Why do I need a colposcopy?Pap smears are done to look for abnormal, or precancerous cells, on the cervix. The cervix is the lowest part of the uterus, and can be seen when a speculum is inserted into the vagina. A pap smear is obtained by brushing the surface of the cervix. If abnormal cells are seen on that sample it does not mean that you have, or will ever develop cervical cancer. But it means we need to take a closer look at the cervix. Colposcopy (‘kol-pas-co-pee’), often called "colpo" is a magnified examination of the cervix.
Why do I have abnormal cells on my cervix?
Abnormalities of the cervix are usually caused by HPV exposure. 80% of sexually active people eventually have some exposure to HPV, but it doesn’t always cause symptoms. Some strains of HPV cause changes to the cervix. Men can carry these strains, but since they don’t have a cervix, they won’t have any symptoms and will probably not know that they are a carrier. Other strains of HPV can cause genital warts, which occur in both women and men. The risk of new HPV exposure is highest when you have a new partner or if you have an ongoing partner who has other partners. Condoms decrease the risk of HPV transmission, but do not completely prevent transmission because HPV can be spread by contact with uncovered skin. Abstinence or monogamy is the best way to avoid HPV. Sometimes a colposcopy is done when high-risk HPV is detected or when the cervix looks abnormal, even if the pap smear is normal.
What to expect when you come in for your appointment:First, your history will be reviewed and you will have the opportunity to ask questions.
Then the exam will be done. Initially, it is similar to your routine gynecology exam:
- A speculum is inserted into the vagina
- The cervix is viewed through the magnifying lens of the colposcope
- Vinegar and iodine may be put on the cervix to help highlight abnormal areas
- Often a small piece of the abnormal area is removed and sent to the lab for further evaluation. This is called a biopsy.
- Medicine is then put on the cervix to stop any bleeding.
Will it hurt?The uncomfortable part of the exam is that the speculum needs to stay in for longer than it usually does with a pap smear. The exam takes 15-30 minutes. If biopsies are done, you may have some cramping or discomfort. Usually this only lasts a short time.
How to prepare:
- Schedule the exam to be done when you are not menstruating.
- No sexual intercourse, intravaginal medications or tampons for 24 hrs before colposcopy.
- You may take ibuprofen 600-800mg, with food, 1 hr before your appointment, to help with cramping during the exam.
Should I still get the HPV vaccine (Gardasil) if I already have changes on my cervix due to HPV exposure?Most women with abnormal cells on their cervix should still get the vaccine. There are many strains of HPV. Even if you’ve been exposed to several of them, the vaccine can help to protect you against any of the higher-risk strains that you haven’t already been exposed to. The vaccine will not cure the current cervical changes, but it will decrease the risk of having future problems from new HPV exposures.
- Vaginal rest (that means nothing in the vagina) for 48 hours – no sex, no tampons, no soaking in water (such as in a bath or pool), but showering is okay
- A small amount of spotting or discharge is normal – it’s a good idea to wear a pad or pantiliner for few days to protect your clothing
- Monitor for signs/symptoms of infection such as fever, pain or excessive discharge
- As long as you are feeling well, there are no restrictions to your activities
- A follow up appointment will be scheduled for approximately 2 weeks later, but you can return sooner if you have any problems or concerns
At your follow-up appointment we will review your results and decide on a plan for future care. Usually a healthy immune system eventually suppresses the HPV virus and clears up the abnormal cells. However, it may take 2-3 years to completely resolve. Until the abnormalities resolve, the changes on your cervix will need to be monitored with repeat pap smears. In a small percentage of women, the problem may not improve. Some women may require treatment to remove the abnormal cells (but most women do not need treatment). In addition to follow-up pap smears, sometimes the colposcopy needs to be repeated.
It is very important that you contact us if you are unable to come in for either your scheduled colposcopy or your follow-up appointment.
Rutgers Health Services 848-932-7402