Colposcopy: what exactly is it and what does it detect?

A colposcopy is the medical term used to refer to a thorough examination of the cervix, vagina, as well as the vulva in an attempt to detect any abnormal cells, and/or to diagnose or rule out any potential diseases.

In our latest article, leading consultant obstetrician and gynaecologist, Mr Timothy Hookway, tells us what exactly a colposcopy procedure entails as well as providing an insight into when a cone biopsy might be required.

What is a colposcopy?

If you have an abnormal smear test, or you are concerned about some unusual bleeding, you may be referred for a colposcopy. A colposcopy is a detailed examination of the cervix, also known as the ‘neck of the womb.’

A speculum is inserted (just like a smear test), and a swab is used to apply some fluid to the cervix. This fluid is dilute acetic acid; like a weak, clear vinegar; and sometimes women report some mild stinging when it is applied.

A colposcope is an instrument with two eyepieces, a bright light and a magnifying lens so that the doctor or nurse can examine the cervix after applying the fluid. Sometimes iodine is used, or a green light which can identify abnormal blood vessels. If any abnormalities are detected, a biopsy can be taken to confirm.

What is a cone biopsy?

A cone biopsy is a way of removing abnormal cells from the cervix. Often, electrosurgery is used, which generates a significant amount of heat, so local anaesthetic is also used.

After a colposcopy, if a decision is made to treat some abnormal cells, there are two options. One is a ‘destructive’ treatment, where heat is applied to the abnormal cells to get rid of them.

This is a very quick procedure, but there is no sample sent to the lab. Therefore, it cannot be checked to ensure that all of the abnormal cells are gone. This is precisely why a biopsy must be taken prior to the procedure to check that there are no cancerous cells.

The other form of treatment is ‘excisional’, where the abnormal cells are removed, and sent to the lab for analysis. The aim is to remove all of the abnormal cells, with a margin of normal cells so that it is certain that all of the abnormal cells have been removed.

A cone biopsy can be used for this purpose, but another procedure, called a LLETZ (large loop excision of the transformation zone – the transformation zone is where the abnormal cells are found) is more common in the UK.

For either a cone biopsy or a LLETZ, local anaesthetic is injected into the cervix through a tiny needle. It often also contains some adrenaline, so, as a result, it may sometimes feel like your heart is racing. This sensation, however, generally only lasts for a few seconds.

The abnormal cells are then removed and sent for analysis. The whole procedure lasts no more than 10 minutes overall.

After either a biopsy or a treatment, there may be some black and/or brown discharge. This is to be expected. If the bleeding is heavy, or you feel unwell, then you might require some antibiotics from your doctor.

When is a colposcopy recommended?

A colposcopy is recommended after an abnormal smear test. Referral for this is made automatically in the UK. Sometimes a colposcopy is also recommended following previous treatment and/or abnormal bleeding.

What are the complications and side effects that are the same and which are different?

A treatment colposcopy (LLETZ or cone biopsy) can feel a little warm during treatment. There may be some bleeding or discharge following either a biopsy or a treatment, but it should settle within a few days after a biopsy, or a few weeks after a treatment.

When can the results from the procedures be expected and what is the success rate?

A colposcopy with a biopsy is used to make a diagnosis. Further treatment may be required depending on the biopsy result, which is usually available within four weeks.

The result from a treatment is again usually available after four weeks. The vast majority of the time, all of the abnormal cells have been removed but in some rare cases another colposcopy may be required.

What can patients expect after the procedures?

There may be some bleeding or discharge, and sometimes some cramping pain, just like that of a period. It should settle after a few days.

Mr Timothy Hookway is a highly esteemed, leading consultant obstetrician and gynaecologist. If you have been advised by a doctor to undergo a colposcopy and/or a cone biopsy and are seeking more information with regards to both procedures, rest assured that you have expert medical guidance at your disposal. Check out Mr Hookway’s Top Doctors profile here to book an appointment with him.