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Further investigations

Colposcopy & biopsy

If you’ve received an abnormal smear result, you may be referred for colposcopy. This is a detailed examination of your cervix and is used to confirm your smear results and identify exactly where the abnormal cells are. The colposcopy results will help to determine what, if any, treatment you will be offered.

Colposcopy

Before you go for colposcopy:

• Make sure you do not schedule your colposcopy appointment during your period.
• Ask a friend to come with you for support.
• If possible, schedule a day off work for your appointment in case you are offered treatment at the same time as colposcopy.
• If you have any questions for your doctor, write them down and take them with you to the appointment.
• Make a note of the date your last period started and take this with you to colposcopy.

A colposcopy is done by a specially trained doctor or nurse (colposcopist) in a clinic or hospital outpatient department. The examination takes 10 - 20 minutes but the whole appointment may take about an hour. Colposcopy feels very much like a smear test but takes a little bit longer. You will be asked to undress from the waist down and lie on the examination table with your legs in leg rests.

The doctor or nurse will insert a speculum to hold your vagina open and will look at your cervix through a large microscope. This is the colposcope. It will be about 12 inches in front of your vagina but it does not go inside you or touch you at all. Some clinics can connect the microscope to a video screen so that you can watch the procedure from the doctor’s eye view. You can ask for the screen to be turned off, or back on, at any time.

Once the doctor locates your cervix, s/he will look at it closely for signs of cell changes and then dab it with a number of different liquids. The liquids help to highlight abnormal cells by causing the tissue to change colour. The colposcopist may use some or all of the following:

• Diluted vinegar (acetic acid) – which turns abnormal cells white (this may sting a bit)
• Iodine – which turns healthy cells brown (also called Schiller’s test)
• A combination of salt water and green light – abnormal cells use more blood than healthy cells and this procedure makes it easier to see the different patterns of blood vessels on the cervix

Biopsy

Once the abnormal tissue has been identified, the doctor may want to take a biopsy (sample) from the most affected area of your cervix. S/he will take a small sample, about the size of a match head, and send it to a laboratory for further analysis. You may be given a local anaesthetic to numb the cervix before the sample is taken, but if you do feel the biopsy it may feel like a pinch or a sudden cramp.

After colposcopy and biopsy

Before you leave the hospital or clinic, ask the doctor what s/he found and what treatment, if any, is needed. If you’ve brought a friend with you, you may want to ask them into the room at this point to give you moral support and help remember what the doctor tells you.

If a biopsy was taken it will be a week or two before the results are back, but your doctor may still be able to give you more information about what was found during colposcopy. Ask how and when you will be notified of the biopsy results and who you should contact if you have any further questions or concerns.

What to expect after colposcopy and biopsy

Spotting/bleeding – you may have a little bit of spotting or a dark discharge for a day or two after biopsy. You may want to use a sanitary towel to protect your underwear but don’t use tampons for about a week until your cervix heals. If the bleeding doesn’t stop within a couple of days or if you are concerned, contact your doctor.

Pain – some women feel pelvic pain similar to period cramps after biopsy. Over-the-counter pain medication may help ease the pain, and it usually goes away within a day. If the pain continues or gets worse, contact your doctor.

Sex – if you’ve had a colposcopy only (no biopsy or treatment), there are no restrictions on when you can have sex. If you’ve had a biopsy, however, it’s advised not to have penetrative sex for five days. This gives your cervix time to heal.

Infection – occasionally the cervix becomes infected after a biopsy. If you develop a thick, smelly discharge, fever, or pains in your pelvic area a few days after your colposcopy, contact your doctor immediately.

Cone biopsy

If the doctor can’t see all of the abnormal cells during a colposcopy, s/he may suggest a cone biopsy to get a sample of cells from inside the cervical canal. Cone biopsy may also be used as a treatment to remove abnormal cells, but has generally been replaced by a newer procedure called LLETZ (see treatments).

If you do have a traditional cone biopsy, it is usually done at a separate appointment in hospital. You will be given either a local or general anaesthetic depending on the size of the sample to be taken and whether a laser or a surgical knife will be used. Talk to your doctor about this before your appointment so you know what to expect and how long you are likely to be in hospital.

Once the anaesthetic has taken effect, the doctor will cut a small cone-shaped sample of tissue from your cervix to be sent to a laboratory for evaluation. After the sample has been taken you will have a pack of gauze inserted in your vagina to stop the bleeding. The gauze will be removed the next day but you may continue to have some bleeding and discharge for a few days. Before you leave the hospital, ask when you can expect your results. The biopsy may have removed all of the affected cells in which case you won’t need any more treatment.

After the operation, try to take it easy and rest as much as possible. It may take a few weeks before you feel fully recovered and you should not do any strenuous exercise, heavy lifting or have penetrative sex for four to six weeks to give your cervix time to heal.

Complications

A very deep cone biopsy may damage or weaken the cervix, which may increase your risk of miscarriage in future pregnancies. This can be treated temporarily with a stitch inserted at the beginning of pregnancy and removed after the 38th week.

A cone biopsy may also cause the opening of the cervix (the cervical os) to become tightly closed. This is a rare condition, but can lead to painful periods, difficulty becoming pregnant because sperm may not be able to get through the cervix to your womb, and labour complications. If you don’t have your period after the cone biopsy this may be a sign that your os has closed. Contact your doctor about this.

Written by Tamara Beus and published in printed format (2003) by Women's Health

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