The colposcopy examination looks for dysplasia, which is precancerous lesion 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 have a weakened immune system; for example, because you are
taking immunosuppressive drugs, or you have AIDS.
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 provider 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 provider 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 provider 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 -20 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 provider 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 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 or recurrence of dysplasia and treat it promptly. Then, if your Pap tests have been consistently normal, you may need the test every 1-3 years.
Vulvar/ Vaginal Biopsy
A vulvar or vaginal biopsy is a procedure performed to assess any lesions, redness, discoloration, or persistent itching of the tissue from the labia, clitoris, or vaginal opening/inside vagina. The procedure involves cleaning and numbing the area of concern and removing a small sample of tissue to send to the lab. If the area of concern is in the vagina, a speculum will be inserted (similar to the instrument used for pap testing), to examine the vagina. Most women feel some pressure or slight discomfort. A medication to control bleeding is applied to the area, as stitches are rarely needed. The external areas can be covered with a light bandage or Vaseline. You will need to keep the area clean and dry for a few days. If your biopsy is inside the vagina, we recommend you avoid putting anything in your vagina for 3-5 days.
What is 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.
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 (LSIL) or high grade (HSIL).
LSIL (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.
HSIL (Moderate-Severe Dysplasia):
also called CIN2-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.
An endometrial biopsy is a procedure performed to assess the lining of the uterus. It is a helpful diagnostic test for women over 35 yo who are experiencing abnormal, similar to the instrument used for pap testing irregular or heavy menstrual bleeding. The procedure involves inserting a speculum (similar to the instrument used for pap testing), into the vagina, clean the cervix, and insert a thin suction catheter into the uterus withdrawing the tissue sample. We recommend taking ibuprofen 30 minutes prior to your appointment. You can expect mild cramping during the procedure, which will typically resolve in a few hours. Some women also experience light bleeding or spotting after the procedure. The tissue sample is sent to the lab to look for abnormal cells or hormonal effects on the endometrial lining.