| About Colposcopy | What is Colposcopy ? | How Performed |
| What is Dysplasia ? | Follow Up | |
| Remember | Complications & Pregnancy | Your Appointment |
Women are encouraged to have a regular Pap smear as a normal part of their health care. A Pap smear involves removal of cells from the cervix (the entrance to the womb or uterus) which are then examined for changes in a laboratory under a microscope. If abnormalities are detected early treatment can prevent the development of cancer of the cervix. Other cervical disorders that may require treatment may also be identified.
Only about 10% of women having a Pap smear will be told the test has a "positive" abnormal result. If you are one of these women, you should not feel too anxious -it does not necessarily mean you have cancer. In fact, the whole point of a Pap smear is to identify abnormalities before cancer develops. Having a "positive" smear means that some abnormality appears to be present which will require further investigation. The next step may be to repeat the smear or you may be referred to a gynaecologist for colposcopy.
There are other conditions such as inflammation and infection including HPV (Human Papilloma Virus) infection, which will cause the Pap smear result to be reported as abnormal. HPV, also known as wart virus, is actually a family of viruses, some of which cause genital warts. Mostly, changes caused by the wart virus disappear naturally with time. There is some suggestion that wart virus may be associated with the later development of cancer of the cervix. When these wart virus changes are found to be present, your doctor will discuss follow up care. If a bacterial infection is present, treatment may be required following which you may have the Pap smear repeated.
It is an examination of the cervix through a special instrument called a colposcope. This examination is done to gain a more detailed knowledge of the abnormality so that decisions can be made about the best form of treatment, should this be necessary. The colposcope is an illuminated microscope and it enables both you and the doctor to have a magnified view of the outer cervix. The examination takes about ten or fifteen minutes, and is done while you are awake in the Lucanus Gynaecology colposcopy facility.
The colposcope is placed between your legs which are apart and resting in supports. The doctor will use a speculum to hold the walls of the vagina apart making it possible for the doctor to see the cervix. What follows depends on the appearance of the area. A Pap smear may be taken to check for consistency with the earlier 'positive' smear. Then the doctor will dab a little acetic solution (vinegar) on the cervix which shows up the abnormal area clearly. This may sting a little but the sensation soon disappears. Usually iodine solution is also used to stain the tissue, which reveals abnormal areas. It may be that after this closer observation it will be seen that nothing further needs to be done.
It may be that a biopsy is required, and if this is so, a tiny sample of the tissue will be taken. Pain during the biopsy is usually slight and is minimised by a cough. Medication is available for those patients who desire it. There may be a small amount of bleeding afterwards and period-like cramps may occur for a day or two. The specimen taken at biopsy will be sent to pathology to confirm the diagnosis and to help decide on the treatment required.
Throughout the examination the doctor will explain what is going on and afterwards will discuss the findings as far as he is able to at this stage. If minor changes only are seen, you may be told that treatment is not necessary but you will be reminded to report again for a Pap smear after a certain period of time. If an abnormality (dysplasia) is confirmed, arrangements will be made for treatment. Biopsy results are usually available in three or four days. Please phone us in three days to check this.
Dysplasia, or CIN (cervical intraepithelial neoplasia), are the words used to refer to a condition that occurs when the cells on the surface of the cervix are replaced by abnormal cells. This is not a cancerous condition, but if neglected, it has the potential to become cancerous.
There are three levels from mild to severe:
Human Papilloma Virus (HPV) infection of the cervix skin may co-exist with any degree of dysplasia.
If either or both of HPV and CIN1 are present, the lesion is also known as a "Low-Grade Squamous Intra-Epithelial Lesion", which is abbreviated as "LSIL".
If CIN2 or CIN3 is present with or without HPV infection, the lesion is called a "High-Grade Intra-Epithelial Lesion", or "HSIL" by abbreviation.
In general the distinction is useful as High-Grade lesions demand prompt treatment to remove the CIN or dysplasia component from the cervix. In comparison Low-Grade lesions may regress spontaneously and current best-practice is to observe them with cytology smears after 6, 12, and 24 months. Colposcopic review would be indicated if in those two years any Low-Grade smear showed progression to a higher grade, or if the LSIL was persistent at two years.
The treatment chosen will depend on the extent of the problem diagnosed. The aim of any treatment will be to destroy or remove abnormal cells (dysplasia). HPV condyloma (warts) may be treated, but there is currently no means of eradicating HPV virus infection from the skin of the genital organs.
Most of the treatments outlined above take place at a day surgery unit or in the doctor's rooms. Some treatments take place under general anaesthetic but most are done under local anaesthetic which means that you will be awake during treatment. You should feel well enough for your normal work the following day. Any cramping or period-like pain you may experience should be relieved by paracetamol or Nurofen. As the area treated heals over the next few weeks, there may be some pinkish vaginal discharge. Intercourse should be avoided over the next three or four weeks while healing is taking place.
If you have a conventional cone biopsy, it is possible that a day in hospital may be necessary and you may be advised to take a few extra days off work.
If the more serious condition of cancer is diagnosed, we will discuss treatment options recommended for you. This may mean surgery or radiotherapy or both. Early treatment increases the likelihood of complete cure for most women.
If treatment of CIN has been done, or if the cervix is observed for change, we ask you to return usually in four months for further colposcopic examination to make sure healing has taken place and that treatment has been effective. These are important visits which ensure your good health and feeling of confidence so do not neglect them. You may be advised to have Pap smears more frequently than the recommended one every three years.
Early treatment of abnormalities has the best results and prevents cancer rather than curing it. You should ask us about any further questions you may have on this subject. The information in this file is general and does not contain all known facts about the treatment or complaint. The benefits and risks of the treatment will depend on your medical condition and may vary from person to person. This information file is not a substitute for advice from a doctor. We will answer your questions about diagnosis and treatment.
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The purpose of the operation is to remove all dysplastic (CIN) cells. Clearly the more cervix tissue is removed the greater the probability that all CIN will be removed. Yet it is desirable in young women who still wish to have pregnancies to conserve as much cervix tissue as possible. This may lead to a conflict between removing more tissue than is necessary in an endeavour to remove all disease, or of failing to remove all dysplasia because of a proper intention to spare as much cervix tissue as is possible for further function. Occasionally clearance in these young women may be incomplete and a further operation may be necessary. This is not really a complication as such, but the result of appropriate conservatism.
Following the operation a small percentage of women experience the closure of the cervix canal by the growth of scar tissue or fibrosis. This is usually seen in post-menopausal women who are estrogen-deficient. It may also happen in younger women who may be using progestogenic contraceptive hormones. We recommend that estrogen supplement preparations are used in these women during healing. It is occasionally necessary to re-open the canal to allow period flow and to monitor the canal cytology (smears). In post-menopausal women this complication sometimes gives rise to the necessity for hysterectomy.
Post-operative bleeding is very uncommon because of the use of vasoconstrictive injections and the application of Monsel's paste to the cervix at the time of the operation. Delayed bleeding owing to infection may occur between one and two weeks post-operatively, usually due to infection of the cervix wound. This may necessitate examination, swabs, and treatment with appropriate antibiotics. Prophylactic (preventative) antibiotics are not used after surgery as they do not prevent infection by resistant organisms.
The function of the cervix in pregnancies after treatment is in the vast majority of women quite normal. Very occasionally opening of the cervix in labour may be slow. Weakness (incompetence) of the cervix may occur without any previous intervention, and world Medline data searches do not reveal any significant recognised trend to impairment of cervix function owing to previous treatment of the transformation zone. Cervical examination in pregnancy is nevertheless recommended.
You may phone or email Maureen for an appointment at Lucanus Gynaecology for Colposcopy as on the homepage. Please avoid appointments for colposcopy when your period is still flowing.
(With acknowledgement - adapted from RANZCOG)