The Colposcopy Procedure

If you would like a female nurse or doctor to carry out your Colposcopy, please call the clinic to request this when you receive your appointment as this might not be always possible to provide when you arrive at the clinic.

What is a colposcopy?

Having a colposcopy is similar to having a cervical screening test. The examination on average should take no longer than 30 minutes. You will be required to undress from your waist down and lie down on a special couch that supports your legs.

The colposcopist will place lubricant on a speculum and place it in to your vagina (this is the same as when you had a cervical screening test). The speculum will be opened gently allowing the colposcopist to see your cervix.

The colposcope (which put simply is binoculars on a stand) will be used to allow the colposcopist to visualise your cervix. The colposcope does not enter the vagina and does not touch the skin.

The colposcopist will then place a liquid (acetic acid) onto the cervix using cotton wool – this may feel cold and sometimes sting a little. This liquid highlights any abnormalities on the cells of the cervix to the colposcopist.
It may be required at this time for the colposcopist to take a punch biopsy or carry out treatment on the cervix (known as Large Loop Excision of the Transformation Zone or LLETZ for short).

Informed consent

This leaflet is provided to supplement verbal information that will be given to you by your healthcare provider prior to your procedure. Information sharing between you and the clinician is essential to ensure that your decision to consent is fully informed.

You have a right to be involved in these decisions and should feel supported to do so. Please take the time to consider what is important to you to ensure the information you receive is specific and individualised.

Why have I been referred for a colposcopy?

You have been asked to come for further examination for one of the following reasons:

1. Your cervical screening test has found evidence of a change to your cervical cells. These changes are known as dyskaryosis.
   
   What is dyskaryosis?
   This is a term given to the changes. These changes are not cancer. Low grade changes (often called low grade dyskaryosis, mild or borderline changes) will often resolve on their own. High grade changes (known as moderate or severe dyskaryosis) or unusual glandular cells (also known as glandular dyskaryosis) are less likely to resolve by themselves and usually act as an early warning that over time cervical cancer may develop if they are not removed.
2. If you have had a cervical screening test which has detected the continued presence of high risk human papilloma virus (HPV); or as follow up to cervical treatment and it has detected the human papilloma virus (HPV) or further changing cells, you will be asked to come to colposcopy for further assessment.
   
   What is HPV?
   This is a virus that is extremely common. Four out of five people have genital (penis, vulva, anus, vagina, cervix and rectum) HPV at some point in their lives but will never know they have it as they will show no symptoms. Genital HPV is transmitted primarily by skin to skin contact. It is not possible to determine when you may have come into contact with this virus.
   
   There are over 200 types of HPV. Around 40 of the HPV types affect the genital areas. Around 14 of these types are thought to be associated with the development of cancer and so are called high risk. The remaining genital HPV types have been called low risk as they do not cause cervical cancer, but they can cause other problems such as genital warts. HPV is usually cleared (without treatment) by the body’s natural immune system. However, a small percentage of people do not clear the HPV and it can remain ‘dormant’ (inactive) or persistent in some bodies for many years. 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.
3. If your cervical screening test is reported as unsatisfactory these tests show that the laboratory was not able to give the result. This is usually because there were not enough cells to assess. When this happens, it is best to have a colposcopy to check that your cervix is healthy.
4. You may be experiencing unusual symptoms such as bleeding after sexual intercourse or in between your periods which may be related to the health of your cervix. Your GP / Community Nurse may also offer you a referral if they are concerned about the appearance of your cervix.

Is there anything I need to know before I have a colposcopy?

• There is no need to avoid sexual intercourse before your colposcopy examination, unless you have a coil fitted.
• You can eat and drink as normal. We encourage you to have eaten some food before your appointment.
• Bring a list of any medication you are taking and let the colposcopist know of any medical history and allergies.
• Please make a note of when you had your last period.
• You will be asked to remove your clothing from below the waist. You may wish to consider how you dress the day of your appointment for comfort, taking into consideration comfortable underwear for after the procedure.
• If you require treatment during your appointment, you may have to remove any jewellery you have below the waist. You can do this before your appointment or at your appointment. You can discuss this further with the colposcopist if needed.
• If you require treatment we would strongly advise you avoid the use of moisturisers to the legs in particular the thigh area on the day of your appointment. This is to ensure the pad used during the procedure remains in close contact to the skin. You can discuss this further with the colposcopists if needed.
• After the examination, you will experience some discharge from your vagina. Although we will provide a sanitary pad for you at this time, you are more than welcome to bring your own sanitary pad / panty liner with you if you would prefer.
• You should be able to drive home afterwards. You may feel you wish to bring someone with you in case you do not feel well enough to drive after your appointment.
• You might find it helpful to write down any questions that you have for the Doctor or Nurse colposcopist.

What will happen during my appointment?

You will be called for your colposcopy, where you will meet the colposcopist (who may be a doctor or nurse specialist) and the support nurses who will be with you during your examination.

The colposcopist will ask you some questions, take down your medical history and explain the procedure to you. Following this, the support nurse(s) will show you to the examination couch and help you to prepare for the colposcopy.
The colposcopist will then carry out the examination.

What if a sample of my cells are needed?

If a sample of your cells (a biopsy) is needed, the colposcopist will discuss this with you, and, with your consent, take a tiny piece of tissue from your cervix, so that it can be examined in more detail to see if there are changes in the cells. The biopsy is about the size of a grain of rice.

You may have a brown or red discharge from your vagina for anything up to a week following this. You may also experience some ‘period-like’ discomfort for the next few hours.

What if I need treatment?

The treatment, known as Large Loop Excision of the Transformation Zone (LLETZ) aims to remove the changed cells, allowing healthy cells to grow in their place. 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.

If you have a coil fitted, please use an extra form of contraception for seven days before your appointment, as sometimes it is necessary to remove the coil before you have the treatment.

Large Loop Excision of the Transformation Zone (LLETZ)

This treatment uses a heated device to remove the affected tissue from your cervix. Local anaesthetic (similar to the one you have at the dentist) is used to numb your cervix, and the cells are then lifted off the cervix using a wire loop.

A small pad will be placed onto an area of your skin (usually your upper leg) to aid the equipment. During the procedure, you will hear some noises from the machinery. Occasionally patients report a feeling of heat from the area in which we are working (the cervix) but there should be no pain.

The examination and treatment last roughly 15 minutes. Afterwards, you will be given a sanitary pad (or you may wish to bring your own) and asked to rest in our recovery area for a short period of time (roughly 15 – 30 minutes) before leaving.

What will the results of the biopsy or LLETZ show?

The majority of changes to the cells arise in the lining of the outer cervix (squamous) and the technical term used to refer to cell changes confirmed by a biopsy or LLETZ is Cervical Intra-epithelial Neoplasia, more commonly known as CIN.

To make distinctions between the various stages of changes in the cells, doctors have developed a scale from 1 -3 according to how many cells are affected. So, results will most commonly be CIN 1, CIN 2 or CIN 3.

A small amount of cell changes arise in the lining of the inner cervix (glandular), and the technical term used to refer to these changes is cervical glandular intra-epithelial neoplasia, commonly known as CGIN.

What normally happens after biopsy / LLETZ treatment?

Most people will feel okay after biopsy / LLETZ treatment. In a very small number of cases, people may experience the following;

• Dizziness or feeling faint following the examination. If this happens to you, the nurse will ask you to lie down and will keep you under close observation either in the examination room or recovery area until you have fully recovered.
• 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.
• You will experience some vaginal discharge / bleeding after your biopsy or LLETZ. This loss may be watery / red or brown in colour initially, changing as healing takes place.
• Avoid sexual intercourse for four weeks following LLETZ to allow the cervix to heal however following biopsies we would recommend one week.
• It is advisable that you ‘take it easy’ for the rest of the day following biopsies, if you can, and avoid heavy exercise for the next 24 hours. Following LLETZ we advise two weeks.
• We recommend that you avoid swimming following LLETZ treatment for at least four weeks or at least until the discharge has stopped due to the risk of infection.
• Showers are better than baths for at least two weeks following a LLETZ. With biopsy we would recommend a few days, or at least until the bleeding has stopped.
• Your fertility will not be affected following the removal of these cells. 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. If you have any concerns about this, please discuss this further with your colposcopist / specialist.

Results of biopsy / LLETZ

We will send you a letter with your results to your home address within 6 – 8 weeks.

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.

Rare complications with LLETZ treatment

A small number of patients may suffer a pain in their pelvis or experience heavy bleeding vaginally (from the treated area). This may happen immediately after treatment or within the next couple of weeks.

This may be an indication that you have an infection, particularly if you have a temperature or strong-smelling discharge.

It is very important that you contact your General Practitioner (GP) or Gynaecology Acute Treatment Unit (GATU) (telephone number will be provided at your colposcopy appointment) as you may require examination and/or antibiotics.

Will I need to have check-ups?

Yes. It is important to keep your appointments to make sure that your cervix is healthy. Most colposcopy clinics recommend that you have a follow up 6-12 months after examination or treatment, although this does depend on your results.

Often these check-ups are back with your own General Practitioner (GP) however they may also be at the colposcopy clinic. We will write to you with the results and follow up plan. It is very important to complete the follow up programme as this allows us to check that your cervix stays healthy.

Practical questions

What should I do if I have a period on the day of my colposcopy appointment?

We would encourage you to attend your appointment despite this. If you would prefer to not attend, please contact the appointment team to rearrange.

What happens if I am pregnant or think I might be?

It is important that you keep your colposcopy appointment. A colposcopy can be carried out quite safely during pregnancy, but any investigations will usually be postponed until after the pregnancy. When you come for your appointment, we can discuss this further with you.

Will having a colposcopy affect my fertility or sex life?

Having a colposcopy does not affect either of these. However, different procedures/ treatments may have different effects and we will be happy to discuss this with you further at your appointment. If you have LLETZ treatment you will have to avoid sexual intercourse for four weeks.

Can I travel abroad following LLETZ treatment?

We would recommend that you do not travel abroad in the four weeks following your LLETZ treatment as you may not be covered by travel insurance, should you need medical attention while you are abroad, for a complication following your LLETZ treatment.

Further information

Sources used for this information leaflet