Colposcopy

A colposcopy is a procedure to find out whether there are abnormal cells on or in a woman's cervix or vagina. The cervix is the part of the womb that sits in the vagina.

Abnormalities tend to occur at the opening of the cervix to the birth canal, where it enters the womb. A colposcopy allows a doctor or trained nurse to find these abnormalities.

In some women, the presence of 'abnormal cells' carries the risk of developing cervical cancer. A colposcopy is used to determine whether treatment will be needed to deal with these cells.

When a colposcopy is needed

You may need a colposcopy after having a routine cervical screening test. Other reasons for having a colposcopy may include:

• some of the cells in your cervical screening sample are abnormal (but not necessarily cancerous)
• you are infected with human papillomavirus (HPV), which is the main cause of the abnormal cell changes and might lead to cancer
• you've had several screening tests, but it wasn't possible to give you a result
• the nurse or doctor who carried out your screening test thought your cervix didn't look as healthy as it should

A colposcopy can also be used to investigate things such as unexplained vaginal bleeding (for example, after sex) or an inflamed cervix.

What happens during a colposcopy?

The procedure is usually carried out in an outpatient hospital clinic by a specialist called a colposcopist. This can be a doctor or a specially trained nurse.

You'll be asked to lie down in a special type of chair with padded supports to rest your legs on. A device called a speculum will be inserted into your vagina and gently opened to allow the colposcopist to examine your cervix.

A microscope (colposcope) with a strong light will be used to look at your cervix. The colposcope doesn't enter the vagina and remains outside your body. If the colposcope has a camera attached to it, you may be able to see images of your cervix on a small screen. Some solutions will be applied to the cervix to highlight the abnormal areas.

If any abnormal areas are identified, a small sample of tissue (a biopsy) may be removed for closer examination. A biopsy is similar to a small pinch or scratch in terms of sensation, and shouldn’t be too painful. The purpose of a biopsy is to confirm whether your screening test has been correct in identifying a problem.

However, the colposcopist will sometimes be confident that the screening test has been correct without the need for a biopsy, and may decide to proceed immediately to treatment.

The colposcopy procedure usually takes about 5 minutes, but it can take longer (10 to 15 minutes) if treatment is carried out. Overall, including the time it takes to discuss your problem with the colposcopist, your appointment should last 20 to 30 minutes.

A colposcopy can be slightly uncomfortable for some women. If you find it painful, you should tell the colposcopist, who will try to deal with your discomfort or stop the procedure entirely.

Colposcopy results

The colposcopist will usually be able to tell straight away if there are abnormal cells in your cervix. Biopsy results usually take about 4 weeks and a copy will be sent to both you and your GP in the post.

About 4 out of 10 women who have a colposcopy have a normal result. A normal result means your cervix appears healthy and you have a low risk of developing cervical cancer before your next screening test. Depending on your age, you'll be invited for a cervical screening appointment in 3 or 5 years.

About 6 out of 10 women who have a colposcopy have abnormal cells in their cervix. This doesn't mean they are cancerous cells, but they can sometimes develop into cancer if left untreated.

Very rarely, some women are found to have cervical cancer during a colposcopy. If you have cancer, you'll be quickly referred to a specialist team for care and treatment.

As cervical cancer detected through screening tends to be diagnosed at an early stage, the outcome of treatment tends to be better. This is why it's important for women to attend their screening test when invited.

Colposcopy treatment

Mild abnormalities don't always need to be treated. If treatment is needed, the aim is to remove the abnormal cervical cells while preserving as much normal tissue as possible.

The most common treatment is large loop excision of the transformation zone (LLETZ). The transformation zone is the area of tissue just at the entrance of the birth canal. LLETZ involves using a heated wire loop to remove the abnormal cells, and in the majority of cases is carried out using a local anaesthetic. The procedure lasts a few minutes and can be carried out during a colposcopy.

Removing abnormal cervical cells is usually successful (about a 90% success rate). You should be invited for a follow-up cervical screening test to check that the treatment has been successful. 

Try not to worry

If you're referred for a colposcopy after an abnormal cervical screening test, you shouldn't assume you have cervical cancer.

Less than 1 in 1,000 women referred for a colposcopy are found to have cervical cancer that requires immediate treatment.

Cervical cancer screening is successful because cell changes can occur many years before cancer can develop. Identifying and treating these cell changes at an early stage can prevent cancer from ever developing.

A colposcopy is sometimes carried out after a routine cervical screening test.

Other reasons for having a colposcopy may include:

• some of the cells in your cervical screening sample are abnormal (but not necessarily cancerous)
• you are infected with human papillomavirus (HPV), which is the main cause of the abnormal cell changes and might lead to cancer 
• you've had several screening tests, but it wasn't possible to give you a result
• the nurse or doctor who carried out your screening test thought your cervix didn't look as healthy as it should

Cervical screening

Cervical screening is a routine test to check the health of a woman’s cervix. It identifies abnormal cells on the cervix, which in some cases may develop into cervical cancer if left untreated.

Regular cervical screening helps to ensure that any cell changes are picked up early. If necessary, any abnormal cells can be removed to prevent cervical cancer developing.

About 1 in 20 tests reveal mild cervical cell changes, most of which don't need treatment because they return to normal by themselves.

Approximately 1 in 100 cervical screening tests indicate moderate cell changes, and 1 in 200 indicate severe cell changes. If you have moderate or severe cell changes, you'll be referred for a colposcopy and you may need treatment.

However, less than 1 in 1,000 women referred for a colposcopy are found to have invasive cervical cancer that requires immediate treatment.

Read more about cervical screening tests.

Further investigation using a colposcopy

Although abnormal cervical screening results rarely indicate cancer, it's important to investigate all moderate and severe abnormal cell changes, so that any problems can be treated as soon as possible.

You may also be referred for a colposcopy as a precaution if the laboratory was unable to get a result from your screening test sample.

A colposcopy allows the cervix and the tissue on its surface to be examined more closely. This gives a clearer idea of exactly where the abnormal cell changes are located and how advanced they are.

A colposcopy isn't a treatment for abnormal cells, it's simply a way of examining cell changes in more detail. However, treatment can be carried out during a colposcopy if abnormal cells are detected.

Other reasons for a colposcopy

A colposcopy may also sometimes be used to investigate:

• unexplained vaginal bleeding – for example, after sex 
• an abnormal appearance of the cervix after an examination
• an inflamed cervix (cervicitis)
• benign (non-cancerous) growths – such as polyps and cysts 
• genital warts found on the cervix

A colposcopy is a safe and quick procedure. However, some women find it uncomfortable and a few experience pain.

Tell the doctor or nurse (colposcopist) if you find the procedure painful, as they will try to make you more comfortable.

A colposcopy is a safe procedure to have during pregnancy.

Before your colposcopy

You'll be referred for a colposcopy if your cervical screening test reveals cervical cell changes, or symptoms such as unexplained pelvic pain or vaginal bleeding need to be investigated. It will usually be carried out in the outpatients department of your local hospital.

If you would prefer a female doctor or nurse to carry out your colposcopy, you can request this by phoning the clinic beforehand. You can also bring a friend, partner or family member to help you feel more at ease.

Phone the clinic if your period is due on the day of your appointment. In some cases, such as if it's your first colposcopy, you may still be able to attend your appointment. However, in other circumstances, such as if it's a follow-up appointment, you may need to reschedule the appointment. You can have a colposcopy if you're pregnant.

Don't have sex or use vaginal medications, lubricants, creams or tampons for at least 24 hours before your appointment. This will make examining your cervix easier.

Take a panty liner to your appointment, as a small amount of discharge can come out of your vagina after the procedure. If a small cell sample (a biopsy) is taken, there may also be some bleeding.

During your colposcopy

The colposcopist will explain the procedure, to help put you at ease.

You'll be asked to undress from the waist down and lie on a special couch with your knees bent. Your legs can rest on padded supports. If you prefer, you could wear a loose skirt that can be lifted up without having to take it off.

A device called a speculum will be gently inserted into your vagina to hold it open and allow the colposcopist to take a closer look at your cervix – in the same way your cervical screening was done.

A colposcope is used to examine the cells. It looks similar to a pair of binoculars. The colposcope doesn't touch you – it stays about 30cm (12 inches) outside your vagina and allows the colposcopist to see the cells on your cervix on a screen. In some cases, photos may be taken for your medical records.

Your colposcopist may dab different liquids onto your cervix. These stain abnormal cells a different colour, so they can be seen more clearly. You may feel a mild tingling or burning sensation when the liquid is applied to your cervix.

If abnormal cells are found, a small sample of tissue (a few millimetres across) may be taken from your cervix (a biopsy). This shouldn't be painful, although you may feel a slight pinch or stinging sensation. If necessary, you may be given a local anaesthetic to numb the area. The tissue sample will then be sent to a laboratory for testing.

In some cases, treatment may be recommended straight away, rather than a biopsy being done.

A colposcopy is a quick and safe procedure. It usually takes 5 to 10 minutes, but you should allow about an half an hour for the whole visit. Most women find the procedure uncomfortable and some experience pain. Tell the colposcopist if you feel pain and they will try to make it more comfortable for you.

After your colposcopy

You should be able to continue with your daily activities after your appointment, including driving.

For a few days after your colposcopy, you may have a brownish vaginal discharge, or light bleeding if you had a biopsy. This is normal and will usually stop after 3 to 5 days.

You should wait until any bleeding stops before having sex or using tampons, vaginal medications, lubricants or creams.

Follow-up appointment 

Following a colposcopy, you should be invited to a follow-up appointment to check that the cells in your cervix have returned to normal. This will usually be 4 to 6 months after your colposcopy.

After a colposcopy, your colposcopist will usually be able to tell you what they have found straight away.

If there is any uncertainty, a small sample of tissue from the cervix may need to be removed (a biopsy) for further examination. In some cases, abnormal cells can be treated during your colposcopy.

About 4 out of 10 women who have a colposcopy have a normal result. A normal result means that your cervix appears healthy and you have a low risk of developing cervical cancer before your next screening test. Cervical screening is routinely offered to anyone with a cervix in Scotland between the ages of 25 and 64 every five years.

About 6 out of 10 women who have a colposcopy have abnormal cells in their cervix. The most common type of abnormality is known as cervical intra-epithelial neoplasia (CIN). CIN isn't cancer, but it can sometimes develop into cancer if left untreated.

Biopsy results

If you've had a biopsy during your colposcopy, the tissue sample will be sent to a laboratory for testing. This will determine the extent of the cell changes in your cervix. You will need to wait about 4 weeks for your biopsy results to arrive by post.

In some cases, cell abnormalities are detected in the glandular cells found in the inside lining of the birth canal of the cervix. These abnormalities are known as cervical glandular intra-epithelial neoplasia (CGIN). CGIN is less common than CIN.

The detection of CIN or CGIN does not necessarily mean you have cancer, or that you'll develop it.

Grading CIN and CGIN

CIN is graded from 1 to 3. Grade 1 corresponds to a mild type of abnormality, as detected by your screening test. Grades 2 and 3 reflect moderate and severe abnormalities respectively.

CGIN is usually classed as either low-grade or high-grade. In terms of severity and risk, high-grade CGIN is equivalent to CIN 3.

CIN 1

If you have CIN 1 (low-grade) cells, it's unlikely that you'll develop cancer. The abnormal cells will often disappear without treatment to remove them.

You'll usually be invited for a cervical screening test in 12 months to check that the abnormal cells have gone.

CIN 2, CIN 3 or CGIN

If you have CIN 2, CIN 3 or CGIN (high-grade) cells, your risk of developing cervical cancer is increased.

Removing the abnormal cells will usually be recommended to lower your risk of developing cervical cancer.

In rare cases, the results of a colposcopy and biopsy will show cervical cancer. If this happens, treatment should be started as soon as possible. You'll be referred to a team of specialists, who will advise you about your treatment.

Cervical cancer diagnosed through screening tends to be found at an earlier stage. Women who have early-stage cancers are more likely to survive than women with later-stage cancers.

You may need treatment if the results of your colposcopy show that there are abnormal cells in your cervix.

The abnormal cells will be removed, which usually involves removing an area of the cervix about the size of a finger tip.

The type of treatment depends on the number of abnormal cells in your cervix and how advanced the abnormalities are.

The aim is to remove the abnormal cells while minimising damage to healthy tissue. Treatment has about a 90% success rate.

Timing of treatment

It's often possible to have treatment at the same time as your colposcopy.

Some more intensive treatments can't be done on the same day as a colposcopy. Your colposcopist can discuss treatment options with you, and what each type of treatment involves.

Large loop excision of the transformation zone

In the UK, large loop excision of the transformation zone (LLETZ) is the most common treatment for abnormal cervical cells. LLETZ is also known as loop diathermy, loop cone, loop biopsy or loop excision.

The 'transformation zone' is the junction between the skin on the surface of your cervix and the delicate tissue that lines the birth canal at its entrance. This is the area where the majority of abnormalities occur and is where HPV creates changes to the cells.

LLETZ can be carried out at the same time as a colposcopy and involves removing the area of the cervix where abnormal cells are. This is done using a thin wire loop that's heated with an electric current.

LLETZ takes 5-10 minutes and is usually carried out as an outpatient procedure, which means you won't need to stay in hospital overnight. A local anaesthetic is usually injected into the cervix to numb the area. However, you may experience some mild pain, similar to period pain.

If a larger area of the cervix needs to be treated, the procedure will take longer and you may need a general anaesthetic.

You'll need to bring a sanitary towel with you, as you'll bleed after having LLETZ. You may have light bleeding for several weeks after the procedure.

After having LLETZ, you should avoid:

• using tampons for 4 weeks (use sanitary pads instead)
• having sex for 4 weeks
• exercising, including swimming, for at least 2 weeks, or while there's still any bleeding or discharge 

These all increase your risk of developing an infection after the procedure. 

There's some evidence to suggest that women treated with the LLETZ procedure have an increased risk of premature birth in future pregnancies. However, in most cases, the benefits of treatment will greatly outweigh this small risk. Your doctor can advise further about this, if necessary.

Cone biopsy

It's not possible to carry out a cone biopsy at the same time as a colposcopy. A cone biopsy is a minor operation that may require an overnight stay in hospital. It's not carried out as often as LLETZ and only tends to be used if a large area of tissue needs to be removed.

A cone biopsy is carried out under general anaesthetic. A cone-shaped piece of tissue is removed from your cervix using a scalpel. The tissue will then be sent to a laboratory for closer examination.

Following a cone biopsy, a dressing (pack) may be placed in your vagina to help stop any bleeding.

It's normal to bleed for up to 4 weeks after having a cone biopsy. You may also have some period-like pain, although any discomfort should only last for a couple of hours.  

After treatment

Following a cone biopsy, you'll probably be advised to avoid:

• using tampons for 4 weeks (use sanitary pads instead)
• having sex for 4 weeks
• exercising, including swimming, for at least 2 weeks, or while there's still any bleeding or discharge

Your GP or staff at the clinic will be able to answer any queries or discuss any concerns you may have about your colposcopy or treatment.

Other treatments

Abnormal cells can also be treated in a number of other ways. Your doctor can give you advice about the procedures outlined below:

• Cryotherapy – where the abnormal cells are frozen and destroyed.
• Laser treatment – a laser is used to pinpoint and destroy abnormal cells on your cervix.
• Cold coagulation – a heat source is applied to the cervix to burn away the abnormal cells.
• Total hysterectomy (surgical removal of the womb) – this will only be considered if abnormal cells on your cervix have been found more than once or if they're severely abnormal.

Cervical screening and HPV testing following treatment for abnormal cells

6 months after your treatment for abnormal cervical cells, you should have a cervical screening test.

The test will be carried out to check for the presence of abnormal cells and the human papilloma virus (HPV). If some mildy abnormal cells are found but the virus is no longer present, it's highly likely that the condition has been cleared from your cervix.

If HPV isn't found, you won't need to be screened for another 3 years. However, if HPV is found, or if more significant cell changes (moderate or severe) are detected again, you should be referred for another colposcopy.

Risks of removing abnormal cervical cells

Removing abnormal cervical cells is an effective way of preventing cervical cancer. However, there are some risks associated with the treatment.

There's a risk of developing an infection after having cells removed.  See your GP if you have:

• heavy or persistent bleeding
• a smelly vaginal discharge
• persistent tummy pain

There's also a slightly higher risk of having a baby prematurely if you get pregnant after having cells removed from your cervix.

Not all women with abnormal cervical cells will need treatment to remove them. However, all women with serious cell abnormalities will be offered treatment to have them removed.

Not all serious cell changes will develop into cancer, but it’s impossible to tell which will and which won’t. You'll be advised to have the abnormal cells removed anyway, just in case.