Colposcopy clinic: Information for people referred with a cervical sample (smear) abnormality

You have been asked to attend the colposcopy clinic because your last cervical sample (smear) showed that your cervix needs closer inspection.

We have tried to anticipate the questions you might ask and provide answers which will make you feel more comfortable about colposcopy.

If there are any points which are not clear, or you have any questions about your examination please ask when you come to your clinic appointment.

We are part of a large teaching hospital and there maybe medical students, student nurses, student midwives, student nurse associates and Practice Nurses present in our clinics, your permission will be sought before they are present.

Contact

You can also telephone the nurse practitioners if you have any queries or questions before your appointment on.

Monday to Friday, during working hours.

0191 282 5670

0191 282 0140

What is colposcopy?

Colposcopy is a means of looking at the neck of the womb (cervix) with a magnifying instrument (colposcope).

This helps the colposcopist, a nurse or a doctor to detect any abnormalities which are present on your cervix.

What will happen at my appointment?

When you come to the colposcopy clinic for the first time you will be seen by a doctor or nurse who will check your personal details and medical history. Your cervical sample report and what you can expect to happen during your appointment will be explained.

You will be shown to a separate private changing room adjacent to the examination room and asked to remove your lower garments and put on a gown.
You will then enter the examination room.
You will be asked to lie on a couch with your legs supported on rests.

Every effort will be made to ensure your privacy and dignity is maintained throughout the examination e.g. the examination room door will be locked.

A nurse will be present throughout the examination, a partner or friend can also be present if you wish.

The examination

A speculum will be gently inserted into your vagina to allow the colposcopist to see your cervix clearly, some people find this slightly uncomfortable, but it should not be painful.

The clinic can offer gas and air (nitrous oxide/laughing gas) to inhale if you feel nervous or anxious during the examination.

Your cervical sample may be repeated if it is over six months since the last one was taken.

The colposcope does not go inside you; it is positioned about 30 cm away. The colposcopist uses the colposcope to magnify and direct light onto your cervix to assist with the examination.

A solution of weak acetic acid (mild white vinegar) is then dabbed over your cervix to help identify any abnormal areas.

This should not hurt; you may feel a slight stinging sensation. Sometimes a solution of iodine is used. If an abnormal area is identified, small amounts of tissue called punch biopsies will be taken for examination in the laboratory.

The colposcopist uses a small instrument to take these tiny samples of tissue from your cervix. Some people may feel a slight cramp discomfort in your abdomen when the samples are taken but this resolves within a few minutes; some people do not feel anything at all. You will be advised what to do if discomfort persists.

Please bring a sanitary towel with you and ensure you have something to eat and drink before you attend.

What is HPV?

HPV or human papillomavirus is transmitted by sexual skin-to-skin contact which means that penetration is not required to contract the virus.

There are many different types of HPV and it is a very common virus which can affect everyone.

Some types of HPV are potentially associated with the development of cervical cancer but most people with HPV will never get cervical cancer.

HPV is a transient virus, and most people will clear the virus.

The type of HPV which is associated with the development of abnormalities on the cervix has no symptoms so people are unaware of the presence of the virus and most people may have had the virus for many years before it was detected. It is therefore not recommended that you confront or blame your current or previous sexual partners.

If you are worried about your sexual health or sexually transmitted infections, then we would recommend you visit your local Sexual Health Clinic.

Your cervical sample may have shown one of the following abnormalities:

Inadequate or unsatisfactory cervical sample

An inadequate cervical sample means the laboratory were unable to analyse it thoroughly and has therefore requested a further cervical sample. This should not be repeated earlier than 3 months. You may be referred to the Colposcopy Clinic if you have consecutive cervical samples which are inadequate, unavailable, or unsatisfactory.

High risk HPV detected and low grade cells

Your cervical sample has shown slight changes in some cells.
It is quite common to have a smear which is reported as abnormal.

(1 in 12 people tested have an abnormal cervical sample).

We know that up to 60% of these mild changes in non-smokers may resolve without treatment, however, we cannot identify the 40% that might progress to a more severe change.

High risk HPV detected and high-grade cell changes

Your cervical sample has shown high grade changes in some cells. Most people with these grades of cervical sample have a wire loop biopsy of cervix at the first visit to the clinic. When your details and history are taken you will be given a full explanation about the possibility of having treatment (a wire loop biopsy of the cervix). You will be asked to sign a consent form allowing us to perform the treatment.

If an abnormal area is identified on your cervix, the colposcopist will then decide whether to take punch biopsies from your cervix or a wire loop biopsy.

The colposcopist may decide it is in your best interest to take punch biopsies rather than a loop biopsy to confirm the diagnosis and this will be discussed with you at the time.

Occasionally, the colposcopy findings do not reflect the cervical sample result. If, however, the punch biopsies confirm the abnormality shown on your sample referral, then you will be given an appointment to return for treatment (loop biopsy) at a later date.

Alternatively, if the punch biopsies indicate milder changes in the cells only, then you will be sent an appointment for 6 months’ time for a further cervical sample and colposcopy examination in the clinic.

Cervical samples, while they may suggest a problem, they are not diagnostic.

Punch biopsy information

You may have a tampon inserted into your vagina after the punch biopsies have been taken. The tampon is used to apply pressure to the area to help control any bleeding from the site of the biopsies. You may have silver nitrate, an agent to control bleeding, applied to the area. You will be given more information before you leave the clinic which will advise you on removal of the tampon and what to avoid following your biopsy.

Most people do not notice when the biopsy is taken, or they are surprised at how little they feel. You may experience a cramp like discomfort in your lower abdomen rather like mild period cramps.

The laboratory will check the specimen and issue us with a report which will provide guidance about your future follow up and management. You will receive a letter from us in 4-6 weeks after your visit telling you about the results of these tests and your future care.

If you need a follow-up appointment this will be included in the letter.

Wire Loop Biopsy of Cervix (Treatment)

Usually only performed at your first appointment if you are referred with HPV and high-grade cells changes:

A wire loop biopsy of the cervix is performed to remove a small portion of the cervix containing the area where the abnormal cells identified on your cervical sample were taken from.
This procedure takes approximately ten minutes.
Your cervix will be injected with local anaesthetic to numb the area. Most people feel nothing at all and even those who do feel something, say the discomfort quickly disappears. The local anaesthetic has some side effects, such as feeling light-headed, but these feelings resolve very quickly.
As the treatment is carried out, you will be aware of the procedure, but you should feel no pain, if you do, tell the nurse who is with you.
The treatment is performed using an electrical machine so you will have a “jelly pad” placed on your thigh to ensure the procedure is safe. This is to “earth you” to ensure the colposcopist does not receive an electric shock during the procedure. No harm will come to you.
After the wire loop biopsy has removed the abnormal area, a small pen-like device is used to seal the area and stop any bleeding.
You will be given full written instructions telling you what to do and what to avoid, including contact telephone numbers.
You can expect a watery vaginal discharge for 2-4 weeks following treatment. We ask you to use sanitary towels only and to avoid the use of tampons. Do not have sexual intercourse for 4 weeks after treatment to reduce the chance of infection of the treated area. We ask you to avoid strenuous exercise for 48 hours after treatment e.g. running.
Most people will be discharged back to their GP following a loop biopsy for a follow-up cervical sample in six months.
However, timing of your future cervical samples depends on the result of the loop biopsy sample taken. You will be advised by the colposcopist by letter when your next cervical sample is due and whether this can be performed at your GP’s surgery or in the colposcopy clinic.

Will treatment cause problems in a future pregnancy?

Any medical treatment may have unwanted side effects; however, a wire loop biopsy is a very effective way of preventing cervical cancer and must be balanced against any possible harmful effects of treatment. People who have had a loop biopsy may be at a slight increased risk of giving birth early.

Colposcopists recognise the importance of the cervix to support future pregnancies and will remove as little tissue as possible while making sure the treatment is successful.

Please discuss this with your colposcopist when you attend the clinic.

Test of cure (TOC)

All people who have been treated for CIN (Cervical Intraepithelial Neoplasia which means pre-changes) will have a cervical sample performed six months following their treatment.

This is called the test of cure (TOC) cervical sample. If high risk HPV is not detected, the next sample is due in 3 years. If HPV is detected, you will be referred directly back to colposcopy.

Please remember approximately 80% of people will have a negative cervical sample result (TOC) and therefore will not be referred to colposcopy at this point.

Day Case Admission for Treatment of the Cervix

A small number of people require a general anaesthetic or sedation for their treatment (loop biopsy). This is usually recommended if the area to be removed is large and would be difficult to remove using local anaesthetic in the clinic.

Sometimes people may have other medical conditions which make treatment under general anaesthetic or sedation more appropriate. The colposcopist will recommend this to you after examining your cervix. Arrangements will be made for your admission to the Gynaecology ward or the Women’s Health Unit to have the procedure performed.

You will be sent a letter giving you details about where and when to attend.

Smoking and abnormal cells on your cervix

Smoking is thought to lower the body’s immune system, and this makes the cervix less resistant to pre-cancerous change. If you are a smoker, you should give serious consideration to stopping. You can attend your GP practice / local pharmacy for advice and support.

We do not have enough evidence at the present time to know what the effects vaping has on the cervix.

Cervical samples are taken to detect the presence of high-risk HPV and reduce cervical cancer developing.
An abnormal sample does not mean that cancer is present.
Colposcopy identifies areas on the cervix at potential risk of developing cancer in the next 5-10 years and these areas can be removed with a wire loop biopsy treatment.
80% of the population will have the high-risk HPV associated with the development of cervical abnormalities and it does not cause a problem for many people.

Further information

GOV – Your guide to NHS cervical screening

Other leaflets and information is available on this website about the NHS Cervical Screening Programme, including ‘Cervical Screening; the colposcopy examination’