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Colposcopy

You have been referred to the smear clinic because you have an abnormal result from the cervical smear. At the smear consultation, the gynaecologist will investigate what is causing this. If necessary and possible, abnormalities are also treated immediately. Most women with an abnormal smear will never develop cervical cancer, but sometimes treatment is wise. This page tells you more about its origin, examination, diagnosis and treatment.

An abnormal smear is almost always caused by infection with HPV, the human papillomavirus. You cannot protect yourself from infection with this virus. There are more than 100 types of HPV. Some of them pose an increased risk of cervical cancer. These are called high-risk human papillomavirus (hrHPV).

hrHPV
The virus can infect the cervix during sexual contact. The virus is often already in the pubic area. Besides vaginal sex, objects entering the vagina can also infect the cervix.

  • Almost everyone who is sexually active gets infected with hrHPV at some point.
  • Condoms protect somewhat but not completely against HPV infection.
  • You or your partner will not notice if you have hrHPV.
  • It affects men much less often than women.
  • Almost always, the body clears hrHPV again within 2-3 years.
  • Therefore, if HrHPV is found in a smear test, you may have had the virus for a long time.
  • There is no treatment for hrHPV. Usually, the virus disappears by itself. Treatment of your partner with possible hrHPV is not possible.
  • hrHPV can give abnormal cells of the cervix. These can be treated. This prevents abnormal cells from growing into cervical cancer.
  • How abnormal the cells are in the smear is indicated in a PAP result. PAP 1 means the cells are normal. Abnormal results are PAP 2, 3a, 3b, 4 or 5.
  • hrHPV is not hereditary.
  • Women who smoke are less able to get rid of the hrHPV virus. If you stop smoking, chances are that your body can repair the abnormal cells on the cervix again without treatment.

What examination will the gynaecologist perform?

You have an abnormal result from your smear test. This is why you are going to the gynaecologist for tests. The gynaecologist will look at your cervix with a microscope. This is called a colposcopy. You will first have a conversation with the gynaecologist. The gynaecologist will ask you some questions and give you information about:

  • abnormal smears
  • the colposcopy
  • any treatment
  • follow-up phase

Do not hesitate to ask questions.
The colposcopy takes place next.

The colposcopy

The gynaecologist inserts a spreader (also called a duck's mouth) into the vagina, just like when taking a smear test. In front of the entrance to the vagina, the gynaecologist places a microscope with a bright light. This is the colposcope. This allows the gynaecologist to look closely at the cervix and vagina.

To see more details, the gynaecologist applies one or more dyes to the cervix:

  • the one dye is acetic acid, you can sometimes smell this a little. Some women feel the liquid stinging a little
  • the other dye is lugol, an odourless brown dye (contains iodine). Tell your gynaecologist if you are allergic to iodine.

The gynaecologist will then discuss with you whether it is necessary to:

  • wait and see
  • take biopsies
  • treating you immediately (lisexcision)

The following explains the different options.

Wait and see
The gynaecologist looks closely at the cervix. If the gynaecologist sees no suspicious spots, no biopsy or treatment is necessary. Of course, you will remain under observation. You can read more about this under the heading: 'What does your follow-up procedure look like'.

Biopsies
Does the gynaecologist see an abnormality? Then the gynaecologist will take one or more pieces of tissue from the abnormal area using small forceps. This may hurt for a while. You will feel this less if you cough while taking the biopsy. The gynaecologist may also suggest removing the abnormal spot directly (see the information below on 'Lisexcision'). This is done with local anaesthetic.

The biopsy creates a small wound that may bleed. Sometimes the gynaecologist will dot the wound with silver nitrate to reduce bleeding. You will then feel some mild cramps at the bottom of the abdomen. Usually the bleeding is very light and using a sanitary towel is sufficient. The bleeding usually disappears on its own within a few days. Does it take longer or is it more than an ordinary period? If so, contact the clinic.

The pathologist examines the tissue under the microscope. The gynaecologist will call you after one to two weeks to give you the results.

What results can I expect?

The result of the cervical examination by the gynaecologist is expressed in CIN. CIN is an abbreviation of Cervical Intraepithelial Neoplasia.

Result Meaning
CIN 1 Slight abnormality
CIN 2 Moderate abnormality
CIN 3 Severe anomaly

Which rash requires treatment?

CIN 1:

  • no treatment is needed
  • the abnormal cells usually disappear on their own
  • follow-up smears do need to be taken to check this

CIN 2:

  • this sometimes requires treatment
  • These abnormal cells may also disappear on their own
  • the gynaecologist gives a recommendation to wait or treat. She/he will take into account your age and whether you still want to have children

CIN 3:

  • gynaecologist recommends treatment
  • chances are slim that the abnormality will disappear on its own
  • Do the results of your smear test and the findings of the colposcopy fit a CIN 3 abnormality? If so, the gynaecologist may decide not to take biopsies, but to perform immediate treatment (lisexcision)

What treatment is possible?

Possible treatments after colposcopy are:

  • Lisexcision
  • Conisation

Reimbursement and prices

Your visit to Parkway Clinic Sommer is regularly reimbursed in the same way as a visit to the hospital. For this, check our fees page or if you have any questions, take contact with us.

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