Dr Hans Nagar

Consultant Gynaecological Surgeon & Oncologist

What is colposcopy?

Colposcopy is a more detailed examination of the cervix. I use a special magnifying binoculars to see the changes at high magnification. Please don’t worry about the sound of this as the magnifying binoculars stay outside you. All that goes inside is the speculum, which is the same instrument your GP or practice nurse used to see your cervix when taking your smear. 

The examination may take a little longer than a standard smear test, but I will talk to you, before, during and after the examination

Why have I been referred for colposcopy?
Most women will have been referred following an abnormal smear test. Some women are referred by their GP or practice nurse if they want an expert to examine the cervix.

How is a diagnosis made?
I apply dilute acetic acid to the cervix and If there is an abnormality I should be able to estimate whether it is a likely pre-cancerous abnormality or not according to:
  • How white the tissue goes after using acetic acid

  • How quickly the tissue turns white

  • How smooth or irregular the surface is

  • The different patterns of the blood vessels (mosaic and punctation) under the surface of the cervix

To be sure of the diagnosis, a biopsy is often required. This means taking a small sample of tissue from the cervix with a special instrument. This sample is taken very quickly and usually does not require local anaesthetic. Depending on the results of this biopsy the I will discuss with you whether you need treatment.
In some cases, if it is obvious that you will be likely to need treatment, this can be done at the first visit – in this case all of the abnormal area is removed, and you will be given a local anaesthetic first and this constitutes the biopsy.
These possibilities will be discussed with you in clinic.  

Your colposcopy should never be painful and if you are having having any difficulty please discuss this with me or our nurses. If necessary the colposcopy will be stopped.

Sometimes taking the biopsy can be uncomfortable, but I will warn you before the biopsy is to be taken. You may have a blood stained discharge or light bleeding for a few days. During this time you should avoid sexual intercourse and tampons. 

How can CIN be treated?
Low grade changes such as CIN 1 do not normally require treatment as most of these will regress with time (6 to 18 months).
There are a number of different ways that pre cancerous changes such CIN 2 or 3 can be treated. The treatment options available are either to remove a small part of the cervix or neck of the womb or to treat by heating the tissue (called ablation).
You may have heard of ‘loop treatment’ as this is the commonest way of treating CIN today. The full name for the procedure is ‘Large Loop Excision of the Transformation Zone’ or
LLETZ for short. The abnormal area is removed using a wire loop through which an electric current is passed. This can usually be performed after you are given local anaesthetic to ‘numb’ the cervix. LLETZ is a simple and safe technique which gives excellent results. Treatment can be offered at the first visit and you will be advised in advance in the documentation about your clinic appointment.
If ablation is chosen for your method of treatment a small biopsy is required at the first visit and when the result of the biopsy is available, you will be offered a further appointment to return and then have your treatment.
The reason for choosing one treatment instead of another may depend upon the site or size of any abnormality or the exact microscopic appearance of the pre-cancerous abnormality (CIN 1, 2 or 3, CGIN). All treatments are highly effective (around 90%).

What can I expect after treatment?
If your treatment was carried out with a local anaesthetic, you may notice some period-like cramps as the anaesthetic wears off. If this is the case, try taking 2 x 500mg paracetamol or 2 x 200mg Ibuprofen (if you have no allergies or previous problems with Aspirin) tablets to relieve the pain.
If the CIN has been treated by LLETZ (loop treatment) you will have a blood-stained vaginal discharge for some time. This usually settles in 2 weeks but may last for up to 4-6 weeks. The discharge should not be heavier than a period and should get progressively lighter. If you are worried that this is not the case, you will be have been given the contact number of a person you can call at the UIC .  Otherwise you should contact your GP.
You will be given an information leaflet informing you what to expect after treatment and advising you of telephone numbers to contact if you have any problems.
You are usually to avoid sexual intercourse for 4 weeks after treatment. You should also avoid using tampons during this time. You may be advised to avoid bathing or swimming for 2-4 weeks.