Advice following your Colposcopy

At your visit, you may either have had biopsies taken from the cervix or had treatment known as LLETZ (Large Loop Excision of the Transformation Zone). These are explained below.

What is Human Papilloma Virus (HPV)?

There are over 100 types of HPV and around 40 of these affect the genital areas of men and women (penis, vulva, anus, vagina, cervix and rectum). Most HPV types do not cause cancer but around 13 are high risk types and are linked to cancer, in particular types 16 and 18 which cause most cervical cancers (70%). The other HPV types are classed as low risk and do not cause cervical cancer however they can cause other problems such as genital warts.

Nearly all cervical cancers (99.7%) are caused by human papilloma virus (HPV).
HPV is very common and 4 out of 5 people at some point in their life will get the virus but will never know they had it as they will show no symptoms. It is spread through skin to skin contact through sexual activity with either a man or a woman. Usually HPV is cleared naturally by the body’s own immune system. In a small percentage of people it can persist or remain dormant or undetectable for many years. It is not possible to know when you came into contact with the virus.

Smoking is an important co-factor in the persistence of an abnormality on the cervix. Smoking lowers the immune system making it less likely that HPV will disappear on its own.

Advice following cervical biopsies

A cervical biopsy is taken as a small sample of tissue to assess any abnormal area on the cervix. Biopsies are not intended to treat the area.
After your biopsy, you may experience some of the following minor symptoms and also have some questions about your after-care.

It is advisable that you ‘take it easy’ for the rest of the day, if you can and avoid heavy exercise for the next 24 hours.

You may experience some ‘period like’ discomfort. This usually settles after a few hours; however, simple pain relief such as paracetamol or ibruprofen can be taken to ease discomfort. Please read the instructions and do not take more than the recommended dose.

After having a biopsy taken, you can expect to experience a red or brown / black discharge (due to a chemical cautery used called silver nitrate) for anything up to a week following this.

It is advisable to avoid sexual intercourse, tampons and swimming for up to a week, or until your discharge returns to what is normal for you.

If you continue to experience problems or are worried, please contact your GP or the clinic for advice.

What is Cervical Intra-epithlial Neoplasia (CIN) and Cervical Glandular Intra-epithelial (CGIN)?

The majority of the cervical abnormalities arise in the lining of the outer cervix (squamous) and the technical term used to refer to cell changes confirmed by biopsy is
Cervical Intra-epithelial Neoplasia, commonly known as CIN. Depending on the depth of cells affected, CIN is graded as 1-3

• CIN 1 (low grade changes) will often revert back to normal, but will need regular screening to monitor. However, in some circumstances persistent change can be treated (LLETZ).
• CIN 2 (moderate changes) is often treated (LLETZ), but in some circumstances your Doctor / Nurse Specialist may offer you surveillance of this change depending on numerous factors. This will be discussed with you and the multi-disciplinary team (MDT) whether it might be possible to wait for it to revert to normal.
• CIN 3 (high grade / severe changes) will need treatment (LLETZ) to return the cells to normal.
• CGIN (Cervical Glandular Intra-epithelial) – A small proportion of the cervical abnormalities arise in the lining of the inner cervix (glandular tissue). Sometimes your cervical screening test may have indicated change to this area. You will need treatment (LLETZ) for this.

Treatment

LLETZ – Large Loop Excision of the Transformation Zone

The aim of treatment is to remove abnormal cells allowing healthy cells to replace them.
Treatment can usually be done in the colposcopy clinic as an outpatient on your first appointment. We would expect you to go home and rest following treatment.
Your cervix will need time to heal; this will be for a period of 4-6 weeks. We would therefore advise that you do not travel outside of the United Kingdom during this time.

Advice following treatment of the cervix – LLETZ or loop biopsy

After your treatment, you may experience some of the following symptoms and may have some questions about your after-care and what activities to avoid.

• You may experience ‘period like’ discomfort. This usually settles after a few hours; however, pain relief such as paracetamol or ibuprofen can be taken to ease the discomfort. Please read the instructions and do not take more than the recommended dose.
• Vaginal discharge varies after treatment, and can last between 4-6 weeks. This loss may be watery/red brown initially, changing as healing takes place, before returning to your normal discharge.
• Very heavy, fresh red bleeding, immediately after treatment or within the first two weeks after treatment, should be regarded as abnormal. If this occurs, please seek advice from the 24 hour number provided on the back of this leaflet.
• If you notice a smelly, offensive vaginal discharge, this could indicate an infection and you should contact your GP who may prescribe antibiotics.
• It is advisable to use sanitary towels for protection (avoiding tampons / vaginal cups) to prevent introducing infection during the healing process.
• Sexual intercourse should be avoided for 4 – 6 weeks or until your discharge has returned to normal.
• Your next period may occur earlier than expected and should not be confused with post-treatment bleeding. It may be heavier and/or longer than usual; this is nothing to worry about.
• Swimming should be avoided for 4 – 6 weeks.
• Showers are better than baths and we would recommend this for at least two weeks following LLETZ treatment.
• It is advisable that you take it easy and avoid heavy exercise for two weeks.
• In recent research there has been shown to be a small increased risk of preterm delivery (delivering a baby before 37 weeks) and miscarriage however each person’s cervix is different, and each treatment is different. We advise that you inform your Obstetrician or Midwife about any previous treatment you have had to the cervix.

If you continue to experience problems or are worried, please contact your GP or the hospital for advice. The telephone numbers can be found on the back of this leaflet.

Results of biopsy / LLETZ

We will send you a letter with your results to your home address. If you have not received this letter 6-8 weeks after your appointment date, we would advise you to contact the clinic directly.

Cervical Cancer

Rarely, some people having a colposcopy examination, biopsy and/or LLETZ treatment are found to have cervical cancer. If you are found to have a cancer you may be called with an appointment to attend the colposcopy clinic to discuss your results face to face. Most early cancers found are successfully removed with the LLETZ treatment.

Follow-up after treatment

You will be advised when to have your next cervical screening test (usually six months after treatment). This test will look for the presence of the Human Papilloma Virus (HPV). Depending on the results of this test, you will either require normal cervical screening follow up in three years or be asked to return to the colposcopy clinic for follow up.

Following treatment of CGIN, two negative cervical screening samples at six and eighteen months following treatment are required before returning three year follow up.

It is important to adhere to the follow up advice given from colposcopy. There is a small risk of reoccurrence (5-10%); attending your cervical screening tests when recalled will allow early detection of any cell changes.

Useful contact telephone numbers

Out of hours emergency number

Colposcopy Nurses

• Annemarie Dalton
• Lauren Mann
• Lynsey Bettany
• Michelle Winters

Useful Websites