Having a colposcopy

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What is this information about?

This information is about having a colposcopy. It explains: 

• the reasons why we invite people to have a colposcopy
• what happens when you have a colposcopy
• what happens if we take a biopsy (small tissue sample), or you have treatment at the same appointment as your colposcopy
• what might happen and what you should do, and not do, after you have had your colposcopy
• what the side effects of a treatment called LLETZ (large loop excision of transformation zone) may be. Some people have a LLETZ at the same appointment as their colposcopy.
• who you can contact if you would like further information and support after you have read this information.

Why have I been given this information?

You have been given this information because we have invited you to an appointment to have a colposcopy. Reading this information will help you to prepare for your colposcopy and to know what will happen during and after it.  

What is a colposcopy?

A colposcopy is a test to take a closer look at your cervix. The cervix is the opening to your womb from your vagina.

Why do I need a Colposcopy?

We have invited you to have a colposcopy because of the result of your last cervical screening test (‘smear test’). This could be for any of these reasons:   

• we found that you have an infection with human papillomavirus (HPV) and some abnormal cells in your cervical screening test sample
• you have an HPV infection which has not gone away
• you have had several screening tests where we could not give you a result. It is likely there is nothing wrong, but a colposcopy can tell for sure.
• The doctor or the nurse who carried out your screening test:
  • thought your cervix did not look as healthy as it should and needed a further check. For example, they found a cervical polyp (a small growth of tissue from your cervix which can be benign but some of which could develop to be cancer) or symptomatic cervical erosion (a red and often raw looking area on the outer surface of the cervix. Many people have this. It is not a cervical cancer).
  • they could not see your cervix clearly enough or take a sample that could be tested
  • you have had bleeding after having sex or in between your periods.

What is Human Papilloma Virus (HPV)?

• HPV is a virus that 8 in 10 people will get during their lifetime.  
• It is passed on during sexual contact. 
• In most cases, our immune system clears HPV within two years without it causing any problems.

For some people with HPV there may be at risk of their cells changing. They can sometimes change into cancer cells, so the changes need to be checked and sometimes treated.

About your colposcopy appointment

Can I bring someone with me to my colposcopy appointment?

 Yes. You are very welcome to bring someone with you to your appointment for support. If you have any concerns or anxiety about your appointment, please contact the Colposcopy Coordinator when you get this information.

I would prefer a female healthcare professional to do my colposcopy. Who should I contact to arrange this?

Please phone the Colposcopy Coordinator when you get this information. The contact number is on your appointment letter and at the end of this information. Be aware, we may have to change the date of your appointment to make sure a female healthcare professional can see you.

Do I have to stay in hospital (be admitted) when I have my colposcopy?

No. You will visit the hospital as an outpatient.

How long is my appointment visit likely to be?

A colposcopy usually takes around 20 minutes.  

Can I still have my colposcopy appointment if it is my period or I am pregnant?

Yes, you can usually still have your colposcopy if it is your period or you are pregnant.

• Periods (menstruation). You can still have your colposcopy appointment unless your period is very heavy.
• Pregnancy. It is safe to have a colposcopy if you are pregnant. Please phone the Colposcopy Coordinator to let them know that you are pregnant. If you cannot call for any reason do still come for your appointment.

What will happen at my colposcopy?

The first part of the colposcopy is like having a cervical screening test. You may find having a colposcopy slightly uncomfortable.

• You will be asked to undress from the waist down and lie or sit on a special chair or couch for the examination. You will have a paper sheet or towel to cover the lower part of your tummy (lower abdomen) and hips.

• A speculum is then put into your vagina. This opens the passage of your vagina enough to let us see your cervix.

• The colposcopist, will take a closer look at your cervix using a magnifying lens and a light (a colposcope). A colposcopist is a health professional that is qualified in doing colposcopies. They may be a Nurse, Surgical Care Practitioner, Specialist Registrar or Consultant.

• While the colposcopist is looking at your cervix, they will put either one or two liquid solutions on to it. These are very diluted (‘watered-down’) acetic acid and iodine. They help to make any abnormal cells show-up.

• If any areas of your cervix look unusual the colposcopist may remove a small sample of tissue (biopsy). This may be sent for tests to help decide if you need treatment in the future, or you may be offered treatment on the day.

• We may take photographs of your cervix. These are to help other specialists to diagnose what condition you may have and what treatment you may need. They will be kept as part of your medical records.

What does it mean when I am asked for my ‘consent’ before I have my colposcopy or other procedures?

Before you have your Colposcopy, we must tell you (inform you) why we think you need the treatment. We will explain: 

• what the benefits of having the treatment might be
• what the risks of having the treatment might be
• whether there are any other treatments and how suitable they might be for you
• what might happen if you decide not to have treatment

We tell you these things to help you to decide whether the treatment is the best thing for you and whether you want to have it. The final decision about whether to have the treatment is yours. 

Once you know about the treatment, we will ask you whether you agree to have it (consent to it). It is important that you understand what you are agreeing to. If you do not understand anything about the treatment do ask.

We may ask you to tell us that you consent to have the treatment by either speaking with us (giving verbal consent) or by signing a consent form.

What do I need to know about having a cervical biopsy?

The colposcopist may need to take a very small sample of tissue (biopsy) from your cervix. This is sent to the laboratory. They will do tests that help us to tell if you have a condition and what it might be.

After the biopsy it is likely that you will bleed from your cervix. This may be like a light period and could last for a few days. We advise that you do not have sexual intercourse (vaginal sex) whilst your cervix is still bleeding. This is to reduce the chance that you may get an infection.

We will provide you with a sanitary pad or you may wish to bring your own. Please wear underwear that will hold this in place, not a thong.

What is loop excision treatment and when might I have it?

You may be offered treatment at your appointment if you have been sent (referred) for a colposcopy because your cervical screening test showed that you have cells which could become cancer if not treated. This is known as a high-grade abnormality or sometimes ‘pre-cancerous cells’.

The treatment is called a LLETZ (large loop excision of transformation zone). It aims to remove abnormal cells from your cervix.

What happens if I have a LLETZ?

A local anaesthetic will be injected into your cervix. This numbs the area so that you should not feel any pain during the treatment. After a few minutes, once the anaesthetic has worked, a very fine wire loop is used to remove the abnormal cells. The treatment is usually quick and painless.

The treatment usually takes about 10 minutes. We may ask you to wait for a short time after your appointment to make sure you are well enough to leave the department.

The tissue (area of abnormal cells) that has been removed will be sent to the laboratory for tests. The results will be sent to you in the post when they are ready. This usually takes 4 weeks.

After your LLETZ

• It is usual to have some bleeding (like a period) or a discharge from your vagina after a LLETZ. This can carry on for up to four weeks after your LLETZ.

We will provide you with a sanitary pad or you may wish to bring your own. Please wear underwear that will hold this in place, not a thong.  

• Do go home and rest for a while if possible and do not return to work on the day of the treatment if you do not have to.
• Most people do not get lower pelvic pain after their treatment. If you do have pain, which can feel like period cramps, take your usual painkillers such as paracetamol or ibuprofen. Follow the dose instructions on the packet.
• We advise that you do not have sexual intercourse (vaginal sex) whilst your cervix is still bleeding. This is to reduce the chance that you may get an infection. 
• Avoid any strenuous, high impact exercise for at least a week or longer if you are still bleeding.
• Avoid swimming for two weeks or longer if you are still bleeding. This is to reduce the chance that you might get an infection.

Will I have a follow-up appointment to check how well my treatment worked?

Yes. You will be asked to have a cervical screening test at your GP surgery six months after your treatment. A reminder will be sent nearer the time.

What are the possible risks or complications of having a LLETZ?

 The complications that people are most likely to get after a LLETZ are bleeding and infection.

• Bleeding. You may have bleeding for up to four weeks after your LLETZ. It is rare to get very heavy bleeding. If you get very heavy bleeding do go to A&E straightaway. If you are unable to get to A&E phone 999 for an ambulance.  
• Infection. Signs that you may have an infection include:
  • pain in the lower part of your tummy (lower abdomen)
  • thick, badly smelling or unusually coloured discharge (offensive discharge) from your vagina
  • heavy bleeding from your vagina when it is not your period.

What must I do if I become pregnant after I have had LLETZ?

What happens to my tissue samples (biopsy) after the colposcopy?

Your samples will be kept by the laboratory for at least 10 years.

Your results may be seen by staff who work elsewhere in the health service. This is so that they can make sure the service is as good as possible and improve the skills of specialist staff.

Where can I get further information and support or have any questions about my colposcopy answered after I have read this information?

What must I do if I am on blood thinning medication and I am due to have a colposcopy?

There is a low chance that having a colposcopy causes harmful blood loss, but the chance of this happening is greater if you are on blood thinning medication.

Please ensure you inform us prior to your appointment if you have: 

• A deep vein thrombosis (blood clot) in the last 6 weeks 
• A deep vein thrombosis (blood clot) related to cancer in the last 3 months
• A stroke in the last 12 months
• A heart attack in the last 12 months
• A cardiac stent inserted in the last 12 months 
• If you are taking 2 blood thinners at the same time
• If you take a blood thinner because of a mechanical heart valve
• If you take warfarin and your INR range is 2.5 – 3.5; or 3 – 4
• If you are taking dabigatran (we will need to advise you as below)

Anti Coagulation Therapy Guidance

Please see below the guidance for managing anticoagulation therapy prior to you attending for a procedure.

Apixaban / Edoxaban / Rivaroxaban:

• Take your last dose at least 48 hours before the procedure
  • (ie two full days without your blood thinner)
• Restart: Day after the procedure

Dabigatran:

• Please contact us if you are taking dabigatran. We will advise you when to stop your blood thinner:
• Group A (creatinine clearance >50ml/min):
• Take your last dose at least 48 hours before your procedure (ie two full days without your blood thinner)

• Group B (creatinine clearance <50ml/min):
• Take your last dose at least 96 hours before your procedure (ie four full days without your blood thinner)
• Restart:  Day after procedure (For both Groups A&B)

Warfarin:

** Please contact your health care provider that monitors and manages your blood thinning medication as soon as you have a date for your procedure. You should speak to them directly before stopping treatment as you may need heparin injections & advice on re-commencing treatment.

• You should stop taking warfarin 5 days before your appointment.
• The INR should be checked the day before / the day of your procedure and should be INR of 1.5 or less.
• If you take a blood thinner because of mechanical heart valves or your INR range is 2.5-3.5; or 3-4 you will need heparin injections before and after the procedure.
• Enoxaparin/ Dalteparin/ tinzaparin injections:
  • Take your last dose at least 24 hours before the procedure (ie one full day without your blood thinner)
  • Restart: Day after the procedure

Clopidogrel:

You should stop taking these 7 days prior to your appointment unless you have had a stroke or myocardial infarction (heart attack) and/or cardiac stent insertion within the last 12 months.  

Aspirin:

There is no need to stop aspirin before your procedure.

Reference:

Perioperative Bridging Guideline UHSussex (1MB pdf)

Who can I contact for further information or support after I have read this information?

Thank you for taking the time to read this information.

If it has not answered all your questions, please call your unit to speak with the Colposcopy Coordinator.

If they are unable to answer your query, they will ask a clinical member of the colposcopy team to return your call. They may be working within a clinic but will call you back as soon as possible.

Use the space below to write down any questions that you would like to ask the colposcopy team: (Please print off PDF version for this)

Are there any other sources of information about that you recommend?

 Yes. These are reliable sources of information:

• NHS screening – NHS (www.nhs.uk)
• Cancer Research UK