Colposcopy: A follow-up to abnormal Pap test results

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Colposcopy: A follow-up to abnormal Pap test results

Colposcopy is a procedure used to determine whether abnormal cervical cells are cancerous.

After your pelvic exam and Pap test, your doctor informs you of some troubling news: You have had abnormal cells identified on your Pap smear. The presence of abnormal cells could mean that you have a precancerous condition of the cervix or, possibly, cervical cancer.

What's next? Your doctor may recommend colposcopy — a procedure to closely examine your cervix — to identify the source of the abnormal cells. Alleviate some of your anxiety about this procedure by understanding what it involves, how you can prepare and what you can expect afterward.

Who is colposcopy for?

Colposcopy is the direct examination of your genital area, including the cervix, vagina and vaginal opening (vulva), using a special lighted microscope called a colposcope. A trained specialist (colposcopist) performs this procedure. The colposcope magnifies the surface of your cervix and vagina by 10 to 40 times the normal size. This aids the colposcopist in identifying areas of abnormal cell growth that can't be seen by the naked eye.

If the colposcopist detects abnormal cells during the exam, he or she may collect a sampling of the tissue (biopsy) to send to a lab for analysis.

Your doctor might recommend a colposcopy to find out the cause of your abnormal Pap test results or to evaluate a visible abnormality. You might also have a colposcopy if your doctor wants to examine the outcome of previous treatment for an abnormal Pap test result.

Female reproductive system

Illustration of female reproductive system

The ovaries, fallopian tubes, uterus, cervix and vagina make up your reproductive system. During a colposcopy, a colposcopist uses a specialized instrument to closely examine your cervix, vagina and vaginal opening (vulva).

How do you prepare for a colposcopy?

Preparing for a colposcopy isn't much different from preparing for any pelvic exam. However, colposcopy can't be performed when you have your period, so you should schedule the test for a time when you won't be menstruating. Also, don't use vaginal medications, douches or tampons, and avoid having sexual intercourse for 24 hours before the colposcopy.

You may be more comfortable during the exam if you empty your bladder and bowels beforehand. Your doctor might also recommend that you take an over-the-counter pain reliever an hour before the exam. This can help alleviate any discomfort you might feel during the colposcopy.

How is colposcopy done?

Colposcopy is similar to what you experience during a pelvic examination and Pap test. The procedure is performed in an examination room. You lie on your back on a table with your knees bent and your feet in supports called stirrups. The colposcopist examines your external genitals before gently inserting an instrument called a speculum into your vagina. The speculum holds your vagina open to allow your doctor to see your cervix.

The doctor positions the colposcope — the special lighted microscope — so that he or she can look into the opening of your vagina. The colposcope never enters your vagina.

A saltwater (saline) solution may be used to clean the cervix. You may feel a cool sensation as the cervix is rinsed. Next, your doctor applies a vinegar solution (acetic acid) to your cervix with a cotton ball or swab. Using the magnifying power of the colposcope, your doctor carefully inspects your vaginal and cervical tissues.

Acetic acid reacts differently when it comes into contact with areas of abnormal tissue versus normal tissue. The abnormal areas turn white. If using acetic acid fails to reveal any abnormality, a second solution (Lugol's solution) may be used to stain cervical tissues. Lugol's solution doesn't stain any cells that are abnormal. Using these solutions allows your doctor to easily identify any areas of concern.

If areas of abnormal tissue are present, your doctor can adjust the colposcope to increase magnification of the tissue. This helps to discern the course of blood vessels and other characteristics of the tissue.

Your doctor may also perform a biopsy of one or more sites. To do this, he or she collects a sample of the tissue from any areas in question and from inside your cervical canal (endocervical curettage). Another specialist (pathologist) examines the tissue samples for the presence of abnormal cells.

Positioning the colposcope

Illustration of doctor positioning the colposcope

A trained specialist (colposcopist) positions the colposcope to examine your vulva, vagina and cervix for the presence of suspicious areas of tissue that might indicate cancer.

What can you expect during a colposcopy?

The procedure may cause you some discomfort. Insertion of the speculum can be uncomfortable, and the acetic acid may feel chilly. If you have a biopsy, you will feel a pinch and you may experience cramping as the tissue is removed.

Try relaxing by taking deep, slow breaths during the procedure. This may help ease any pain or discomfort you feel. If you become too uncomfortable, tell your doctor.

You might experience some bleeding and other vaginal discharge for up to a week after the colposcopy. This is especially true if you've had a biopsy. Use sanitary pads — not tampons — for the bleeding and discharge. The dark-colored vaginal discharge results from your body expelling the fluids used during the procedure.

Rarely, your doctor may stop heavy bleeding with a suture or by packing the vagina with a tampon or gauze.

If you had a biopsy, don't put anything into your vagina for at least one week after the procedure or until your doctor tells you it's safe.

This means you should avoid:

  • Sexual intercourse
  • Using tampons
  • Douching
  • Vaginal medications

Other than these restrictions, you should be able to resume your normal activities, including bathing, after your exam.

Results from a colposcopy

You'll get the results from your colposcopy examination within a week or two. Your doctor's office contacts you when these results are available. Make a follow-up appointment with your doctor to discuss the results and what further steps might be necessary. If you don't have the results after three weeks, call your doctor's office. It's important to have the follow-up appointment as soon after the colposcopy as possible in case you need additional treatment.

Risks associated with colposcopy

Colposcopy carries with it a very slight risk of infection. You may also experience bleeding after the procedure.

Call your doctor if you develop any of the following:

  • Excessive vaginal bleeding, such as soaking more than one pad an hour
  • Signs and symptoms of infection, including a fever above 100.4 F, foul-smelling vaginal odor or thick yellowish vaginal discharge

Severe pelvic or abdominal pain after the procedure isn't normal and merits emergency medical attention.

Looking ahead

In March 2006 the Food and Drug Administration (FDA) approved an imaging device called the LUMA Cervical Imaging System to evaluate cervical tissue. The LUMA system shines a light on the cervix and gathers data about how different areas of the cervix absorb and reflect this light. The LUMA system is approved for use only immediately after colposcopy.

If during colposcopy your doctor detects abnormal areas that should be biopsied, he or she may use the LUMA system to see whether any additional cervical tissue should be biopsied. Studies have shown that the LUMA device can catch cervical pre-cancer missed when colposcopy is performed alone.

Experts are still weighing the appropriate use of this device in routine assessment of abnormal Pap smears.

Last Updated: 05/17/2007
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