Colposcopy is an outpatient procedure performed with the woman positioned on her back, legs in stirrups, and buttocks at the lower edge of the table (a position known as the lithotomy position). A speculum is inserted to open the vagina so that the cervix can be seen. The colposcope is a microscope that is placed outside the speculum (and outside the body) to see the cervix under magnification. Special solutions are used to paint the cervix to demonstrate any abnormal appearing areas. The solutions commonly used are 3-5% acetic acid and iodine. It is necessary to visualise an area on the cervix called the transformation zone where most precancerous and cancerous lesions arise.
Areas of the cervix which turn white after application of acetic acid or have an unusual pattern of blood vessels are abnormal. Application of iodine helps in highlighting these areas as they do not take the dark brown stain of the iodine. Colposcopy usually classifies the lesion as low grade and high grade.
Areas with the highest degree of visible abnormality are defined and biopsies taken. Most doctors and patients consider local anaesthesia unnecessary for the biopsy, but may be used to reduce discomfort. The raw areas after biopsy are cauterised with silver nitrate to control bleeding. Women can expect to have a thin grey discharge for up to several days after the procedure. The tissue obtained from the biopsy is sent for examination.
When the colposcopy appearances appear high grade, the abnormal appearing area can be treated if the individual has previously been counselled and has consented. This is done by a procedure known as LLETZ after giving local anaesthesia to the cervix.
LLETZ is the shortened name for the procedure Large Loop Excision of Transformation Zone. It is an outpatient procedure, the person undergoing the procedure can go home thereafter. It involves removing the abnormal areas on the transformation zone on the cervix using a thin, heated metal loop. The procedure is done with local anaesthesia and under colposcopic guidance. However, for very anxious individuals or where the procedure is expected to be difficult, it can be done in operating theatres under general anaesthesia. The tissue obtained is sent for examination.
Results of biopsy/ LLETZ
Abnormalities in the tissue sample obtained by either biopsy or LLETZ may be described as one or more of the following types:
HPV changes only with no pre-cancerous change
Precancerous changes are described as Cervical Intrepithelial Neoplasia (CIN)
- CIN 1 – one third of the thickness of the lining covering the cervix has abnormal cells
- CIN 2 – two thirds of the thickness of the lining covering the cervix has abnormal cells
- CIN 3 – the full thickness of the lining covering the cervix has abnormal cells
Precautions after a cervical biopsy or a cervical LLETZ
To help with healing, individuals are advised to take the following precautions, for 1 week after biopsy and for 4 weeks after LLETZ:
- Avoid swimming or bathing but can take a shower.
- Avoid use of tampons
- Avoid sexual intercourse
- Avoid strenuous exercise, such as weights training, jogging, bicycling, or horse riding
- Avoid vaginal douching
What happens next
When the biopsy shows HPV changes only, there is no immediate concern and no additional smears are required. The individual is returned to routine recall with the next smear in 3 years.
Where the biopsy shows CIN1 (the earliest of pre-cancerous changes), it is expected that the cells will recover in a year. Therefore, a cervical smear is repeatrd in one year. If this repeat smear is negative for high risk HPV, the individual is, thereafter, returned to routine 3 yearly screening.
For those who have had a LLETZ procedure with a report of CIN 1/2/3, a test of cure is done by a cervical smear after 6 months to test for high-risk HPV. If this smear is negative, the patient will return to routine 3 yearly screening.
How can Mr Alak Pal help
Mr Alak Pal can offer individuals the full care pathway from taking a smear through colposcopy if required, follow up smears and interim cervical smears for reassurance.
Find the nearest location
Patient seen for : Dilation and Curettage
Dr Alak Pal was great. He made me feel comfortable and explained everything clearly, including next steps. Would recommend.
Patient seen for : Hysteroscopy
Very professional and helpful in explaining everything. Helped me make an informed decision with this vast knowledge.
Patient seen for : Total Abdominal Hysterectomy
From the initial appointment, surgery, aftercare and to my final appointment, Mr Pal was extremely professional and understanding to my particular medical circumstances. The entire abdominal hysterectomy procedure was extremely satisfactory. He spent time listening to any concerns that I had and explained clearly and simply the process surrounding the surgery. I would highly recommend him for anyone contemplating such a procedure. Additionally, post-surgical care and appointments were excellent too.
Fantastic doctor, very pleased with consultation. Thanks