Colposcopy Clinic Information

We have invited you for a colposcopy because of the result of your cervical screening test (smear test). This is usually for one of the following reasons:

• An abnormal cervical screening test with High Risk Human Papilloma Virus (HR HPV) detected
• A cervical screening test showing persistent HR HPV detected for the past 3 screening test results
• You have had several cervical screening test where we were unable to give you a result (not enough cells for an adequate result)
• Your Nurse or Doctor who performed your examination or cervical screening test has requested we take a closer look at your cervix.

A colposcopy is an examination of the cervix (neck of the womb) to check if there are any abnormal cells on your cervix. We use a colposcope which is a special magnifying lens with a light to have a closer look at your cervix. We apply some solutions onto the cervix which helps us to identify any abnormal cell changes and have a close look at them with the colposcope.

If the colposcopy confirms there are any abnormal cells on your cervix, we may take a small biopsy (a small tissue sample) to be tested. We may also offer a treatment for the abnormal cells on the day, but this tends to be to treat High Grade Dyskaryosis (moderate or severe changes) found on your cervical screening test.

If you need to change your appointment or have any specific requests or concerns, please call us on 01270 612172.

We would still like to see you for your colposcopy appointment if you are on your period, you are pregnant or if you have had any issues around examinations in the past. If you wish to not be seen during your period, then we can rearrange your appointment at your request. Colposcopy is safe to be carried out during pregnancy and if further examinations are required during your pregnancy we will arrange them accordingly.

Your appointment will be for 30 minutes and this includes a consultation and examination. Some ladies may have a slight vaginal discharge following a colposcopy examination. We advise that you may wish to bring your own sanitary towel/panty liner although we do have some available for your use.

HPV is a very common virus and can affect 8 out of 10 women. HPV is usually passed on through skin to skin contact and is very common among people who are or have been sexually active.

It can be passed on through:

• Oral, anal or vaginal sex
• Touching in the genital area
• Sharing of sex toys

You can get HPV the first time you have sexual intercourse/contact. HPV does not have symptoms and there is no treatment for it. HPV is common and our immune system should clear it within 2 to 3 years.

You will have had a cervical screening test (smear test) which is offered in the UK to ladies aged 25 to 65 years. All ladies who have their cervical screening tests are primarily screened for the HPV virus. If HPV is detected on your cervical screening test, then the sample will be reviewed by cytology (looked at under a microscope).

Once you have booked in for your appointment at the main reception area in Gynaecology Outpatients Department, you will be asked to wait in the waiting room.

You will be called for your appointment and asked to confirm your details before entering the room. You will be introduced to the Colposcopist and Nursing staff in the room. Firstly you will be asked some questions about your results and reason for attending. If you have any questions about your results or referral reason this is the time that these can be discussed and answered. Further questions will be asked in relation to past medical history, operations, contraception and current medications you take.

The Colposcopist will explain the procedure and if treatment is required this will be explained and you will be asked to sign a consent form. For the examination you will be asked to step into the changing area and you will be asked to undress from the waist downwards. You will be provided with a sheet to cover you for the examination.

The Colposcopist will help to position you on the examination couch. Once you are comfortable and ready the Colposcopist will gently insert a speculum into the vagina just like when you had your cervical screening test taken.

A colposcope is used to take a close look at your cervix. The colposcope is a specially adapted type of microscope. It might look a bit alarming but is just a large magnifying glass with a light source attached. It looks like a large pair of binoculars on a stand. It does not go inside you, or even touch your skin. The image of your cervix from the colposcope will appear on the screen.

The Colposcopist will apply different solutions onto your cervix to help identify and highlight any area of abnormal cells, which if seen, a small tissue sample (cervical biopsy) may be taken from the cervix. A biopsy is about the size of a pin head. You may feel a slight stinging, but it should not be painful. The biopsy will then be sent to the laboratory for testing.

If you find the examination uncomfortable or have any concerns, please inform the Colposcopist or Nursing staff so we can try and alleviate the discomfort where possible.

You will be asked to get dressed. The Colposcopist will discuss any findings from the examination with you and whether treatment has been carried out. A leaflet and post treatment advice will be given to you. If a biopsy has been taken, then the results from this will determine follow up.

After your appointment you should feel well enough to continue with your usual routine, but some ladies may need to rest for a short while. You may have a brown discharge vaginally following examination due to solutions used during your colposcopy. If you have had a biopsy you may have some light blood stained discharge from your vagina. This is normal and usually stops after three to five days. Its best to avoid sexual activity, tampons and vaginal medications, lubricants or creams until the bleeding stops.

Colposcopy defines the type and extent of the abnormal area on the cervix. The results of the biopsy shows the level of abnormality and if treatment is required. Once we have the results from the histology department, we will write to you and confirm your follow up plan. The medical term for abnormal cells is Cervical Intraepithelial Neoplasia (CIN). CIN is not cancer, but it can sometimes go onto develop into cancer. There are three grades of CIN and they relate to how deeply the abnormal cells are on the cervix.

CIN 1 (Low Grade)

You are unlikely to develop cervical cancer from CIN 1. These changes can go away on their own when your immune system clears the HPV virus and this happens in most cases within two to three years. We would advise a further cervical screening test in 12 months to check if the HR HPV is still present.

CIN 2 or CIN 3 (High Grade)

We will normally offer you treatment to remove the abnormal cells on your cervix if CIN 2 or CIN 3 is present. This reduces the future risk of developing cervical cancer. It is extremely rare for a biopsy to show cell changes that have already developed into cancer. If this did happen a referral to a specialist team would happen for management of this. There is a rare abnormality called CGIN (Cervical Glandular Intraepithelial Neoplasia) and this is the same type of pre cancerous change involving the inner glandular cells of the cervix. Treatment for CGIN is usually the same as CIN 2 or 3.

We offer two treatments to treat abnormal cells, a loop excision of the transformation zone or a thermocoagulation to the cervix. In most cases these can be carried out as an outpatient at the colposcopy clinic with local anaesthetic.

Large Loop Excision of The Transformation Zone (LLETZ)

This is the most common treatment for treating High Grade CIN. A fast acting local anaesthetic is given into the cervix and whilst this is taking effect a sticky pad is attached to your thigh to ensure a safe return path for the electric current being used.

The local anaesthetic can sometimes make you feel a little strange, it can make your heart beat faster and your legs wobbly. If this happens it is normal and will settle quickly. A thin wire loop is used to remove the abnormal area to the cervix and then a procedure called diathermy is used to seal the area to prevent bleeding. This treatment can be carried if required at your first appointment/visit. The area of abnormality that has been removed will be sent to the histology department for testing.

Thermocoagulation

This is a treatment that uses heat to destroy the abnormal cells on the cervix. This treatment is usually carried out at a second colposcopy appointment as a biopsy is required before any treatment is carried out to the cervix.

On the day of treatment a fast acting local anaesthetic will be given into the cervix and a probe will be applied to the cervix for 30 seconds at a time to destroy the abnormal cells. Depending on the area of abnormality that requires treatment, we may need to apply the probe multiple times.

We will confirm any follow up, which is normally a cervical screening test six months after treatment at your GP surgery, but on some occasions will be back at the colposcopy clinic.

The reason for choosing one treatment instead of another may depend upon the site or size of any abnormality or appearance of the area. All treatment methods are highly effective at treating CIN/abnormal cells on the cervix. Sometimes treatment can be carried out under general anaesthetic. This can be due to your preference or other reasons which your Colposcopist will discuss with you. All options will be discussed with you so you can make an informed choice.

If your treatment was carried out at your colposcopy appointment under local anaesthetic, you may notice some period like cramps as the anaesthetic wears off. If you experience this, then you could take some pain relief (either paracetamol or ibuprofen, if you have no allergies to either of these medicines) to reduce any discomfort. Always follow the instructions packet for doses and timings for pain relief.

If you have had a LLETZ you may have a blood stained discharge for two to four weeks. The discharge should not be heavier than a period and should get gradually lighter. If your discharge is not reducing, and you are worried, call the Colposcopy Team to discuss any symptoms that you may be worried about. Alternatively you could contact your GP.

If you have had a thermocoagulation treatment again you will have an increased vaginal discharge that could be blood stained why your cervix heals over three to four weeks. Again if you have any concerns following treatment, please call the Colposcopy Team. We advise you avoid the following for four weeks after your treatment:

• Sexual activity
• Tampons
• Swimming and hot tubs

You will be provided with a post treatment leaflet with all of this information in. This will advise you what to do if you have any problems and relevant telephone number to contact.

A letter will be sent with biopsy or treatment biopsy results approximately six weeks following your appointment. This letter will confirm your results following a LLETZ and confirm your follow up plan. Normally follow up is a repeat cervical screening test six months post treatment. This is normally at your GP surgery but on some occasions will be back at the colposcopy clinic.

You will be primarily tested for the HR HPV virus and if this is not detected you will return to routine recall of a cervical screening every three years.

If your cervical screening test is HR HPV detected with no abnormal cells or with abnormal cells detected you will be referred back to colposcopy clinic.

If you have any further questions or concerns, please do not hesitate to contact the Colposcopy Team on 01270 612172, Monday – Friday, 9:00am to 4:30pm, excluding bank holidays. Alternatively, a message can be left on the answer phone out of these hours and someone will get back to you as soon as they can.

Further information about HPV, colposcopy and Cervical Screening Programme can be found at:

www.Jostrust.org.uk

www.nhs.uk/conditions/cervical-screening/