Colposcopy

What is Colposcopy?

A colposcopy is a diagnostic procedure used to closely examine a woman's cervix, vagina, and vulva for signs of disease. It is typically performed using a colposcope, a special magnifying instrument that allows the healthcare provider to see the tissues of the cervix and vagina in much greater detail than is possible with the naked eye.

Common Names for Colposcopy

Colposcopy is the medical term for the procedure, but it may also be referred to by other names, such as:

• Cervical Colposcopy: This name emphasises the focus of the examination on the cervix.
• Vaginal Colposcopy: This name emphasises that the procedure is done through the vagina.
• Genital Colposcopy: This name encompasses the examination of the whole genital area.

Who is Suitable for a Colposcopy?

Colposcopy is typically recommended for women with abnormal cervical cells found during a routine Cervical screening test or Pap smear. There are several reasons why a Pap smear may be abnormal, such as an infection, inflammation, or abnormal growths on the cervix.

Colposcopy is also recommended for women with a cervical biopsy showing precancerous cells or cervical cancer.

You might need a colposcopy if you have the following:

• abnormal results from a cervical screening test (CST) (which has replaced the old PAP smear)
• unusual or unexplained bleeding, such as after intercourse
• an abnormal lump or growth on your cervix or vagina

The procedure can help diagnose conditions such as:

• cervical cancer or precancer
• benign growths such as polyps
• inflammation of the cervix
• genital warts

Not all women with abnormal cervical screening tests require a colposcopy. Dr Alyousif will consider the Cervical screening test results, the patient's age, and other risk factors to determine whether a colposcopy is necessary. 

Benefits of Colposcopy

Some of the potential benefits of colposcopy include the following:

• Early detection of abnormal cervical cells: Colposcopy allows the healthcare provider to examine the cervix and surrounding area more closely, which can help to detect abnormal cervical cells that may be precancerous or cancerous. This can help detect cervical cancer early when it is more likely to be treated successfully.
• Identification of the specific area of abnormal cells: Colposcopy allows the healthcare provider to identify the particular area of abnormal cervical cells, which can help to determine the appropriate treatment.
• Biopsy: Colposcopy can be used to take a small biopsy (tissue sample) of any abnormal cervical cells for further examination in the laboratory. This can help to confirm the diagnosis and determine the appropriate treatment.
• Reduced need for repeat Cervical screening tests: Colposcopy can help identify the specific cause of an abnormal Pap smear, reducing the need for repeat Pap smears or other cervical cancer screening tests.
• Emotional support: Colposcopy can give emotional support to women who may be worried about the results of an abnormal Cervical screening test. The procedure can provide a more accurate diagnosis and help to address concerns.

Types of Colposcopy

Colposcopy is a diagnostic procedure that allows Dr Alyousif to examine the cervix and the surrounding area more closely. Different types of colposcopy are used depending on the indication, the patient's preference, and the healthcare provider's expertise. These include:

• Simple colposcopy: This is the most common type of colposcopy, and it examines the cervix and surrounding area for abnormal cells. The healthcare provider uses a colposcope (a magnifying device) to examine the cervix and surrounding area and may take a small biopsy (tissue sample) of any abnormal cervical cells for further examination in the laboratory.
• Directed biopsy colposcopy: This type of colposcopy is used to biopsy a specific cervix area identified as abnormal during a previous examination. It is performed when the healthcare provider wants to confirm a diagnosis or determine the appropriate treatment.
• Endocervical curettage (ECC) colposcopy: This type of colposcopy takes a sample of cells from the endocervical canal, the inner portion of the cervix that opens into the uterus. It is occasionally done in conjunction with a simple colposcopy and is used to identify abnormal cells that may not be visible on the surface of the cervix.
• Large loop excision of the transformation zone (LLETZ) or Loop electrosurgical excision procedure (LEEP) colposcopy: This type of colposcopy uses a thin wire loop heated with an electrical current to remove abnormal cervical cells. It is used to treat cervical precancer and cervical cancer in situ.

What to Do Before a Colposcopy?

Preparing for a colposcopy involves several steps to ensure the procedure goes smoothly and yields accurate results:

• Schedule Appropriately: Avoid scheduling the colposcopy during your menstrual period.
• Avoid Vaginal Interference: Do not use tampons, vaginal medications, douches, or have vaginal intercourse for 24-48 hours before the procedure.
• Medication and Allergies: Inform your healthcare provider about any medications you are taking and any allergies, especially to iodine or latex.
• Pain Management: To help with discomfort, consider taking over-the-counter pain relief, such as ibuprofen or acetaminophen, an hour before the procedure.
• Bring a Companion: If possible, bring a friend or family member for support and to drive you home if you feel uncomfortable afterwards.

Colposcopy Procedure

A colposcopy is a straightforward procedure typically performed in a doctor’s office and lasts about 10 to 20 minutes:

• Positioning: You will lie on an examination table with your feet in stirrups, similar to a pelvic exam.
• Speculum Insertion: A speculum is inserted into the vagina to keep it open and provide access to the cervix.
• Application of Solutions: To highlight abnormal areas, the doctor will apply vinegar (acetic acid) or iodine (Lugol’s) to the cervix.
• Examination with Colposcope: The colposcope is positioned outside the vagina, and the doctor will look through it to closely examine the cervix and vagina.
• Biopsy (if necessary): If abnormal areas are detected, the doctor may take small tissue samples (biopsies) for further examination. This can cause a brief pinch or cramping sensation.

What to Expect After a Colposcopy?

You can carry on normal activities immediately after a colposcopy without a biopsy.  You could have a brown discharge from the iodine that might stain your clothes, so we suggest you wear a liner.

You could have cramps for a day if you also had a biopsy. If so, paracetamol can help. It is normal to have a slight vaginal discharge or to bleed for around 5 or 6 days.

Avoid sexual intercourse and heavy exercise; do not use tampons for a few days. You can shower but don’t have a bath or a swim.

Your future treatment will depend on what the biopsy shows. 

• No further treatment is often required; you only need another CST in 12 months. 
• Other possible treatments include an LLETZ, a cone biopsy or rarely a hysterectomy.

Colposcopy Prognosis

The prognosis following a colposcopy largely depends on the findings and subsequent actions:

• Normal Results: If no abnormalities are found, regular cervical screening (Pap smears or HPV tests) will continue as per the recommended schedule.
• Abnormal Results: If precancerous changes or cervical cancer are detected, the prognosis will depend on the stage and extent of the abnormality. Early detection generally leads to better outcomes, with various treatment options to address the issues.
• Monitoring and Follow-Up: Patients with minor abnormalities may require more frequent monitoring to ensure no progression. In such cases, the prognosis remains good with appropriate follow-up.

Colposcopy Risks

A colposcopy is generally a safe procedure, but there are some associated risks, particularly if a biopsy is taken:

• Infection: Rare, but there is a slight risk of infection following the procedure.
• Bleeding: Light bleeding or spotting is common, especially after a biopsy. Heavy bleeding is rare but requires medical attention.
• Pain or Discomfort: Some women may experience mild cramping or discomfort during and after the procedure.
• Emotional Distress: The anxiety of undergoing the procedure and awaiting results can be stressful for some patients.

What if Colposcopy is Delayed?

Delaying a colposcopy after an abnormal cervical screening result can have serious implications:

• Progression of Disease: Precancerous changes or cervical cancer may progress without timely diagnosis and treatment.
• Limited Treatment Options: Early-stage diseases are easier to treat and manage. Delays can result in more advanced diseases that require more complex and invasive treatments.
• Increased Anxiety: Waiting longer for a diagnosis can increase stress and anxiety levels, affecting overall well-being.

Cost of Colposcopy

In the public system, the procedure may be covered by Medicare, potentially resulting in little to no out-of-pocket cost for the patient. Patients should check with their specific hospital or healthcare provider for details.

The costs of procedures in private clinics can range from AUD 150 to AUD 500 or more, depending on the complexity of the procedure and whether biopsies are taken. Depending on the policy, private health insurance may cover some or all of the costs.