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Colposcopy


Expert reviewer, Mr Robin Crawford, Consultant Gynaecologist
Next review due January 2022

A colposcopy is a simple test to have a detailed look at your cervix (the neck of your womb). It’s usually offered to women who have had an abnormal result from a smear test (cervical screening). The colposcopy test allows the doctor or nurse to look more closely at the abnormal or precancerous cells in your cervix.

Image showing the cervix and transformation zone

Why would I need to have a colposcopy?

You will be offered a colposcopy if your smear (cervical screening test) has indicated that you’re at increased risk of cervical cancer. Cervical screening is offered to all women 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.

During 2019, HPV (human papillomavirus) primary testing is being introduced across the UK. This means the cell sample from your cervical screening will be tested for high-risk HPV first. This type of HPV 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.

Under the new system, you will be offered a colposcopy if you’ve tested positive for HPV and your sample also shows some abnormal cell changes. Previously, HPV wasn’t routinely tested for, and you may have been offered a colposcopy depending on how severe the cell changes were.

You may also be offered a colposcopy if you’ve had three samples classed as being ‘inadequate’ in a row. Inadequate means the cells aren’t clear enough to make an assessment, or there has been a problem with the way the sample was taken. You might also be referred for a colposcopy outside of the normal NHS screening programme if you’ve had symptoms of cervical cancer.

If you’ve had an abnormal cervical screening result, the clinic should send you clear written information about your results and what they mean. They will invite you for a colposcopy and should explain exactly what will happen during your appointment.

What happens during a colposcopy?

A colposcopy takes about 20 minutes and is usually done in a colposcopy clinic as an out-patient procedure. This means you have the examination and go home the same day. You can bring a friend or relative with you if you’d like to.

The procedure is done by a health professional called a colposcopist – this is a doctor or a specialist nurse who has been trained in colposcopy. They’ll take some time to talk to you about the results of your cervical screening test when you get to the clinic. You’ll also have a chance to discuss any concerns you might have.

Once you’re ready, you’ll be asked to undress from the waist down. You’ll be given a sheet to cover yourself. You’ll need to lie on your back on a special couch 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 gently hold open your vagina. They’ll then 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 look at the cells on your cervix. The colposcope will stay outside your body the whole time.

During the examination, your colposcopist may take a biopsy (small piece of tissue) from your cervix to be tested. The biopsy can be a bit uncomfortable. Let your colposcopist know if you do have any discomfort.

The biopsy will be sent to a laboratory for testing. The results will then be sent back to your doctor.

What treatment might I need?

If you have abnormal or precancerous cells, you’ll be offered treatment to remove them. Your doctor may be able to remove any abnormal cells during your first colposcopy appointment. This is called a ’see-and-treat’ appointment. You’re more likely to be offered this if you have moderate or severe changes in your cells. Your clinic will tell you in your invitation letter if you’re going to be offered treatment during your colposcopy, and provide you with information about what to expect. You’ll need to give your consent before any treatment, so talk to your doctor if there’s anything you’re unsure about.

If you need treatment and don’t have a ‘see-and-treat’ appointment, your doctor will arrange for you to have any abnormal cells removed at a second appointment.

The treatment you’re offered will depend on how severe the changes in your cells are, and how far into your cervix they go. Your doctor will advise which option is best for you. The main types of treatment are listed below.

  • LLETZ (large loop excision of the transformation zone). This is the most common treatment used in the UK. LLETZ uses a small wire loop with an electric current passing through it, to cut away the abnormal cells from your cervix. You’ll usually have it under local anaesthesia.
  • NETZ (needlepoint excision of the transformation zone). This is similar to a LLETZ, but a needle is used to cut away the tissue.
  • Cryotherapy. This is involves freezing the affected area of your cervix, to destroy the abnormal cells.
  • Laser treatment (or laser ablation). This treatment uses a laser to cut out abnormal cells or destroy them.
  • Cold coagulation. Despite the name of this procedure, it involves using a heated probe to destroy any abnormal cells.
  • Cone biopsy. This is a procedure to remove a cone-shaped wedge from the cervix. You may also have this if the abnormal cells go far up into your cervix. Cone biopsy is done under general rather than local anaesthetic.

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What to expect afterwards

You should feel fine straight after your procedure and will be able to go home when you feel ready. If you’ve had a treatment, you might have a bit of pain after a couple of hours, when the local anaesthetic has worn off. 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, so you’ll need to wear a sanitary pad. If you had a treatment too, this may continue for two to four weeks. You may also notice some dark material on your pad (it can look a bit like coffee grounds). This is just the fluid that your doctor used during the examination, so it’s nothing to worry about.

Don’t have sex, use tampons or use medication for your vagina until any bleeding has stopped. If you’ve had treatment, you should also avoid swimming for a couple of weeks. You should be able to drive and can go back to doing light exercise and other daily activities as normal.

You should usually find out the results of your colposcopy within about four weeks. You may be asked to go back to the hospital for an appointment to get your results, or they may be sent to you in the post. Your doctor will also tell you if they recommend any further treatment.

Complications of colposcopy

Complications are problems that occur during or after an examination or procedure. The most common complications of colposcopy include the following.

  • Pain in your lower abdomen (tummy) or pelvis.
  • 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).

Contact the colposcopy clinic for advice if you have these, or any other problems after your procedure.

Frequently asked questions

  • A colposcopy can be done when you’re on your period, but some clinics prefer not to carry out the examination at this time. Your invitation letter should give you information about this. If you’re not sure, phone your clinic as soon as you think you might have your period that day to rearrange your appointment.

  • If you’re pregnant, you can safely have a colposcopy – but sometimes the colposcopy clinic may advise you to delay it until after you’ve had your baby. If you know or think you could be pregnant, it’s important to let the clinic know before you go for your appointment.

    Routine cervical screening tests are usually postponed when you’re pregnant. If you have an abnormal result from a cervical screening test and have since found out you’re pregnant, your doctor will advise you when to have a colposcopy.

    • If you have only mild cell changes, you’ll usually be asked to have your colposcopy after you’ve had your baby.
    • If you have moderate or severe changes, your doctor may advise you to have a colposcopy while you’re pregnant. If it’s still early in your pregnancy, they may ask you to come back for a second one later on in your pregnancy too.

    Your doctor will usually aim to postpone taking a biopsy or having any treatment until after you’ve had your baby. But sometimes this needs to be done while you’re still pregnant. If your doctor does recommend this, they’ll explain why, what is involved and how they will minimise any risks to you and your baby.


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Related information

    • Colposcopy and cervical treatments. PatientPlus. www.patient.info, last checked 2 February 2016
    • NHS cervical screening programme. Colposcopy and programme management. Public Health England. gov.uk, March 2016
    • Cervical screening. Medscape. emedicine.medscape.com, last updated 27 November 2017
    • Cervical screening. Primary HPV testing. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised September 2017
    • What GPs need to know about the introduction of primary HPV testing in cervical screening. Public Health England (PHE) screening. phescreening.blog.gov.uk, 14 June 2017
    • What happens after cervical screening. Jo's Cervical Cancer Trust. www.jostrust.org.uk, last updated 23 October 2018
    • Colposcopy. Cancer Research UK. www.cancerresearchuk.org, last reviewed 6 June 2017
    • Going for colposcopy. Jo's Cervical Cancer Trust. www.jostrust.org.uk, last updated 22 January 2016
    • Tests done at colposcopy. Jo's Cervical Cancer Trustwww.jostrust.org.uk, last updated 22 January 2016
    • Treatment of abnormal cervical cells. Jo's Cervical Cancer Trust. www.jostrust.org.uk, last updated 2 May 2017
  • Reviewed by Pippa Coulter, Freelance Health Editor, January 2019
    Expert reviewer, Mr Robin Crawford, Consultant Gynaecologist
    Next review due January 2022



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