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After your pelvic exam and Pap test, your doctor informs you of some troubling news: You have abnormal cells growing on your cervix. The presence of abnormal cells could mean that you have a precancerous condition of the cervix or, possibly, cervical cancer.
What's next? Your doctor may recommend colposcopy — a procedure to closely examine your cervix — to identify the cause of the abnormal cells. Alleviate some of your anxiety about this procedure by understanding what it involves, how you can prepare and what you can expect afterward.
Colposcopy is the direct examination of your genital area, including the cervix, vagina and vaginal opening (vulva), using a special lighted microscope called a colposcope. A trained specialist (colposcopist) performs the procedure. The colposcope magnifies the surface of your cervix and vagina by 10 to 40 times its normal size. This aids the colposcopist in identifying areas of abnormal cell growth that can't be seen by the naked eye.
If the colposcopist detects abnormal cells during the exam, he or she may collect a sampling of cells (biopsy) to send to a lab for analysis.
Your doctor might recommend a colposcopy to find out the cause of your abnormal Pap test results or to evaluate a visible abnormality. You might also have a colposcopy if your doctor wants to examine the outcome of previous treatment for an abnormal Pap test result.
Preparing for a colposcopy isn't much different from preparing for any pelvic exam. However, colposcopy can't be performed when you have your period, so you should schedule the test for a time when you won't be menstruating. Also, don't use vaginal medications, douches or tampons, and avoid having sexual intercourse for 24 hours before the colposcopy.
You may be more comfortable during the exam if you empty your bladder and bowels beforehand. Your doctor might also recommend that you take an over-the-counter pain reliever an hour before the exam. This can help alleviate any discomfort you might feel during the colposcopy.
Colposcopy is similar to what you experience during a pelvic examination and Pap test. The procedure is performed in an examination room. You lie on your back on a table with your knees bent and your feet in supports called stirrups. The colposcopist visually examines your external genitals before gently inserting an instrument called a speculum into your vagina. The speculum holds your vagina open to allow your doctor to see your cervix.
The doctor or an assistant positions the colposcope — the special lighted microscope — so that he or she can look into the opening of your vagina. The colposcope never enters your vagina.
A saltwater (saline) solution may be used to clean the cervix. You may feel a cool sensation as the cervix is rinsed. Next, your doctor applies a vinegar solution (acetic acid) to your cervix with a cotton ball or swab. Using the magnifying power of the colposcope, your doctor carefully inspects your vaginal and cervical tissues.
Acetic acid reacts differently when it comes into contact with areas of abnormal tissue versus normal tissue. The abnormal areas turn white. If using acetic acid fails to reveal any abnormality, a second solution (Lugol's solution) may be used to stain cervical tissues. Lugol's solution doesn't stain any cells that are abnormal. Using these solutions allows your doctor to easily identify any areas of concern.
If areas of abnormal tissue are present, your doctor can adjust the colposcope to increase magnification of the tissue. This helps to discern the course of blood vessels and other characteristics of the tissue.
Your doctor may also perform a biopsy of one or more sites. To do this, he or she collects a sample of cells from any areas in question and from inside your cervical canal (endocervical curettage). Another specialist (pathologist) examines the tissue samples for the presence of abnormal cells.
The procedure may cause you some discomfort. Insertion of the speculum can be uncomfortable, and some women experience mild stinging as the acetic acid is applied. If you have a biopsy, you may feel a pinch or have some cramps as the tissue is removed.
Try relaxing by taking deep, slow breaths during the procedure. This may help ease any pain or discomfort you feel. If you become too uncomfortable, tell your doctor.
You might experience some bleeding and other vaginal discharge for about three to five days after the colposcopy. This is especially true if you've had a biopsy. Use sanitary pads — not tampons — for the bleeding and discharge. The dark-colored vaginal discharge results from your body expelling the fluids used during the procedure.
If you had a biopsy, don't put anything into your vagina for at least one week after the procedure or until your doctor tells you it's safe.
This means you should avoid:
- Sexual intercourse
- Using tampons
- Vaginal medications
Tampon use generally isn't advised after a biopsy of your cervix or vaginal tissues. However, if you're one of the few women who experiences heavy bleeding after the biopsy, your doctor may recommend using a tampon instead of a sanitary pad to stop the bleeding. In that case, change the tampon every four hours or as needed.
Other than these restrictions, you should be able to resume your normal activities, including bathing, after your exam.
You'll get the results from your colposcopy examination within a week or two. Your doctor's office contacts you when these results are available. Make a follow-up appointment with your doctor to discuss the results and what further steps might be necessary. If you don't have the results after three weeks, call your doctor's office. It's important to have the follow-up appointment as soon after the colposcopy as possible in case you need additional treatment.
Colposcopy carries with it a slight risk of infection. You may also experience bleeding after the procedure.
Call your doctor if you develop any of the following:
- Signs and symptoms of infection, including a fever above 100.4 F, foul-smelling vaginal odor or thick yellowish vaginal discharge
- Excessive vaginal bleeding, such as soaking a pad an hour for four or more hours
Severe pelvic or abdominal pain after the procedure, although rare, merits emergency medical attention.
Promising advances in electronic screening techniques may be on the horizon. Experts are exploring the possibility of using an electronic probe, placed directly on the cervix, to evaluate cervical tissue. The probe works by gathering data about the amount of light the tissue absorbs and reflects. By comparing the results with data of known healthy cervical tissue, doctors may be able to identify diseased tissue in need of biopsy. More research is needed to determine whether electronic screening may be as effective as or more effective than colposcopy.