A colposcopy is an examination usually carried out in a clinic by a medical professional who is a trained or accredited ‘colposcopist’. It involves the use of a specialist magnifying instrument called a colposcope which is used to look at the cervix (neck of the womb) and determine the presence of any pre-cancerous cell abnormalities.
What happens at the colposcopy?
Before the examination, Dr Novikova will discuss your pap smear results again and you will have the opportunity to ask questions.
The colposcope remains outside the body whilst the examination takes place. Only the speculum is inserted, which is the same instrument used during a pap smear.
Dr Novikova uses the latest equipment during the procedure and it is even possible to view the entire process on a screen, should you wish to do so. Images are taken for your personal medical records. Visualizing the area will help you gain a better understanding of the condition of the treatment and why you need it and Dr Novikova will discuss her findings as she goes along.
During the examination, Dr Novikova will inspect your cervix and apply two liquid solutions that help highlight any abnormal cells. A very small biopsy (a piece of tissue) may be taken for further testing at the laboratory. Most women do not feel the tissue removal at all, while others feel a small pinch. The examination takes around ten minutes.
What about my coil?
Dr Novikova will generally not need to remove your coil (IUD / Mirena IUS) in order to carry out a colposcopy examination.
We advise that you wear a panty liner as you may have a brown discharge from the iodine solution used or spotting from the biopsy. We also advise that you refrain from using tampons for a week after.
You should abstain from having vaginal sexual intercourse for a week after the procedure.
If you develop heavy bleeding or foul-smelling discharge after the procedure please contact Dr Novikova.
Abnormal pap smear result
Pre-cancerous changes of the outer (squamous) cells of the cervix have the potential to turn into cancer if left untreated. In the cervix, these changes are called ‘Cervical Intraepithelial Neoplasia’ or CIN for short.
There are different grades of CIN according to how severe the changes are, from CIN1 minor change referred to as Low-Grade Squamous Intraepithelial Lesions (LSIL) to CIN 2&3 referred to as High-Grade Squamous Intraepithelial Lesions (HSIL).
The risk of CIN1 developing into cancer is very small, however, we know that CIN2 and CIN3 may develop into cancer in some cases if left untreated.
There is a rare abnormality called ‘Cervical Glandular Intraepithelial Neoplasia’ or cGIN and this is the same sort of pre-cancerous change involving the inner glandular cells of the cervix. Treatment of cGIN is usually the same as CIN.
What causes these abnormal changes
Humanpapilloma (HPV) viruses are a group of viruses that infect skin and mucosal cells, as found in the cervix. HPV infections can cause changes in cervical tissue and cause genital warts (which are growths on the cervix, vagina, vulva and anus). HPV infection is associated with a diagnosis of cervical carcinoma.
Most HPV infections do not cause any symptoms, HPV is a very common sexually transmitted infection that is found in 95% of the sexually active population. Most women are able to clear the infection without treatment and with no lasting effects.
There are over 100 types of HPV and around 5% of women with an HPV infection will have abnormal pap smears. Around 1-2% develop pre-cancerous cells (CIN). 80% of cervical cancer is caused by HPV strands 16 & 18 whilst the other 20% is caused by other types of HPV.
The test for HPV is recommended for women with low-grade pap smear abnormalities. This will determine whether a follow-up colposcope will be required.
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What are different types of abnormal cells?
Women who have high-risk Humanpapilloma (HPV) should have a colposcope to better assess changes in the cells of the cervix as pap smears only test superficial cells in the cervix. A colposcope will highlight the abnormal cells, which will be taken for biopsy and tested for pre-cancerous changes.
‘Cervical Intraepithelial Neoplasia 1’ (CIN 1) or Low-Grade Squamous Intraepithelial Lesions (LSIL) changes are considered to be minor. Women with CIN 1 or LSIL will be observed every six months with a pap smear and possibly a colposcopy. The vast majority of CIN 1 lesions disappear within 18 to 24 months without any treatment. In about 5% of cases, however, they may progress to CIN2/3 or High-Grade Intraepithelial Lesions (HSIL).
Women with CIN 2/3 require a procedure to remove these abnormal cells. The procedure is called LLETZ (Large Loop Excision of the Transformation Zone or Loop Diathermy). It is a minor procedure performed in the operating room under general or local anaesthesia. Please refer to the patients’ information on LLETZ for details.
CIN 2/3 develops into cervical cancer in about 20% of cases and usually takes around 5 to 10 years.
The screening program for pre-cancerous cells of the cervix now includes an HPV test and Dr Novikova may offer it to you during your routine visit.
Alternatives to colposcopy
There are no recommended alternatives. If you have an abnormal cervical cytology result and are advised to have colposcopy then it is the only effective way to investigate the abnormality further.
The exact risk of CIN2 and CIN3 turning into cancer is not accurately known, as it would be unacceptable to watch this happen without offering treatment to see what proportion developed cancer.
Do I have cancer?
No, you don’t have cancer. CIN lesions are pre-cancerous changes. Screening programs for cervical cancer through pap smears aim to identify pre-cancerous cells and treat them before cancer develops
Do I have STI?
Yes, HPV is STI. However, almost all sexually active people will contract HPV at some point in their life and the body usually clears itself of the infection.
Do I have to tell my sexual partner about HPV?
You don’t have to tell your partner about HPV as there are no interventions or treatment required for your partner.
Condoms do not protect against the HPV virus as it is transmitted through skin-to-skin contact which is why it is so common.
Can I do anything to prevent HPV virus?
Nowadays, girls (and in some countries boys) are being vaccinated against the HPV virus. The vaccine is most advantageous when it’s administered before any sexual activity. The vaccine can, however, be used for people who have already had sex. When the vaccine is given to sexually active individuals, it will have no impact on HPV infection they have already acquired, but it will protect against an HPV infection they may get from the future sexual partners.
In South Africa, we currently use the vaccine Gardasil which protects against 4 HPV viruses, which are responsible for 80% cervical cancer and for genital warts. The vaccine does not protect against all HPV types and regular screening with pap smears remains essential.
Healthy lifestyle choices and a strong immune system are necessary to prevent the progression of HPV infections. People with weak immune systems as a result of chronic illness, HIV, or immune-system suppressing medication are at a greater risk to the quick progression of pre-cancerous cells of the cervix into to cervical cancer.
Smoking increases the risk of getting an HPV infection and cervical cancer. If you are a smoker, seek help to stop. This is the best thing you can do for yourself.
Can men develop any problems from HPV?
Yes, men can develop warts, anal cancer, penile cancer or even throat cancer. Cancers caused by HPV virus are 10 times less common in men than in women. As a result screening programs for men are rare.