Colposcopy

What is a colposcopy and when do I need one?

A colposcopy is a procedure to examine your cervix and vagina. A device called a colposcope is positioned outside your vagina, where it gives your doctor an illuminated and magnified view of the outside of your cervix and the tissues lining your vagina.

The team at Westmoreland Obstetrics and Gynecologic Associates may perform a colposcopy to diagnose and treat bleeding, polyps, and genital warts. However, they most often use colposcopy to examine your cervix when you have abnormal cells on a pap smear done to screen for cervical cancer.

What is cervical cancer screening?

Cervical cancer screening is used to find abnormal changes in the cells of the cervix that could lead to cancer. Screening includes the Pap test and, for some women, testing for a virus called human papillomavirus (HPV) (see FAQ085 "Cervical Cancer Screening").

What causes abnormal cervical cancer screening test results?

The main cause of cervical cancer is infection with HPV. There are many types of HPV. Some types have been linked to cancer of the cervix, vulva, vagina, anus, and penis. Some also can cause cancer of the head and neck. These types of HPV are known as “high-risk” types. Most cases of cervical cancer are caused by just two high-risk types of HPV—type 16 and type 18. Cells that are infected with HPV appear different from normal cells under a microscope. Abnormal changes can be mild, or they can be more serious. The more serious changes can lead to cancer if not treated (see FAQ191 "Human Papillomavirus [HPV] Vaccination").

When you have an abnormal Pap smear, it means your sample contained some abnormal or unusual cells, referred to as Squamous Intraepithelial Lesion or SIL. “Squamous” refers to the type of cells that make up the tissue that covers the cervix. SIL is not a diagnosis of precancer or cancer. The Pap test is a screening test. It cannot tell exactly how severe the changes are in cervical cells. A cervical biopsy is needed to find out whether precancer or cancer actually is present. A biopsy may be performed during the colposcopy to determine the degree of “dysplasia” or abnormality.

Cervical intraepithelial lesion (CIN) is used to report cervical biopsy results. CIN describes the actual changes in cervical cells. CIN is graded as 1, 2, or 3. CIN 1 is used for mild (low-grade) changes in the cells that usually go away on their own without treatment. CIN 2 is used for moderate changes. CIN 3 is used for more severe (high-grade) changes. Moderate and high-grade changes can progress to cancer. For this reason, they may be described as “precancer”.

What testing is needed after an abnormal cervical cancer screening test result?

If you have an abnormal cervical cancer screening test result, you may need further testing. The following tests may be done depending on your age and your initial Pap test result :

Repeat Pap test or co-test

A repeat Pap test or a repeat co-test (Pap test and a test for high-risk types of HPV) is recommended as a follow-up to some abnormal test results. These repeat tests may be done in 1 year or in 3 years depending on your initial test result, your age, and the results of previous tests.

HPV test

An HPV test looks for the presence of the HPV types that have been linked to cervical cancer. An HPV test can be done on the same cells used for the initial Pap test. This is called reflex HPV testing. There is another kind of HPV test that looks specifically for HPV type 16 and HPV type 18. These two types cause the most cases of cervical cancer. This kind of HPV test is called HPV typing.

Colposcopy, biopsy, and endocervical sampling

Colposcopy is an exam of the cervix with a magnifying device. If an area of abnormal cells is seen, your health care provider may decide that a cervical biopsy is needed. For a biopsy, the health care provider removes a small sample of tissue and sends it to a lab for testing. The lab tests can determine whether CIN is present and, if so, what grade it is. Endocervical sampling also may be done. A small brush or other instrument is used to take a tissue sample from the cervical canal.

What Happens during a colposcopy?

Your doctor at Westmoreland Obstetrics and Gynecologic Associates swabs a liquid over your cervix that makes it easier to see abnormal tissues. If any unusual tissues or growths are identified, they’re biopsied and sent back to the lab to determine the degree of abnormality, or dysplasia.

Once the biopsy returns, depending on the degree of dysplasia, your doctor may recommend\ one of these techniques to remove the area with and surrounding the abnormal cells:

• Loop electrosurgical excision procedure (LEEP)
• Conization or cone biopsy
• Laser ablation
• Cryotherapy

If you’re due for a Pap test or you need to schedule a well-woman exam, call Westmoreland Obstetrics and Gynecologic Associates or used the online booking feature.