COLPOSCOPY - patient's guide
Dr Barry Lowe - Obstetrician & Gynaecologist
- A colposcopy is a detailed examined of the cervix by a
- A colposcopy is usually necessary to identify the source of
- A colposcope is a small microscope inserted in the vagina to
view the cervix
- A tissue sample is normally taken from the abnormal area and
- Results are available within one week
- Mild abnormalities may be treated at a further appointment or
left to see if they spontaneously resolve
- More serious abnormalities are treated at another
What is a colposcopy?
An abnormal cervical smear indicates that there are abnormal cells
on the surface of the cervical skin. The smear alone, however, is not
sufficiently accurate to act on.
A more detailed examination of the cervix by colposcopy is
necessary for persistent low grade abnormal smears, all high grade
abnormal smears, any cervix that looks abnormal at the time of taking
a smear, even if the smear result is normal, and any woman with
abnormal symptoms such as bleeding after sex.
It is important to reassure women, that an abnormal smear in
itself, is highly unlikely to signify invasive cancer. Colposcopy is
needed to identify the location of any abnormal skin and to take
specific samples (biopsies) of affected skin to be sent for
laboratory examination (histology), to identify pre-cancerous
changes, called cervical intraepithelial neoplasia (CIN). Colposcopy
itself is NOT a treatment.
How is colposcopy performed?
Colposcopy is performed by a specialist who uses a small
microscope (mounted on a movable stand) to focus on the surface of
the cervix which is at the top of the vagina.
The woman is asked to attend when she is not bleeding and lies on
a reclining chair or at the end of an examination couch with her legs
apart and supported on foot rests. Her lower half is covered with a
A speculum is gently inserted in the same way as for a smear test.
The specialist sits between the woman's feet and the colposcope and
its light are directed onto the cervix. The colposcope remains
outside the vagina but it can magnify the view of the cervix. A weak
solution of acetic acid (similar to vinegar) is wiped onto the cervix
and upper vagina. Abnormal areas of skin usually will become white
and can be located. Often the specialist will then seek the patient's
permission to take one or two small pinches of skin (biopsies) from
the white coloured areas. These biopsies will be sent for detailed
examination to accurately determine the extent of the abnormal
The discomfort from the biopsy is brief and may feel like a sharp
pinch. Afterwards the patient may have a small amount of vaginal
spotting for a day or two. The colposcopy examination itself takes
about 10 minutes, but extra time is needed to discuss matters before
What happens when the colposcopy results are available?
Results of the biopsies are usually available within a week and it
is important the patient and specialist have a clear idea of how the
result will be communicated and whether specific treatment is needed
Low grade changes on smear with colposcopic biopsies confirming
mild CIN1 or HPV can either be treated at a further appointment, or
purposefully not treated. These minor abnormalities can spontaneously
disappear in about 50% of women. Those that do not disappear will
either remain unchanged or be a higher-grade abnormality. If the
patient chooses not to be treated she should be seen in about 6
months for repeat colposcopy and smear to monitor any changes.
High-grade changes of CIN2 or CIN3 confirmed by colposcopic
biopsies are generally treated at a further appointment.
Do cervical smears and colposcopy always agree?
In some instances what is seen at colposcopy does not match with
the cervical smear report. This may be in a number of ways such
1. The colposcopy and biopsies show a higher or lower grade of CIN
than the smear. Usually the biopsies are regarded as more accurate
and used as the basis for treatment or not.
2. The colposcopy and biopsies may show CIN even when the cervical
smear is normal. Again the biopsy results are taken as more accurate
as it is known that smears can occasionally not detect CIN.
3. The colposcopy may show NO abnormal areas despite an abnormal
smear. It may be decided to repeat the cervical smear and repeat the
colposcopy in a month or two for further confirmation and to see if
there is consistency in the findings.
4. The colposcopy views may be inadequate if the woman has a small
or closed cervical canal (e.g. menopausal women). Abnormal cells may
exist within these narrow canals and may not be visible to
colposcopy, but the abnormal cells that are shed are picked up on the
In these situations, a repeat colposcopy after a one-week course
of oestrogen hormones may help widen the view into the canal. If this
is not successful, then a cone biopsy may be suggested. This
operation under anaesthesia involves taking a cone shaped section
from the centre of the cervix so that part of the central canal is
included. This cone of tissue (about the size of 1x2 cms) is sent for
laboratory investigation (histology).
Colposcopy is NOT a treatment, but a means to more accurately
assess the significance of an abnormal smear and to plan any
treatment if necessary.
Understandably women will be anxious and worried about their smear
result. To ensure the colposcopy procedure is as acceptable and
comfortable as possible, it is important the patient and colposcopist
have fully communicated beforehand and the patient is aware of what
is going to happen.
Dr Barry Lowe
- Obstetrician & Gynaecologist
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