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CIN 2 and 3 – These are more definite changes and, if you have not
already had treatment at your first visit, you will normally be asked to
come back to have the abnormal area removed.
Remember that you are very unlikely to have cancer. Only very rarely The Colposcopy Clinic
will a biopsy show cell changes that have already developed into
cancer.
Will I need any follow up?
Everyone who has had a sample showing abnormal cells will
be followed up with further samples at 6 and 12 months after
Colposcopy. If these samples are normal and the biopsy showed CIN
1 you will have a further sample in one year. If this is normal you
will go back to the normal sample interval. If the initial two follow
up samples are normal and you had CIN 2 or 3 you will then have
samples taken every year up to 10 years after the treatment. If these
remain normal you will go back to the normal sample interval. These
samples may be done by your GP, at the Colposcopy Clinic, or in the
Gynaecology Outpatient Department.
Provided there are no further problems, you will be returned to
the care of your GP and will have sample tests taken at the normal
frequency for your age (3 yearly for women under 50, and 5 yearly for
women aged 50 to 65).
Treatment is almost always successful and it is unlikely that the CIN
will recur. In the unlikely event that you do have a further abnormal
sample, you will be referred back to the Colposcopy Clinic for a further
examination.
What if I have any questions?
Any questions you may have can be dealt with in the clinic during
your appointment. Alternatively please do not hesitate to contact
the Colposcopy Clinic using the telephone number printed on your
appointment letter. The hospital switchboard number is:
08454 222222.
GHPI0298_09_08
Author: Colposcopy
Patient Information for the
Review due: September 2011 Gloucestershire Health Community
This leaflet has been produced to answer some of the more commonly What if I choose to postpone treatment?
asked questions about your visit.
Although most women find it convenient to be treated when they are
first seen, you may prefer to postpone your treatment. For example,
if you have a holiday planned in the days following your appointment
Introduction then the bleeding experienced after treatment may be a nuisance for
You have been asked to attend for a Colposcopy examination. This you. There is no problem in delaying treatment for a short while and
may be for a number of reasons, but the most common are: you would be sent a further appointment for another day.
• Abnormal sample – Your recent sample test showed the presence
of abnormal (dyskaryotic) cells
• Borderline sample – Your recent sample test showed some
Is anything else done during the appointment?
borderline or minor cell changes The doctor or nurse may ask your permission to take some swabs from
you to test for chlamydia or other infections. If you consent to the
• Inadequate sample – The laboratory has been unable to interpret
swabs, then the doctor will first take a swab from the urethra (urine
your sample either because there are not enough cells to see, or
passage); this may feel a bit uncomfortable. While the speculum is
because they are hidden by blood or debris. You will usually only
inserted into your vagina for the Colposcopic examination they will
be referred when you have had three of these inadequate samples
take a further 2 swabs from your cervix.
in a row
• Referral by your doctor – Your GP or other doctor has referred you
because of symptoms you have been experiencing, or because When will I get any results following the biopsy
they are concerned about the appearance of your cervix
or treatment?
Your appointment letter will tell you why you have been referred.
When the laboratory reports an abnormal or inadequate sample they The doctor or nurse who performed your Colposcopy will write to you
inform the Colposcopy Clinic directly at the same time as your GP, in to let you know the results of your biopsy or treatment. You should
order to avoid any delay in your being seen. get a letter within 2-3 weeks. If you had swabs taken you will only be
given the results if they are positive and treatment is needed.
The sample test What do the results of the biopsy or treatment
The cervical sample test is designed to prevent cancer and works by
detecting abnormal cells in the cervix (neck of the womb). Abnormal mean?
samples are quite common and about 1 in 10 samples will show The result of the biopsy shows how abnormal the area is. The
some type of abnormality. The presence of these pre-cancerous or technical term used to describe this is cervical intra-epithelial
dyskaryotic cells increases the risk of you developing cervical cancer neoplasia; more commonly referred to as CIN.
later in life. Treatment in the Colposcopy Clinic can prevent this
There are 3 grades of CIN 1,2 or 3 depending on how many cells are
happening. Very few people with an abnormal sample have cancer
involved.
as it usually takes an average of 12 to 15 years to develop. Minor
cell changes or borderline abnormalities often return to normal by CIN 1 – these are relatively minor changes with a very low risk of
themselves without the need for any treatment. proceeding to cancer and will usually return to normal by themselves.
Treatment is not usually necessary, but is likely to be recommended if
the changes persist for two years.
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What if I have a biopsy? Diagram of the female reproductive system
A tiny piece of tissue will be taken from the cervix for microscopic
examination in the laboratory. You may feel a slight discomfort or
Fallopian tube
stinging, which should not last long. You may have a light blood
stained discharge for a few days following the biopsy. This is normal
and it should clear itself. It is safe to use tampons during this time. It
is best however to refrain from intercourse for up to five days to allow
the biopsy site to heal.
Uterus
Ovary
What if I need treatment? Sample taken Cervical canal
This will usually be done by a technique called LLETZ (large loop from shaded
excision of the transformation zone). This is usually done under local area
anaesthetic in the Colposcopy Clinic either at your first visit or at a Vagina
second visit following the result of your biopsy. The procedure takes Cervix
approximately 15 minutes.
Local anaesthetic is used to numb the cervix to ensure that minimal
discomfort is felt during the treatment. The Colposcopist then
removes the abnormal area using a diathermy loop. This is a hot
wire and you may notice a burning smell but will not experience any
burning sensation. The tissue removed is then sent to the laboratory
for further analysis.
Where is the cervix?
The womb (uterus) is a pear shaped organ situated at the upper end
Very occasionally it may be better to treat you under general of the vagina. The cervix or neck of the womb is the narrow end of
anaesthetic, or by alternative treatments such as laser or cone biopsy. the pear shape, which projects into the upper end of the vagina. It
It is very rare for hysterectomy to be considered and this is usually only can be felt during a vaginal examination and can also be seen when
if you have other gynaecological problems as well. an instrument (a speculum) is inserted in the vagina to hold the
vaginal walls aside.
What can I expect after treatment?
Following treatment you will probably have a blood stained vaginal What causes an abnormal sample?
discharge, which may last up to 4 weeks. Please remember to bring The exact cause of changes in the cells of the cervix is unknown.
a sanitary pad with you to wear after your appointment. The cervix However these changes are often associated with the Human
takes 3-4 weeks to heal so, to reduce the risk of infection, tampons Papilloma Virus (HPV or Wart Virus). This virus is very common and
and intercourse should be avoided during this time. If you should studies have shown that most women will carry it at some time in their
experience any unexpected bleeding following treatment please life. The reasons why the virus causes cell changes in some women and
contact your GP for advice. Treatment will have little or no effect not in others is not known. It is known that smoking increases the risk
on your ability to conceive or to maintain a normal pregnancy in the of persistent cell changes and cervical cancer. If you want help with
future. giving up smoking, advice is available in the Clinic.
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What is Colposcopy? What happens during the examination?
The examination you are going to have is called a Colposcopy. This is The nurse will help you to position yourself on a special type of
a simple examination that allows the Colposcopist to see the type and couch. The couch has padded supports on which you rest your legs.
area of any abnormality on your cervix. It also lets them decide if you When you are lying comfortably the Colposcopist will gently insert a
need treatment. speculum into your vagina, just as when you had your sample taken.
The instrument used is called a colposcope and is really just a Sometimes another sample is taken. After this the Colposcopist will
large magnifying glass, which lets the doctor look more closely at look at your cervix using the colposcope, which is a specially adapted
the changes on your cervix. It does not go inside you. For most type of microscope. It might look a bit alarming, but is just a large
women this is a painless examination, but some may find it a bit magnifying glass with a light source attached. It looks like a large pair
uncomfortable. of binoculars on a stand. It does not touch you or go inside you.
The actual examination only takes about 15 minutes, but you will need During the examination the Colposcopist will dab different liquids
to allow at least an hour for the whole visit. onto your cervix using cotton wool and cotton buds. This is not
usually painful. The liquids show up any abnormal areas and help
the Colposcopist to decide whether you need treatment. The most
Is there any reason to delay the appointment? common findings are as follows:
If you are likely to have a period (with more than light bleeding or
spotting) on the day of your appointment it makes it difficult to see No Abnormality
the cervix clearly. In this case please telephone in advance to change The Colposcopist may not find any abnormality and this is frequently
your appointment. the case where samples have shown only borderline changes or have
Colposcopy can safely be done during pregnancy and will not been inadequate. You would then be reassured and told about
affect delivery of your baby, nor will it affect your ability to become arrangements for follow up samples.
pregnant in the future. It is important to check your cervix to exclude
the rare possibility of cancer. However any treatment that is necessary Minor Changes
is usually postponed until after the delivery of your baby. The Colposcopist may find some changes, but think that they are very
minor or are uncertain. They would then usually take a small sample
or biopsy. When the results are available you will be contacted with
What happens before the examination? advice about whether treatment is necessary and what follow up is
First the Colposcopist will ask you some questions, which relate to your needed.
periods, type of contraception you use and any operations or illnesses
you have had in the past. You will then be asked to undress from the Abnormalities Found
waist down (you do not necessarily need to remove a skirt or socks). If the Colposcopist finds an abnormal area it can usually be removed.
Providing you are agreeable this can often be done straight away. If
you prefer to postpone treatment then a biopsy can be taken and you
can return for treatment on a different day.
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