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Colposcopy

Expert reviewer, Mr Robin Crawford, Consultant Gynaecologist
Next review due May 2024

A colposcopy is a simple procedure to have a detailed look at your cervix (the neck of your womb) and vagina. It can help to identify abnormal cells that may be more likely to turn into cancer. These can then be removed or treated, reducing your risk of developing cervical cancer.

Image showing the cervix and transformation zone

Why would I need to have a colposcopy?

You’ll be offered a colposcopy if your cervical screening test (‘smear’) has shown that you’re at increased risk of cervical cancer.

Cervical screening is offered to anyone with a cervix aged between 25 and 64 in the UK. It involves taking a sample of cells from an area of your cervix called the transformation zone, where most abnormal cell changes are seen. The cells are tested for HPV (human papillomavirus). This is a virus that can cause abnormal changes in the cells in your cervix. If the test shows up positive for HPV, the sample will also be checked for abnormal cell changes. You may be offered a colposcopy for one of the following reasons.

  • You’ve tested positive for HPV infection and your sample also shows some abnormal cell changes.
  • You’ve tested positive for HPV infection, and it hasn’t gone away after two years – even if you haven’t had abnormal cell changes.
  • You’ve had two cervical screening samples classed as being ‘inadequate’ in a row. Inadequate means the cells aren’t clear enough to assess them, or there has been a problem with the way the sample was taken.
  • The nurse or doctor who carried out your cervical screening test noticed changes in the appearance of your cervix.
  • You’ve had symptoms of cervical cancer and been referred for a colposcopy by your doctor.

A colposcopy allows a doctor or nurse to have a closer look at abnormal cells in your cervix. It can help identify cells that may be more likely to develop into cancer. Your doctor or nurse may also be able to remove or treat abnormal cells during the colposcopy.

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Preparing for colposcopy

If you’re invited for a colposcopy, you’ll be given information to explain exactly what will happen during your appointment. The clinic will tell you if you’re likely to need any treatment during your colposcopy. A colposcopy is usually done in a colposcopy clinic as an out-patient procedure. This means you have the examination and go home the same day. If you would prefer a female nurse or doctor to carry out your colposcopy, you should contact your clinic to request this.

If you think you may have your period on the day of your colposcopy, contact your clinic. You may still be able to have the colposcopy when you’re on your period. But some clinics prefer to rearrange it to another time.

If you’re pregnant or think you could be, let the clinic know before your appointment. It’s usually still fine to have a colposcopy during pregnancy, but it’s important that the clinic knows. If you need treatment as part of your colposcopy, they may advise you to delay it until after you’ve had your baby.

You can eat and drink as usual before a colposcopy. Some clinics may advise you not to have sex for at least 24 hours before your appointment. You might also be asked not to use creams or lubricants in your vagina beforehand. It’s best to follow any advice you’ve been given by your clinic on this. You may want to bring a panty liner or sanitary pad to use afterwards, as it’s common to have some discharge or light bleeding.

What happens during a colposcopy?

When you get to the clinic, you’ll meet the doctor or nurse carrying out your colposcopy (the colposcopist). They’ll talk to you about why you’ve been invited for a colposcopy and what to expect. Do tell your colposcopist if you’re feeling nervous or worried. They’ll be able to reassure and support you.

Once you’re ready, your colposcopist will give you a private area where you can undress from the waist down. They may give you a paper sheet to cover yourself with. You’ll need to lie on your back on the bed with your feet drawn up and your knees bent and apart. There may be supports for your legs or feet.

Your colposcopist will use a piece of equipment called a speculum to hold open your vagina. They usually put special solutions on the surface of your cervix to show up any abnormal cells more clearly. The colposcopist will use a colposcope (a special type of microscope) to have a detailed look at your cervix. The colposcope will stay outside your body the whole time. Your colposcopist will look through the colposcope and get a close-up view of the cells in your cervix.

During the examination, your colposcopist may take a biopsy (small piece of tissue) from your cervix to be tested. The biopsy will be sent to a laboratory for testing and the results sent to your doctor.

The examination and the biopsy, if you have one, can be a bit uncomfortable. Some people also find it a little painful. Let your colposcopist know if you do have any discomfort, and they’ll try to make it more comfortable for you.

Colposcopy treatments

If abnormal cells are found at your colposcopy, you may be offered treatment to remove them. Whether or not you’re offered treatment depends on the ‘grade’ of the cells (how likely they are to develop into cancer).

If your colposcopist can tell that you need treatment during your colonoscopy, they may be able to remove the cells straightaway. This is called a ’see-and-treat’ appointment. Your clinic should tell you before your appointment if this is a possibility, and explain what treatment will involve. You’ll need to give your consent beforehand, so talk to your colposcopist if there’s anything you’re unsure about. If you have abnormal cells but don’t have treatment at your first colposcopy appointment, you’ll be invited back for a second appointment later.

The treatment you’re offered will depend on a number of factors. These include how severe the changes in your cells are, and how far into your cervix they go. The main types of treatment include the following.

  • LLETZ (large loop excision of the transformation zone). This is the most common treatment. It uses a small wire loop with an electric current passing through it, to remove the abnormal cells from your cervix. You’ll usually have it under local anaesthesia, which means you’ll be awake but the area being treated will be numb.
  • NETZ or SWETZ (needlepoint or straight wire excision of the transformation zone). These are similar to LLETZ, but a needle or straight wire is used to cut away the tissue. You may have this if the abnormal cells are deeper into your cervical canal.
  • Cone biopsy. This is a minor operation to remove a cone-shaped piece of tissue from your cervix. It’s done under general rather than local anaesthesia, and you may need to stay in hospital overnight.

Sometimes other treatments are used to get rid of abnormal cells. These aren’t used as often, but they may include the following.

  • Cryotherapy. This involves freezing the affected area of your cervix to destroy the abnormal cells.
  • Laser treatment (or laser ablation). This treatment uses a laser to burn away abnormal cells.
  • Cold coagulation. Despite the name of this procedure, it involves using a heated probe to destroy any abnormal cells.

What to expect after a colposcopy

How you’ll feel after your colposcopy will depend on whether you’ve just had an examination, or if you’ve had a biopsy or treatment too.

After a colposcopy, you’ll usually be able to go home as soon as you feel ready. You may feel well enough to go about your normal day-to-day activities – including driving and light exercise – straightaway. Take some time to rest if you need to though. If you’ve had treatment, you might have some pain for a couple of days afterwards. This can feel a bit like period pain. You can take ordinary over-the-counter painkillers for this.

You might have some spotting and light discharge for around three to five days after your colposcopy, especially if you had a biopsy. If you had treatment, you may experience heavier bleeding for up to four weeks. You may also notice discharge from your vagina that looks a bit like coffee granules. This is very normal as you start to heal. Don’t have sex, use tampons or swim until any bleeding or discharge has stopped. You shouldn’t use any medications, creams or lubricants for your vagina until any bleeding has stopped too.

Colposcopy biopsy results

Your colposcopist may be able to tell you if they found anything during their examination straightaway. But if you had a biopsy, this will need to be sent to a laboratory for testing. You’ll usually receive your biopsy results within about four weeks, but it can sometimes take a bit longer. These may be sent to you in the post, or you may be contacted by the clinic. Your doctor will also tell you if they recommend any further treatment.

Complications of colposcopy

Complications are problems that may occur during or after your colposcopy. The most common complications of colposcopy include the following.

  • Pain in your lower abdomen (tummy) or pelvis. Some pain is to be expected for a couple of days. But if it continues or is severe, speak to the clinic or your GP.
  • Heavy bleeding. Some bleeding is normal after a colposcopy and especially if you have treatment. But if it gets particularly heavy, you should seek advice.
  • Infection. This can be a risk if you’ve had a treatment such as LLETZ. Signs of an infection include vaginal discharge that smells bad or unusual, and having a fever (high temperature).

There may be particular risks associated with different treatments too. Your colposcopist will go through these with you before you agree to any treatment.

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Related information

    • Colposcopy and cervical treatments. PatientPlus. patient.info, last checked 2 February 2016
    • Cervical screening: having a colposcopy. Public Health England. www.gov.uk, updated 15 January 2020
    • About colposcopy. Jo's Cervical Cancer Trust. www.jostrust.org.uk, last updated 19 May 2020
    • Cervical screening: programme overview. Public Health England. www.gov.uk, last updated 17 March 2021
    • About cervical screening. Jo's Cervical Cancer Trust. www.jostrust.org.uk, last updated 9 September 2020
    • What happens at cervical screening? Jo's Cervical Cancer Trust. www.jostrust.org.uk, last updated 14 June 2020
    • The cervix. Jo's Cervical Cancer Trust. www.jostrust.org.uk, updated 9 July 2020
    • Cervical screening: programme and colposcopy management. Public Health England. www.gov.uk, last updated 5 February 2020
    • Your colposcopy appointment. Jo's Cervical Cancer Trust. www.jostrust.org.uk, last updated 2 July 2020
    • Treating cervical cell changes. Jo's Cervical Cancer Trust. www.jostrust.org.uk, last updated 12 June 2020
    • Treatment if you have abnormal cervical cells. Cancer Research UK. www.cancerresearchuk.org, last reviewed 5 March 2020
    • Colposcopy results. Jo's Cervical Cancer Trust. www.jostrust.org.uk, last updated 13 May 2020
    • Cervical Screening Programme, England - 2019–20. Official Statistics, National Statistics. NHS Digital. digital.nhs.uk, published 26 November 2020
  • Reviewed by Pippa Coulter, Freelance Health Editor, May 2021
    Expert reviewer, Mr Robin Crawford, Consultant Gynaecologist
    Next review due May 2024

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