The colposcope is a magnifying instrument with a light source that stays outside the vagina; it does not enter the body. Colposcopy is a diagnostic method, not a treatment: the aim is to determine the location and grade of changes in the cervix and to take a biopsy if necessary. Where needed, the vagina and the external genital area are also examined in the same way.
When is it performed?
- HPV 16 or 18 found at cervical cancer screening
- An abnormal Pap smear result
- HPV positivity that persists on a repeat test
- A suspicious appearance of the cervix noticed during an examination
How is it done?
On the examination table, a speculum is placed in the vagina and the cervix is examined with the colposcope. A dilute acetic acid (vinegar) solution and, if needed, an iodine solution are applied to the cervix; these make areas with changes easier to see. A mild burning or stinging sensation may be felt when the solution is applied. If a suspicious area is seen, a small tissue sample about the size of a pinhead (biopsy) is taken from it. If needed, a sample is also taken from inside the cervical canal (endocervical curettage). A brief pinching or cramping sensation may be felt during the biopsy. The procedure usually takes 15–20 minutes. The tissue is sent for pathological examination.
It is advised to avoid intercourse, vaginal medicines or creams and douching on the day before the procedure. A pregnancy, or the possibility of one, should be reported before the procedure.
Biopsy results
Biopsy results are usually reported according to the grade of the change:
- Low-grade change (LSIL / CIN 1): often regresses on its own; it is usually followed with regular check-ups rather than treated.
- High-grade change (HSIL / CIN 2–3): a precancerous change that may progress to cancer over the years if left untreated. Removal of the changed tissue is usually recommended. In pregnancy and in some young people, treatment may be postponed with close follow-up.
If cancer is found on biopsy, planning is done with a gynecologic oncology assessment.
Treatment options
- LEEP (loop excision): removal of the changed tissue with a thin wire loop carrying an electrical current. It is usually performed under local anesthesia of the cervix and takes a short time; in suitable cases, it can be done at the same visit as the colposcopy.
- Conization: removal of a larger, cone-shaped piece of tissue from the cervix. It may be preferred when a larger area needs to be removed and is mostly performed under anesthesia.
- Ablative methods: destruction of the changed tissue by freezing (cryotherapy), heat or laser. Because no tissue sample is obtained with these methods, they are used only in selected cases.
The removed tissue is sent for pathological examination, which assesses whether the change has been completely removed.
After the procedure and possible risks
After colposcopy and biopsy, mild period-like pain, light bleeding or dark discharge may occur for a few days. During this time, avoiding tampons, vaginal creams and intercourse is advised; the length of time depends on the extent of the procedure. Colposcopy and biopsy do not affect the ability to become pregnant or later pregnancies.
After LEEP and conization, bleeding and discharge may last a few weeks, and the recommended time before intercourse and tampon use is longer. Possible risks of these procedures include bleeding, infection and narrowing of the cervical canal. An increased risk of preterm birth in later pregnancies has been reported; this risk rises as more tissue is removed and when the procedure is repeated. For this reason, the amount of tissue to be removed is decided with the person’s pregnancy plans in mind.
Changes can come back after treatment. For this reason, people who have been treated are followed for many years with HPV-based check-ups.