Colposcopy

What is colposcopy?

To understand colposcopy, it is important to know what a Pap smear is. A Pap smear is a screening method for cervical cancer or other abnormalities. It is done by taking cells from the cervix and examining them under a microscope for signs of change. If cellular changes are detected, a health care provider may prescribe further tests, including colposcopy.

Colposcopy is a procedure used to examine the cells of the vaginal walls and cervix for abnormal patterns. It may also be done to examine external sores, such as genital warts, or other abnormalities. The examination, which is done between menstrual periods, takes from 10-30 minutes. There is usually little or no discomfort during the exam.

How is Colposcopy done?

As with a routine annual examination and Pap smear, you will be asked to lie back on the exam table and put your feet in the stirrups. Your health care provider will then insert a speculum into the vagina. Next, a swab is used to remove mucus and stain the cells so that the health care provider can tell the difference between healthy and unhealthy cells. An instrument called a colposcope, which looks like tiny binoculars on a tripod, is used to examine the cervix, vagina, and vulva from the outside; the instrument does not even touch the body. The colposcope allows the health care practitioner to see the cells 10 to 20 times larger than without the instrument. Some colposcopes have cameras attached so that pictures can be taken for future reference.

If abnormal areas are seen, a tiny piece of tissue may be taken for further examination. This is called a biopsy. This tissue is then sent to a laboratory to determine whether the changes indicate cancer. If a biopsy is performed, you may experience some cramping and slight bleeding. Most health care providers recommend that you avoid intercourse, douching, and tampon use for a week after the procedure.

How are the abnormalities found by Colposcopy treated?

The most common abnormalities health care providers find by performing colposcopy are:

• dysplasia, which means that the cells of the cervix are developing in a pre-cancerous way
• HPV (Human Papilloma Virus), the virus that causes genital warts

The four methods of treatment most often used are cryotherapy or cryosurgery, laser therapy, Loop Electrosurgical Excision Procedure (LEEP), and conization.

Cryotherapy or cryosurgery involves the use of liquid nitrogen to freeze and destroy abnormal tissue so that new healthy tissue can grow. Both procedures can be done in a physician's office.

Laser therapy involves the use of a laser beam to remove unhealthy cells on the surface of the cervix. The procedure is usually done on an outpatient basis and a local anaesthetic is used.

LEEP involves removing the abnormal tissue before it turns into cancer. To do this, a thin wire loop cuts the abnormal tissue, which is then examined in a laboratory. A local anaesthetic is used and the procedure takes approximately 10-20 minutes.

Conization is prescribed for a small number of women and involves removing a small cone-shaped piece of the cervix. The tissue is then sent to a laboratory to make sure the abnormal areas have been removed completely. Conization may require a general anaesthetic and a short hospital stay.

Following any treatment method, most health care providers recommend that you not have sex for about a month to allow the cervix to heal. In addition, regular Pap smears every three to six months will be required to make sure all abnormal areas were removed and no further abnormal tissue has developed. Follow-up colposcopy will be required if a Pap smear is again abnormal. Further treatment may also be needed.

What are the costs of Colposcopy?

Costs for colposcopy vary depending on what additional tests, such as a Pap smear or biopsy, are done and what follow-up measures are taken. Medical insurance usually covers all or part of the costs. Ask your health care provider for specific information about the costs of the procedure.

Who can do a colposcopic examination?

Both physicians and nurse practitioners can be trained to perform colposcopy. Although most major medical centers have colposcopes, the procedure may not be available in all areas. Getting a colposcopic exam may require travel. However, the advantages of this diagnostic examination are worth the possible inconvenience of travel.

Are all health care providers familiar with Colposcopy?

Some health care providers may not be completely familiar with the advantages of the procedure. Colposcopy complements the Pap smear and is particularly valuable if it enables a woman to avoid surgery. More and more health care providers are recommending colposcopy whenever a question exists about the condition of the cervix or vagina. Colposcopy is another advance in the continuing battle against cancer of the cervix.