Once you have undergone your cervical screening test (CST, as outlined in the first post in their blog series), you may need to be referred to a gynaecologist for further investigation. Usually this is due to the presence of a relevant human papillona virus (HPV) strain, or changes in the cells on the cervix. This can be concerning news to receive, and can cause anxiety; it’s important to remember that these results don’t necessarily indicate that you have cancer. They are a screening test, and indicate that further investigation is required; these additional investigations will guide ongoing management.

What is colposcopy?

A colposcopy is a detailed examination of the cervix, vagina, and vulva using a specialised instrument called a colposcope. A speculum is inserted to open up the vagina, to allow visualisation of the cervix at the top of the vagina – just like a normal CST. Once this is done, an instrument called a colposcope (which resembles a large microscope), is used to look more closely at the cervical cells. A solution is applied to the cervix that highlights any abnormal cervical cells, thereby making them more obvious to your gynaecologist. If there is the suspicion of abnormal cervical cells, a targeting sample of these may be taken to send to the pathology laboratory, to look at more closely under a normal microscope.

From your point-of-view, the procedure will feel like a cervical screening test, that takes a little bit longer. Colposcopy is typically performed by a gynaecologist or colposcopist.

Potential discomfort

While colposcopy is generally well-tolerated, some women may experience mild discomfort, or a sensation of pressure. It is important to communicate openly with your healthcare provider about any concerns or discomfort you may experience during the colposcopy: the procedure can be stopped at any time if you need.

Deciphering cervical intraepithelial neoplasia (CIN) changes

Cervical intraepithelial neoplasia (or CIN), is a classification used to describe pre-cancerous changes in the cervical cells. Features suggesting the presence of CIN can be identified during a colposcopy. Your gynaecologist can provide an educated guess as to the severity of the pre-cancerous changes of the cervical cells. However, a targeted biopsy of those abnormal cells will allow for definitive management, and guide the course of treatment.

LSIL = low grade squamous intraepithelial lesion = mild pre-cancerous changes

LSIL indicates mild abnormalities in the cervical cells. It is often associated with low-risk HPV infections. The good news is that LSIL changes may resolve on their own, and generally close monitoring (eg. an annual cervical screening test) is recommended, rather than immediate intervention (such as a colposcopic examination).

HSIL = high grade squamous intraepithelial lesion = moderate or severe pre-cancerous changes = a call for attention!

HSIL changes are more concerning, as they indicate a higher likelihood of progressing to cervical cancer if left untreated. It is important to know, these changes are not yet cancer. Early intervention is crucial to prevent the progression of HSIL to invasive cancer. If HSIL is present, your gynaecologist may recommend you undergo a minor surgical procedure to remove the affected area, to prevent the cells undergoing further change and progressing to cancer over time.

The importance of follow-up

Regardless of the colposcopy findings, regular follow-up appointments are essential. Monitoring changes in the cervical cells over time allows for timely intervention (if needed), and provides peace of mind for women navigating the intricacies of colposcopies and CIN.

A colposcopy may feel daunting, but it is a vital part of cervical health management. Understanding CIN changes empowers us to actively participate in our healthcare decisions. By collaborating with healthcare professionals, staying informed, and prioritising follow-up appointments, you can navigate the colposcopy experience with confidence, ensuring the best possible outcomes for your cervical health.

Frequently asked questions about colposcopy

How long does it take for pre-cancerous changes to the cervix to develop into cancer?

If left untreated, pre-cancerous cells can become cervical cancer cells. Generally, this can take 5 – 10 years. Factors that influence the speed and chance of cancerous change are the strain of HPV infection (more aggressive occurs faster, compared to more benign HPV strains which take longer), and the strength of your immune system. If your immune system is suppressed because of a pre-existing illness, medication, or an HIV infection, you may need to be screened more frequently to ensure pre-cancerous changes are picked up promptly.

Is there anything I can do to reduce my risk of cervical cancer?

• HPV vaccination: The most important way to reduce your risk of cervical cancer is to get the Gardasil vaccination, which protects you against HPV 16 and 18. By being vaccinated against HPV 16 and 18, you can protect yourself against 90% of cervical cancers, as well as other HPV-related cancers (such as anal cancer).
• Regular cervical screening tests: Take part in the National Cervical Screening Program, by having regular cervical screening tests which look for the presence of relevant HPV strains.
• Recognise and act upon concerning symptoms: It’s important to be aware of any symptoms that may be out of the ordinary, and mention them to your GP. Vaginal bleeding after sex, between periods, or after menopause can be an indication that you need more investigations, to ensure there is no abnormality on the cervix.
• Quit smoking: Smoking suppresses your immune system, and studies have shown that by quitting smoking, your immune system is more capable of getting rid of the HPV virus naturally.

Are there any risks to having a colposcopy?

The colposcopy examination is uncomfortable, but there are no risks associated with this. If a biopsy needs to be taken, there is a small risk of ongoing bleeding from the biopsy site, or (rarely) infection. You can expect to have some light bleeding or spotting for a couple of days after having a cervical biopsy taken. If you have more than this, or are concerned about your bleeding, reach out to the gynaecologist who performed your examination.

What can I expect after a colposcopy? Will I need time off work?

A colposcopy is essentially a long Pap smear. If a biopsy needs to be taken, you can expect a little bit of bleeding for a day or two, which may look black if mixed with one of the solutions which may be applied to your cervix to stop the bleeding (silver nitrate, or Monsell’s solution). It is advised that you don’t put anything (like tampons) in the vagina, or have penetrative sex, for a couple of days afterwards, to allow the area which has been biopsied to heal.

My gynaecologist took a cervical biopsy. How long does it take for the results to come back?

The cervical biopsy is sent to a pathology laboratory for them to look at the tissue sample under a microscope. These results (called histology), are generally reported back to the gynaecologist within a week or two. The histology result is married with the cervical screening test result, which will dictate the outcome and management plan.