COLPOSCOPY
When The Pap Smear Suggests The Need For Further Evaluation
|
| |||||||||||||||||||||||||
|
||||||||||||||||||||||||||
|
| Gynecology | |
General Information
Is it Safe?
What Happens/Does it Hurt?
How Much Does it Cost?
Where Do I Go?
How Do I Prepare
Results
What Treatments are done?
The Pap smear is a screening test designed to detect
very early changes, which
over a long period of time, may result in cancer of the cervix.
While cancer of the cervix is very rare in
the college population, if the Pap
smear is abnormal a second test
(colposcopy) is usually required to take a better look. Colposcopy
also allows the clinician to treat any abnormalities that are seen. It is
believed that nearly all abnormalities that progress to cancer are associated
with HPV infection (but the vast majority of
HPV infections do NOT progress to cancer).
Colposcopy is the direct magnified inspection of the surface of a woman's genital area, including the cervix, vagina, and vulva using a light source and a binocular microscope (see picture). During colposcopy small tissue samples (biopsies) may be collected from affected sites on the cervix.
If abnormal cells are identified, the treatment is usually freezing (cryotherapy). This is usually done by the colposcopist at a subsequent visit.
The colposcopy, biopsies and cryotherapy are relatively minor office procedures with minimal discomfort which is provided at Rutgers University Health Services. Occasionally, a different method of treatment (e.g. loop excision) is required and referral to another physician outside of the Health Service will be necessary.
The is a very safe office procedure. Risks include bleeding, infection, and pelvic or abdominal pain. If you are pregnant, colposcopy may cause complications with the pregnancy including early labor.
What actually happens (and will it hurt)?:
You will be asked to remove your undergarments and then lie down on an
examination table with your legs placed in stirrups (the same procedure as for a
Pap smear). A speculum
will be inserted (the same as in a Pap smear) to open the vaginal walls and
allow the cervix to be
seen. The speculum will remain in place for the duration of the exam -
which may take up to 30 minutes.
Next a
magnifying lens is used (see picture above). A small amount of saline
(salt water) may be placed into the vagina to moisten the surface. The
saline may feel cool.
Then an acetic acid preparation (vinegar) may be applied to your
cervix. This may also feel cool, and there may be a slight stinging
sensation.
Sometimes additional special stains may be required to better check for abnormalities. An iodine based solution is most commonly used, which again, may feel cool but will not burn.
If any abnormalities are seen or suspected, a biopsy will be taken. You may feel a pinch and some discomfort for several seconds. It is also possible that a gentle scraping (curettage) of the cervical canal may be done that can cause a cramping sensation.
Small amounts of bleeding may occur for 3-5 days following the procedure. It is recommended that you wear a sanitary pad during this period.
It is important to drink lots of fluids while the discharge is present, especially water, and fluids and solids containing generous amounts of potassium, such as citrus fruits and juices, bananas, and raisins. Cut back on beverages containing caffeine.
Colposcopy is provided by Rutgers University Health Services free to all full-time students and those who have paid their activity fees. Most laboratory testing (e.g. biopsies) is also covered by the basic insurance that is provided to full-time students. If an unusually large amount of testing is required, or if a referral to an outside specialist is necessary, then the student may incur a charge.
Hurtado Health Center - Room 216
- Schedule the exam when you are not menstruating.
- Avoid douching, sexual intercourse, vaginal medications, and tampons for
24 hours prior to the exam.
- Eat regularly and consider taking 400 mg of ibuprofen (e.g. 2 Advil) one hour prior to a colposcopy visit and 800 mg of ibuprofen one hour prior to a cryotherapy session.
The colposcopist will be able to give you some information while you are still in the office. Results of biopsies or other tests usually take 2-3 weeks. You will be contacted by phone or letter when the results are ready.
Please remember that it is important to have your next Pap smear approximately 6 months after your colposcopy.
After the biopsy results are reviewed and coordinated with other clinical information, a decision is made about treatment. Options include:
- "Watchful waiting" - this used when the results are
mildly abnormal and it is likely that over a period of months to years your
immune system may cure the HPV infection and heal the damage. If used,
you must stay in medical care (best with us) and get 2-3 Pap smears
within the year. If indicated, repeat colposcopy may be needed.
- Cryotherapy - this is a freezing
technique which is applied to the surface of the cervix to remove the
abnormal areas. The procedure itself takes about 15 minutes and may be
accompanied by some cramping. A rather profuse watery
vaginal discharge starts within an hour after the treatment. It may be
slightly yellow in color. It gradually thickens and becomes darker as it
slows, and should stop completely in 2-4 weeks. For the first two weeks, use a
sanitary pad and avoid intercourse. Discharge persisting after four weeks is not normal and, if
it does persist, you should be examined promptly by the colposcopist at Hurtado, to determine what further treatment,
if any, is required. The discharge should never be bloody, contain pus,
or be foul smelling.
Loop Electro Excision Procedure (LEEP) - this is a procedure done by an outside specialist whereby part of the cervix is sliced away. It is used when cryotherapy is not an appropriate treatment. If necessary, Rutgers University Health Services will refer you to the specialist.
For more information, contact your health care provider.
Last Modified 12.22.2005