procedure, but it's best to avoid sexual intercourse for about a week if a biopsy is performed.

5. What should I do to prepare for a colposcopy? 

   To prepare for a colposcopy, avoid scheduling it during your menstrual period. Refrain from sexual intercourse, using tampons, or applying vaginal creams for 24-48 hours before the procedure. It's also helpful to take a mild pain reliever before your appointment.