Colposcopy

What is a colposcopy?

This is a simple examination of the cervix using a specially designed microscope (colposcope) to look and magnify the skin of the cervix. The colposcope looks like a pair of binoculars on a stand and it stays outside of the body.

What is an abnormal smear test and what does it mean?

Having an abnormal smear test is not unusual. It is not a test for cancer but a test to check the health of the cells. It is extremely rare for these abnormalities to be cancer. Once these changes have been detected, simple and effective methods can be used to treat abnormality, if necessary.

Smear tests are graded from negative (normal), borderline, low grade and high-grade pre-cancer cell changes. They do not mean that you have cancer but act as an early warning sign that cancer may develop if nothing is done. Most women with pre-cancerous cell changes never develop cervical cancer.

What causes an abnormal smear test?

The Human Papilloma Virus (HPV) causes most of the changes in the cells on the cervix. At some point in our life most of us (80% of us) will carry the virus.

Anybody who has ever been sexually active is at risk of acquiring a type(s) of HPV that can change cells in the cervix. It is transmitted primarily by skin-to-skin contact including genital-to-genital contact, anal intercourse and oral sex. The time between exposure to HPV and the development of cervical abnormalities is variable and HPV can remain dormant in some people for long periods of time.

There is evidence to suggest that smoking cigarettes increases the risk of the cervical abnormalities developing. Smoking alters the cells’ ability to protect themselves and to fight off infection.

The colposcopy examination

A female chaperone will be with you throughout the examination. You will be asked to undress from the waist down and a cover sheet will be provided for you to cover yourself during the examination. You will be asked to lie on a couch with your legs supported on rests (stirrups). You may find this position to be embarrassing and a little uncomfortable, but the procedure should not be painful.

Before your colposcopy examination and any procedures your verbal consent is required. The colposcopist will insert a speculum (an instrument used to enable the cervix to be seen) and your cervix will be examined through the colposcope and a smear test may be taken.

A dilute solution called acetic acid will then be applied to the cervix and sometimes another solution called iodine may be applied to the cervix as well. These solutions highlight any abnormal areas and you will be told what the colposcopy examination has revealed during or after the colposcopy.

It is normal that photographs of the cervix will be taken during the examination to act as a record of the appointment and to provide a comparison at a follow up appointment if it is needed. If no abnormality is seen during the colposcopy you will not require treatment. You may be discharged from the colposcopy clinic or given another appointment for follow-up depending on your previous results.

If an abnormality is seen a biopsy or biopsies (the size of a pin head) may be taken to confirm the level of abnormality and if treatment is needed or not. When a biopsy is taken, quite often, it cannot be felt but some women do feel a small pinch and you are likely to experience some period crampy pain afterwards. Treatment is generally not undertaken at the first visit. Any tests taken will be sent to the laboratory for analysis.

The results will be sent to the clinic for us to decide if treatment is required. A results letter will be sent to you and your GP within four weeks and recommended further management. Very occasionally further analysis is required by the laboratory, this can mean the results will take longer to be processed.

If you require a biopsy then we advise no sexual intercourse or use of tampons for up to 1 week. We also advise no overseas travel after the biopsy for 1 week. Should you be planning to fly within 1 week of your biopsy we would advise you to reschedule the appointment.

What your results mean

CIN (Cervical Intraepithelial Neoplasia) is a term used to refer to pre-cancer cell changes confirmed by a tissue sample (biopsy) and there are three grades:

• CIN1 means a third of cells in the affected area are abnormal. If you have just started having abnormalities it is unlikely that we would offer treatment for CIN1. Up to 70% of these abnormalities can clear up on their own with no treatment.
• CIN2 means that up to two thirds of the cells in the affected area are abnormal and treatment is recommended
• CIN3 means that all the cells in the affected area are abnormal and treatment is recommended

Treatment

The treatment is called Loop Diathermy Excision (also known as Large Loop Excision of the Transformation Zone—LLETZ). It is 90–95% effective in removing all the abnormal cells so that your smears will return to normal. Written information will be given to you should you require treatment and further information can also be found on the hospital website.

Follow-up appointments

It is important that you attend for your follow-up appointments, as necessary. Following treatment a cervical smear test is recommended six months afterwards to confirm that treatment has been successful.

If the cervical smear test is negative (normal) or shows borderline or low-grade abnormality the sample will also be sent for HPV testing. If there are no high-risk types of HPV you will be discharged from the colposcopy clinic and back to the care of your GP.

If you are returning for a cervical smear test as part of surveillance it is also important to attend this appointment so that we can monitor the cells and see if they have returned to normal or if treatment is required in the future. A colposcopy will also be performed at your follow-up appointment.

Before you come in—practical information

• It is advisable to wear a skirt to your appointment. If possible avoid wearing thong type underwear as you may need to wear a sanitary pad after the examination.
• You are welcome to bring a friend or relative with you. It is advisable not to bring children with you.
• This is a minor procedure but you may experience some light-headedness due to the position you are in when you lie on the couch.
• Please ensure that you have eaten breakfast or lunch prior to your appointment.
• If you have a coil (IUS/IUD) then this does not need to be removed as a colposcopy can still be performed. Should you require any treatment then we will discuss with you whether your coil needs to be removed.
• If you are pregnant you can still have a colposcopy as this will not cause any harm to you or the baby. However, please contact the colposcopy office for Chelsea and Westminster Hospital on 020 3315 5927 or for West Middlesex Hospital 020 8321 5067/5108 to discuss this further with one of the colposcopy sisters.
• If you have your period at the time of your appointment you will need to re-schedule it. Please contact the appointments office for Chelsea and Westminster Hospital on 020 3315 6666 or for West Middlesex Hospital 020 8321 5067/5108.

Contact information

Chelsea and Westminster Hospital Colposcopy Clinic
Gynaecology Outpatients
1st Floor, Lift Bank B
Chelsea and Westminster Hospital
369 Fulham Road
London
SW10 9NH 

T: 020 3315 5927
E: caw-tr.directreferral@nhs.net 

West Middlesex University Hospital Colposcopy Clinic 
Women’s Day Unit, 1st Floor
Queen Mary’s Building
West Middlesex University Hospital
Twickenham Road
Isleworth
Middlesex
TW7 6AF 

T: 020 8321 5067
E: caw-tr.colposcopy-wmuh@nhs.net