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 many 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 14 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 80-90% of people who are sexually active may experience HPV at some point in their lives but will never know they had it as they will show no symptoms. You can have HPV for many years even if you haven’t been sexually active recently or had a new partner. It is spread through skin to skin contact through sexual activity with either a man or a woman.
Most of the time HPV is cleared naturally by the body’s own immune system within two years without it causing problems. HPV can sometimes stay in your body without it causing any problems or being detected with a test. This is called ‘dormant’ HPV. It is possible that you got HPV years or even decades ago but never knew you had it. Sometimes dormant HPV can become active again. If high risk HPV stays in your body it can cause changes to the cells in your cervix. These changes may become cervical cancer overtime. If cell changes are found they can be treated or monitored to stop them turning into cancer.
Regular cervical screening can prevent cervical cancer from developing.
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 ibuprofen 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.
We recommend showers are better than baths for a few days, or at least until the bleeding has stopped.
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 cervical abnormalities arise in the lining of the outer cervix (squamous) and the technical term used to refer to cell abnormalities 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 abnormality) will often revert back to normal, but will need regular screening to monitor. However, in some circumstances persistent abnormalities can be treated (LLETZ).
- CIN 2 (moderate abnormality) 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. Please see leaflet for conservative management of CIN 2 for further information.
- CIN 3 (high grade / severe abnormality) 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 four weeks. Although there are no known health grounds for avoiding travel following treatment, overseas medical attention for complications arising from the treatment may not be covered by insurance.
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/bleeding varies after treatment, and can last four weeks. This loss may be watery/red or brown/light bleeding initially, changing as healing takes place, before returning to your normal discharge.
- Very heavy, fresh red bleeding/changing your pad every 30 minutes 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 at the end 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.
- Avoid using tampons for four weeks following treatment.
- Vaginal intercourse should be avoided for four weeks or until your discharge has returned to normal.
- There may be a temporary change in your menstrual pattern following LLETZ. 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 two weeks.
- Showers are better than baths for at least two weeks following a LLETZ.
- It is advisable that you take it easy and avoid heavy exercise for two weeks, but light exercise may continue.
- You may drink alcohol in moderation after treatment.
- You may drive following a LLETZ/treatment, unless advised otherwise by the examining colposcopist.
- Having abnormal cells removed may affect future pregnancies you have. People who are pregnant may give birth before 37 weeks (prematurely) or have their waters break early. This is more likely if you have more than 10mm of cervix removed. Most LLETZ remove less than 10mm of cervix.
- Treatment is not associated with any risk of infertility, but may increase the risk of mid-trimester miscarriage.
If you continue to experience problems or are worried, please contact your GP or the hospital for advice. The telephone numbers can be found in the useful contact numbers section 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 six 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, this is usually six months after your LLETZ. This is called ‘Test of Cure’ and will check if HPV has cleared. This test will usually be at your GP surgery or the colposcopy clinic.
Informed consent
We know that there is a lot of information here, and that some of it may be confusing or hard to process. We are here to help you make sense of what your individual situation is, and what your options are, so please do ask us any questions, and share any concerns with us.
Before you agree to a treatment or procedure, a doctor, nurse or another member of your healthcare team will explain what will happen.
This leaflet gives you extra information to help you understand your care and make the decision that is right for you. It is OK to ask questions.
Please talk to us if:
- there is anything you do not understand
- you would like something explained again
- you have any questions or worries
- you need more information before making your decision
Your care, your choice.
You have the right to be involved in decisions about your care. We will listen to you and support you to make your decision.
Take time to think about what is important to you. Please tell us about anything that may affect your decision so we can give you the information and support you need.
Useful contact numbers
Colposcopy Co-ordinator
For general enquiries
