Consultant Gynaecologist and Specialist in Pelvic Floor Surgery

Abnormal Smears

Colposcopy

What is Colposcopy?

Colposcopy is a detailed examination of the neck of the womb (cervix) with a special magnifying instrument (colposcope), which gives a clear view of the cells of the cervix.

Why do I need colposcopy?

A colposcopy is performed when a smear test result is abnormal which indicates there are abnormal changes in the cells of the neck of the womb (cervix).

1 in 10 cervical smear test results are abnormal. Generally an abnormal smear test indicates changes in cells on the cervix. Although abnormal cells rarely turn out to be too serious, it is still important to carry out a further tests to make sure.

Colposcopy is also performed if there is concern about the appearance of your cervix or you have bleeding after intercourse.

What causes abnormal smears?

Most cervical smear test abnormalities are caused by infection with the Human Papilloma Virus (HPV). There are many different strains of HPV, some of which can cause warts and others can cause abnormal changes in the cervical cells called Cervical Intraepithelial Neoplasia (CIN). CIN is graded from CIN 1 to CIN 3. CIN 1 often only needs monitoring as it reverts to normal in the majority of women, but treatment is available for persistent disease.

CIN 2 and 3 requires treatment with diathermy Large Loop Excision of the Transformation Zone (LLETZ).

What happens at a colposcopy clinic?

The first part of the examination is very much like having a smear test and should not be uncomfortable. You will be asked to lie on your back on a special couch that has supports for your legs. As with a smear test, an instrument (speculum) is gently inserted into the vagina and your cervix is examined with colposcope. The examination takes about 15 minutes and various solutions are applied to the cervix to highlight any abnormal cells and biopsies (samples of tissue) are obtained for examination in the laboratory. Taking biopsies may cause some discomfort. The biopsy results help to guide treatment and follow up which may be a further smear test, a further colposcopy, or treatment to remove the abnormal cells.

What Treatment is available?

Some women will need treatment to remove the abnormal cells. The treatment most commonly performed is diathermy Large Loop Excision of the Transformation Zone (LLETZ) where the abnormal cells on the cervix are removed under local anaesthetic and sent for examination in the laboratory. This is very quick and effective procedure and causes minimal discomfort. Other treatment modalities include cold coagulation and cone biopsy

Are there any complications from treatment?

Colposcopy is a safe procedure but you may experience slight discomfort if a biopsy is taken and have a small amount of bleeding and crampy lower abdominal pain for a few hours. You can take painkillers if required.

You MUST refrain from intercourse for 48 hours after a biopsy to reduce the risk of infection.

If you have LLETZ treatment, you may experience discomfort when the local anaesthetic is injected. There is a small risk of significant bleeding and damage to vaginal tissue during the procedure.

Following LLETZ treatment you may experience crampy lower abdominal pain, this should settle with simple analgesia like paracetamol

You may have vaginal bleeding and discharge for up to 4 weeks and MUST refrain from sex, swimming or using tampons until this settles. The discharge may be bloody, brown or watery but should not be offensive or heavy. If you experience heavy bleeding or an offensive discharge, you must seek medical advice as you may have an infection and need treatment.

Will I need extra smears after treatment?

LLETZ treatment removes all the abnormality in over 90% of women, but it is important to have follow-up smears to confirm this. You will have a follow up smear and HPV test of cure 6 months after treatment.

More information can be obtained at www.cancerscreening.nhs.uk.