You may be asked to come for a further examination because your cervical screening test has shown evidence of abnormal cells OR referred due to having had a number of inadequate smear results.
An abnormal result is not unusual – it happens in about one in twenty tests. An abnormal result usually means that small changes have been found in the cells on the cervix (the neck of the womb) and act as early warning signals that cervical cancer might develop in the future. It is important to remember that it is very rare indeed for these abnormalities to be cancer.
The examination you will have is called colposcopy. It is simple, quick and generally painless and allows the doctor to decide if you need treatment. For some women the changes in the cervix return to normal by themselves. Other women will need some simple outpatient treatment that is virtually 100 per cent effective.
What Is Colposcopy?
The instrument used is called a colposcope and is really just a large magnifying glass which lets the doctor look more closely at the changes on your cervix. It does not go inside you. For most women this is a painless examination, but some may find it a bit uncomfortable.
Colposcopy can be done safely during pregnancy and will not affect delivery of your baby, nor will it affect your ability to become pregnant in the future. However, treatment is usually postponed until after the delivery of your baby.
Is There Anything I Can Do Before the Examination?
You are welcome to arrange for a relative or friend to come with you to the colposcopy clinic. We prefer not to do a colposcopy examination when you have your period.
The actual examination only takes about 15 minutes. You may wish to wear a full skirt to avoid removing all your lower clothing during the examination. Some women have a slight discharge after the examination. You may want to bring a sanitary towel, just in case.
What Happens Before the Examination?
First the doctor will want to ask you some questions. These questions relate to your periods, the type of contraception you use, any operations or illnesses you have had in the past, and so on. You will then be asked to undress from the waist downwards (though a full skirt need not be removed).
The colposcopy nurse will help you to position yourself on a special type of couch. The couch has padded supports on which you rest your legs. When you are lying comfortably the doctor will gently insert a speculum into your vagina, just as when you had your cervical screening test.
Sometimes another test is taken. After this the doctor will look at your cervix using a colposcope. The colposcope is a specially adapted type of microscope with light. The doctor will then dab different liquids onto your cervix to help identify and highlight any areas of abnormal cells. The abnormal areas will appear white.
If any abnormal area is identified, a small sample of tissue – a biopsy – will be taken from the surface of the cervix. A biopsy is about the size of a pinhead. You may feel a slight stinging, but it should not be painful.
After the examination the doctor may be able to tell you what is wrong and what treatment, if any, is needed. But often, especially if you have had a biopsy, you will not be given a definite diagnosis immediately after the examination. It will take a week or two before you get the results of the biopsy. After the examination you should feel well enough to continue with your usual routine.
Colposcopy defines the type and extent of the abnormal area on the cervix. The results show if you need treatment and, if so, what sort.
The result of a biopsy shows how abnormal the area is. It may also indicate if further treatment is needed
If you have had a biopsy, you may have a light blood-stained discharge for a few days following the procedure. This is normal and it should clear itself. It is best, however, to refrain from intercourse for up to five days to allow the biopsy site to heal
Treatment usually takes place during another colposcopy and the procedure is very similar to your initial examination. If treatment was done you may have a blood-stained discharge for two to four weeks and it is advised to avoid intercourse for that period, and use sanitary towels rather than tampons.
Treatment for CIN will have little or no effect on your future fertility, nor on your risk of having a miscarriage. It is important to keep your appointments afterwards to make sure that your cervix is still healthy. A follow-up check is usually between four and six months after the examination or treatment. During this visit the doctor will take a cervical screening test and may do another colposcopy examination to make sure that the cervix is healthy again.