Routine Screening with Pap Smears
A pap smear is a screening test that is usually performed at an annual gynecology exam. Pap smears look for changes in the cervix associated with the human papilloma virus (HPV). HPV can cause genital warts and cervicitis (inflammation of the cervix). In rare cases, infection with HPV can lead to cervical cancer.
Pathologists analyze cervical cells from the pap smear and report the results as negative (no abnormalities), mild, moderate, or severe cellular changes. If the cells show mild changes, the laboratory will run an additional test looking for the presence of HPV. If the cervical cells have mild changes and HPV is detected, or if the changes are moderate or severe, a procedure called a colposcopy is recommended to diagnose the gravity of the condition. Colposcopy may also be used to investigate abnormalities of the vagina and vulva.
Preparing for a Colposcopy
Before your colposcopy procedure, do not put anything in the vagina (creams, douches, tampons) and abstain from intercourse for 24 hours. You may leave in contraceptive devices like the Nuvaring, but you may be asked to remove it before the procedure. Vaginal bleeding may make it difficult to collect adequate samples, so if you are bleeding on the day of your appointment, call the office to reschedule. If you are taking any medication to prevent blood clots (aspirin, warfarin, heparin, plavix), notify your healthcare provider in advance. These medications may increase bleeding with the procedure. Since some patients may experience cramping during the colposcopy, you may take Motrin/Ibuprofen 400-800 mg prior to the appointment. We also recommend that you eat prior to your appointment to avoid feeling lightheaded or dizzy.
The Colposcopy Procedure
A colposcopy procedure consists of two parts: a physical exam and, if necessary, biopsies of abnormal cervical tissue. Just like in a regular pelvic exam, the provider will insert a speculum to visualize the cervix. They will then apply an acetic acid solution (vinegar) to the cervix. Next, the provider will use an instrument called a colposcope to magnify cells on the cervix. The acetic acid solution reacts with components of abnormal cells, and when viewed with the colposcope, will highlight abnormal areas. The provider may choose to biopsy any abnormalities so a pathologist can examine the tissue sample. The biopsy can cause a pinching sensation. Usually, the provider will also sample the inner cervix because this area cannot be viewed using the colposcope. This can cause moderate cramping, similar to menstrual cramps. After the procedure, the provider will stop the bleeding with ferric subsulfate, a yellow liquid bandage, or silver nitrate. The colposcopy usually lasts about fifteen minutes.
After the Colposcopy
You may experience vaginal bleeding after the colposcopy, especially if the provider performs biopsies. If the liquid bandage solution is used, you may experience brown-yellow discharge that may resemble gauze, tissue, or coffee grounds. It is important to note that this type of discharge is normal and nothing is left in the vagina. The discharge will resolve in a few days. Any cramping experienced during the colposcopy will resolve in a couple of minutes. Most women can return to their normal activities immediately after the procedure.
Do not put anything in the vagina (creams, douches, tampons) and abstain from intercourse for 48 hours after the procedure.
If a biopsy is performed, the results are typically available ten to fourteen days following the procedure. Follow-up depends on the results of the biopsy. Most women can return for evaluation in four to six months. HPV is not a lifelong infection; usually, the virus is cleared by your immune system.
When to Seek Help After a Colposcopy
Call your clinician if you experience any of the following after the procedure:
•Heavy vaginal bleeding (soaking through a pad in an hour for two hours in a row)
•Vaginal bleeding for more than seven days
•A fever or chills
•Foul smelling vaginal discharge (keep in mind black/brown or coffee-ground discharge is normal for the first few days).
Colposcopy During Pregnancy
If you think you might be pregnant, notify your healthcare provider. Colposcopy is safe during pregnancy, but biopsies are usually not performed.
Please call our office if you have any questions about the procedure or your results. The American College for Colposcopy and Cervical Pathology (www.asccp.org) and the American Congress of Obstetrics and Gyneocology (www.acog.org) may provide helpful information.