Colposcopy

About colposcopy

You may be invited to have a colposcopy if you have had a cervical smear test that showed abnormal cells, or if your cervix looked abnormal to the nurse or doctor who did the test.

The cervix and transformation zone]

An abnormal cervical smear test result usually means that there are changes in the cells of your cervix. Abnormal cells could be pre-cancerous. This doesn’t mean you have cervical cancer but that some of the cells are a little abnormal and may, if left untreated, develop into cervical cancer in the future.

Your GP may also recommend you have a colposcopy if you have symptoms such as:

  • bleeding in between periods or after sex
  • blood-stained vaginal discharge
  • pain in your pelvis

A colposcopy can help to show whether your symptoms are due to cervical cancer, or if they are caused by something else.

In a colposcopy your doctor, or a specialist nurse, will use a colposcope to examine your cervix. A colposcope acts like a magnifying glass, and will help your doctor or nurse to see the cells of your cervix in detail and close up.

Your doctor or nurse may also take a biopsy during a colposcopy. A biopsy is a small sample of tissue. This will be sent to a laboratory for testing to determine the type of cells and if these are benign (not cancerous) or cancerous. If your doctor or nurse finds abnormal cells during the colposcopy, he or she may give you treatment straight away, or you can have this later. 

What are the alternatives to colposcopy?

If your doctor or nurse cannot see the cells on your cervix properly with a colposcope, then he or she may suggest other tests. You may also be able to have some of these tests at the same time as a colposcopy. The other main tests include the following.

  • Large loop excision of the transformation zone (LLETZ). In this procedure, your doctor will use a wire loop with an electric current to remove abnormal areas of tissue. This will be sent to a laboratory for testing to determine the type of cells and if these are benign (not cancerous) or cancerous. LLETZ is usually done under a local anaesthetic and can done during a colposcopy.
  • Cone biopsy. In this procedure, your surgeon will take a small, cone-shaped section of abnormal tissue from your cervix. This will be sent to a laboratory to be examined under a microscope. Cone biopsy is usually done under a general anaesthetic.

Preparing for a colposcopy

Your doctor or nurse will explain how to prepare for your colposcopy. For example if you smoke you will be asked to stop, as smoking increases your risk of getting a wound infection, which can slow your recovery.

A colposcopy is routinely done in hospital as an outpatient procedure. This means you have the procedure and go home the same day.

Some doctors prefer not to carry out a colposcopy if you have your period, so try to arrange your appointment for a suitable date. If you have your period on the day of the test, phone the hospital to check whether you can have the colposcopy or not.

Your doctor or nurse will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during a colposcopy

A colposcopy usually takes between 15 and 20 minutes and may be done by a doctor or specialist nurse.

Your doctor or nurse will ask you to lie on your back on a special couch, with your feet drawn up and your knees apart. There may be leg or pedal rests to support your legs or feet.

Your doctor or nurse will use a speculum (the same instrument that's used in a cervical smear test) to hold open your vagina. He or she will then paint your cervix with a liquid, such as acetic acid or iodine, which will show up any abnormal cells more clearly. Your doctor or nurse will use the colposcope, which has a light attached, to look at the cells on your cervix. The colposcope will stay outside your body at all times.

If your doctor or nurse sees anything that looks abnormal, he or she will take a biopsy and this will be sent to a laboratory for testing. You may have a local anaesthetic to numb the area before you have a biopsy.

If your doctor or nurse doesn't find any abnormal cells, you won't need any treatment. If your doctor or nurse does find abnormal cells, he or she may treat you immediately and remove the cells. Alternatively, after taking a biopsy, your doctor or nurse may ask you to come back (after the results are available) for treatment at another appointment.

The most common type of treatment is LLETZ. Your doctor or nurse will inject a local anaesthetic into your cervix, which will completely block pain from the area. He or she will then use a loop of fine wire with an electric current flowing through it to remove the abnormal cells from your cervix. This will take around five to 10 minutes.

What to expect afterwards

You will usually be able to go home when you feel ready.

If you have a biopsy, you may have some bleeding from your vagina for a few days after the procedure. For this reason, it's a good idea to bring a sanitary towel with you on the day of your colposcopy (don't use a tampon).

If you have a local anaesthetic, you may have some period-like pains as the anaesthetic wears off. If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Recovering from a colposcopy

 You should feel fine straight away after a colposcopy. If your doctor or nurse took a biopsy during the colposcopy, you may have some discomfort for a day or two, but this varies between individuals, so it's important to follow your doctor or nurse's advice.

If you have treatment during your colposcopy, don't go swimming for two weeks and don't have sex or use tampons for around four weeks after your procedure. This will give your cervix time to heal.

Your doctor or nurse may advise you to have showers rather than a bath for between two and four weeks. This is to reduce the chance of developing an infection or bleeding.

If you have a biopsy, the tissue sample will be sent to a laboratory for testing. Your doctor or nurse will tell you when to expect the results. You may need to come back to the hospital for an outpatient appointment, or you may get your results by post.

If you need further treatment to remove any abnormal cells, your doctor will let you know what this will involve.

What are the risks?

As with every procedure, there are some risks associated with colposcopy. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your doctor or nurse to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.

A colposcopy may be uncomfortable because you need to lie in a certain position for the procedure. It’s not usually painful but you may feel a tug or pinch if your doctor or nurse takes a biopsy.

If you have a biopsy or treatment under local anaesthesia, you may have some period-like cramps as the anaesthetic wears off. You may also have some blood-stained vaginal discharge similar to a light period. This will usually clear up after a few days, but can sometimes last for up to four weeks. You may need to wear a sanitary towel during this time. If you’re bleeding heavily or the bleeding gets worse, see your GP or contact your colposcopy clinic for advice.

Complications

Complications are when problems occur during or after the procedure.

A very small number of women have some heavy bleeding after the procedure. This is more likely to happen if you’re pregnant when you have the colposcopy, or if your doctor or nurse takes a large biopsy. If the bleeding seems heavier than a heavy period, contact a hospital or your GP immediately.

The site of a biopsy can get infected. Contact your hospital or GP if you develop:

  • heavy bleeding
  • a fever (high temperature)
  • a vaginal discharge that smells unpleasant


Reviewed by Rachael Mayfield-Blake, Bupa Health Information Team, September 2013.

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