Peachtree Gynecology - Patient Education

COLPOSCOPY:

You have been diagnosed with an abnormal Pap smear. The Pap smear is a screening test, so a colposcopy has been recommended to look for dysplasia, which is precancer of the cervix. Dysplasia usually does not cause symptoms. Sometimes it causes bleeding during or after sexual intercourse.

You may have a greater risk for dysplasia if:

• You have a high risk HPV infection (human papillomavirus).
• You have had more than 1 sex partner.
• Your sex partner has been sexually active with other partners.
• You had sexual intercourse before the age of 18.
• You smoke.
• You have a weakened immune system; for example, because you are taking immunosuppressive drugs, or you have AIDS.

 WHAT IS A COLPOSCOPE?

The colposcope is an instrument that looks like a pair of binoculars mounted on a tripod, and is used to magnify the tissues of the cervix, vagina, or vulva.  This enables the examiner to see minor changes in the color of these tissues and surface blood vessel patterns, which are not visible to the naked eye.  It is these subtle differences, which help to distinguish healthy tissue from abnormal tissue.  The colposcope is usually used to evaluate women with an abnormal Pap smear.  The Pap smear is a screening test and looks at the characteristics of individual cells.  The colposcope allows us to identify any microscopically abnormal areas to biopsy for more thorough tissue evaluation by a pathologist.

WHAT HAPPENS DURING THE COLPOSCOPIC EXAMINATION?

The colposcopy is performed during a regular office visit.  It is preferable to schedule this while you are not on your menses.  We recommend that you take two ibuprofen or Aleve tablets prior to coming to the office, as the procedure can cause some cramping. Prior to the examination, we will want to verify that you are not pregnant.  The colposcopy can be performed during pregnancy, but there certain types of biopsies we would avoid. The doctor will first do a regular pelvic examination.  Then a speculum will be placed in the vagina to visualize the cervix.  The cervix and vagina will then be washed with a vinegar solution to help remove any mucous or discharge from the cervix and vagina.  Another benefit of the vinegar solution is that it brings out the color changes and blood vessel patterns of abnormal tissue.  The doctor will then look through the colposcope to carefully examine all the tissues.  The colposcope itself remains outside the body and is not inserted into the vagina.

If any abnormal areas are identified during the examination, it may be necessary to take a small biopsy.  In cases of colposcopy of the cervix, often a biopsy will be taken on the outside of the cervix, and then a second biopsy taken from higher up inside the endocervical canal.  The biopsies only take a short time to obtain and the doctor will let you know before she is about to take a biopsy.  The biopsy may cause some cramping similar to menstrual cramps and last only a few minutes.  The entire procedure lasts about 15 minutes.

After the procedure, you may resume all normal activities as you feel up to it.  You are able to drive yourself home and/or return to work.  You may experience some spotting for 2-3 days from the biopsy sites. The doctor will often apply some silver nitrate to your biopsy sites, which acts as a chemical cautery.  This may cause a charcoal, grayish discharge, which is to be expected.  We recommend that you avoid intercourse for about a week after the biopsy to allow the biopsy sites to heal.

It usually takes 7 days for the test results from the biopsies to return to our office.  We will call you with the results or notify you through our Electronic Health Record Patient Portal if preferred..  If additional evaluation or treatment is indicated, appointments will be scheduled at that time.

Please remember to bring your insurance card to your appointment so we may file your insurance for the procedure.  There will also be a separate bill from the pathologist if any biopsies are taken.

HOW IS IT TREATED?

It is very important to have dysplasia treated to help stop it from becoming cervical cancer. The specific treatment may depend on whether the dysplasia (squamous intraepithelial lesion) is low grade (LGSIL) or high grade (HGSIL).

LGSIL (Mild Dysplasia): also called CIN 1, often goes away without treatment. Most dysplasia is associated with HPV infections and 80 % of women with an HPV infection will clear the infection within 2 years.  When the infection clears, the abnormal cervical cells go back to normal. These patients are usually followed with repeat Pap smears every 6 months.

HGSIL (Moderate-Severe Dysplasia): also called CIN 2-CIN 3.  The abnormal tissue can be removed with a thin wire loop attached to an electrical unit. This is called the loop electrosurgical excision procedure (LEEP).  Severe cervical dysplasia may also be treated with a cone biopsy, which is the removal of a cone-shaped piece of the cervix. This procedure is also called conization of the cervix. It removes the tissue containing abnormal cells. Your provider can cut the tissue out with a surgical knife, cautery (burning tool), laser, or wire loop. If the procedure is done with a knife or laser, it is usually done in an operating room. The tissue removed is examined in the lab to check for cancer.

Very few women have trouble getting pregnant or have miscarriages as a result of any of these treatments, including cone biopsies.  If you become pregnant and have had a cone biopsy, tell your prenatal care provider about it. Most women who have had a cone biopsy are able to become pregnant and carry the baby to term without problems.

HOW CAN I TAKE CARE OF MYSELF?

Follow your health care provider's advice for treatment and checkups. Your provider may recommend that you have a Pap test at least twice a year for the next 2 to 3 years. This will allow your provider to detect any progression/ recurrence of dysplasia and treat it promptly. Then, if your Pap tests have been normal, you may need the test just once a year.

HOW CAN I PREVENT DYSPLASIA?

• Try to avoid exposure to HPV. Do not have more than 1 sexual partner. It will also help if your partner has not been sexually active with anyone else. Find out your partner has had any sexually transmitted diseases. You can get some protection from HPV by using latex or polyurethane condoms every time you have sexual intercourse. However, condoms do not completely protect against this infection, which can be spread from other parts of the body.
• Have the HPV vaccine
• Avoid sexual intercourse until you are 18 or older.
• Do not smoke. Avoid breathing smoke from other people's cigarettes.