Colposcopy
If you have received an abnormal cervical screening result or your practice nurse has visually noticed changes in your cervix, you will be invited to attend a colposcopy.
Colposcopy is simply a more detailed look at the cervix. Instead of looking at the cervix with the naked eye they will use a special microscope to see the changes at high magnification. Don’t worry about the sound of this! The microscope stays outside you. All that goes inside is the speculum, which is the instrument your GP or practice nurse used to see your cervix when taking your cervical screening. Some clinics may be equipped with video equipment so that you can watch the examination if you wish. The examination may take a little longer than a standard cervical screening but the doctor or nurse performing the colposcopy will talk to you as you during the examination and tell you what is happening.
You should be seen by staff dedicated to the colposcopy clinic. They will understand that you may be worried and will take time to discuss your screening result before the examination. You will be examined on a purpose-built couch. The cervix is viewed using a speculum (the instrument needed for your screening to be taken) and then examined with the colposcope at low magnification (4-6X). The doctor or nurse will put a number of different solutions on the cervix and look for changes that indicate the presence or otherwise of changes to the cells. The medical term for cervical changes is cervical intra-epithelial neoplasia (CIN).
There are two different techniques used to identify abnormal cell changes during the colposcopic examination:
1. Acetic acid colposcopy
Acetic acid (dilute vinegar) is applied to the cervix using a cotton wool ball or by a spray. Abnormal areas such as CIN will tend to turn white (acetowhite). It is important to say that some areas of acetowhite do not indicate CIN at all. One of the challenges facing the colposcopist is to decide which areas of acetowhite truly represent pre-malignancy and to avoid treating minor conditions.
2. Schiller's iodine test
The colposcopist may use another test using an iodine solution. Normal tissue on the outside of the cervix stains dark brown when iodine is applied. On the other hand, pre-cancerous abnormalities may not stain with iodine. This test may be used following acetic acid colposcopy and is often used before treatment.
Diagnosis
Most colposcopists use a combination of the acetic acid and Schiller’s iodine tests. If there is an abnormality the colposcopist 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.
Taking a biopsy
To be sure of the diagnosis, a biopsy is often required – this means taking a bigger sample of tissue from the cervix. Depending on the results of this biopsy the colposcopist will decide whether you need treatment.
If it is obvious that you will be likely to need treatment this can be done during the same visit – in this case all of the abnormal area is removed and this constitutes the biopsy. Other more invasive types of treatment will require a separate appointment.
Treatment options will be outlined to you in your information leaflet before your clinic appointment and will be discussed with you in clinic. Sometimes taking the biopsy can be uncomfortable but the person performing the colposcopy will warn you before the biopsy is to be taken. Your colposcopy shouldn’t be painful and if you have any difficulty you should discuss this with the colposcopist. If necessary the colposcopy can be stopped.
Jo's Trust Case Studies
Allison describes her experience with colposcopy and treatment of abnormal cervical cells:
I lay back and put my legs over the stirrups - they are like something you use at the gym to exercise your thighs! Felt quite comfy actually! The doc then inserted the instrument they use for smears. It went in painlessly. She then told me to look at the screen and said "thats your cervix". Because of the magnification, it looked enormous!
Read more about Allison's story...
Tess describes her experience with colposcopy:
The gynae treating me explained everything clearly and with some humour as he was obviously trying to calm my nerves. He started with a similar process to the cervical screening but had a sort of glorified binocular/microscope that he could see inside with. This machine doesn't touch you but let's them see clearly any areas that need to be dealt with.