The Colposcopy examination
When women receive an abnormal test result they may be asked to attend for a colposcopy examination for further investigation.
“Colposcopy is a simple examination that allows the doctor to see the type and area of the abnormality on your cervix. It also lets the doctor decide if you need treatment.”(NHS Cancer Screening Programme – The Colposcopy Examination 2012)
The examination is similar to a cervical screening test, but it involves a more detailed look at the cervix. A magnifying device, called a colposcope, is used to examine the cervix and to see the area of abnormal cells more clearly. The colposcope does not go in to your body.
A small sample of the abnormal cells (a biopsy about the size of a pinhead) may also be taken during the examination to assess the stage of the abnormal cells.
The colposcopy and biopsy will enable doctors to assess whether the cell changes are Cervical Intra-epithelial Neoplasia (CIN). CIN means abnormal cells found on the surface of the cervix. The cell changes are classed as CIN1, CIN2 or CIN3. This classification is used to indicate how far from the surface of the cervix the abnormality extends.Treatment is usually given to remove CIN2 or CIN3 abnormal cells. It is done in the outpatient colposcopy clinic, sometimes the same time as the examination.
We talked to women about their experiences of the colposcopy examination.
Some of the women we interviewed had had several colposcopy examinations over a number of years without needing treatment. Others had treatment performed at their colposcopy examination (see other topics in 'Treatment and side effects').
Describes her experience of the colposcopy examination.
Then you come back in and you sit on a sort of short couch and that, when you're sitting on it you slide your bottom down to the end of it and your legs are put in kind of like people, one imagines people used to be delivered of child, your knees are hooked over a support so your knees are in the air and then the couch is raised and the doctor sits at the end of it. There's, where I have mine there's a TV camera system so that the examination, the inside of your vagina, whatever, is shown on the screen in rather gory detail which you can or you may, don't have to look at. And if you want, what is seen can be explained to you on the screen.
I've had varying kind of responses, sometimes I feel I'd rather not look at that and sometimes I have a look at it and it's shown to me what, what it means. There are often, because this is a teaching hospital where I go, often medical students present and I'm always asked if that's okay and I always say it is okay as it's very important for them to have learning experience, particularly important to be with a very good doctor who has very good way of handling patients in that situation.
And the procedure is there's an insertion of a spatula I think to take a smear and later there's an application of a solution of vinegar to the walls of the vagina because I think that solution helps the, show up the cellular formulation. May be it comes before the smear does it, I think it comes while it's looked at on the camera and that stings a little bit but only, only mildly it's quite bearable.
And it's very brief and I think there's a nurse attending who slightly mops you up if you need mopping up and you slide, the couch is lowered, you slide off it and go next door and get dressed and then come back and talk to the doctor again and another appointment is made if you need one. And you're told that you'll get the results of the examination in a couple of weeks. Sometimes that happens, sometimes it doesn't.
Describes her experience of her colposcopy examination and biopsy.
It was not an unpleasant experience. The clinic was situated in the maternity unit. It was very calm, it was very well organised. I imagined I'd be kept hanging about for a long time because one generally is on this sort of visit. But once I'd registered my presence I was told there'd be a 15 minute wait or so, I was probably early. And I had a cup of tea and was called in due course.
I was then taken into a separate waiting room from the main waiting room for that particular clinic. I was the only patient there along with a secretary and other administration staff I suppose. A bright, cheery pleasant room, lots to read on the walls and was then introduced to the nurse, before the doctor, who took me through what was going to happen and asked me if I had any worries, about the procedure rather than the condition, or potential condition. And then went in for the treatment after a short while. It was very organised, very easy, friendly, they were very caring.
The doctor was superb as was the nurse, just the two of them in the room. They offered to let me see the cervix on the video screen. I declined that, I felt that was more than I needed to see at that stage. I did say I might look afterwards but didn't need to see the procedure taking place. I was told that it wouldn't be painful, just uncomfortable perhaps. When the biopsy was taken I believe there was some dye used at one stage and when the biopsy was taken it would be like a little pressure or prick but in fact I didn't feel a thing.
It was all very civilised for an undignified condition. And the good thing was I was assured by the doctor at that stage that she didn't feel there was a problem there at all. She said it looked all very healthy and it really wasn't, she said she would be very, very, very surprised had there proved to be a problem in the long term. So I came out of there feeling very positive and, well pleased with the result I suppose.
Describes her experience of the colposcopy and biopsy.
Again it was an, you went into hospital even though it wasn't under a general anaesthetic in a treatment room type area. I think in some respects also the fact that I was quite concerned about it being possibly painful is the fact that when you have a general anaesthetic you don't know what happens to you.
So with a colposcopy it's a bit like a smear but it takes longer. So you're there with your legs in the air sort of feeling very vulnerable, quite exposed and the doctor is sort of, rather than a smear it's over and done with in quite a relatively short period of time. The colposcopy they have to really make sure they can focus on the cervix so therefore you've got the speculum in which is quite uncomfortable and they may need to tweak it around a bit so you're sort of trying to relax as much as possible. And once they actually can see the cervix they paint something on it which shows up the abnormal areas, sort of like a vinegary type solution which does sting slightly. So, and you're just anticipating the next sort of thing, so it's quite nerve-wracking even though they try to reassure you.
And then when they take the colposcopy it is, it is like taking a little nick out of the skin and again you're anticipating that and you read about it, so you know it's coming. Perhaps it's best not to know I don't know and that point it is, as with anything if you get a slight pinch it is quite ooh, ow. And then afterwards you bleed a little a bit. Fortunately I didn't bleed a great deal, but you sort of then, sort of feel right bleeding for a bit, a while afterwards so a bit of discomfort. But I think it's how undignified the whole thing is really and you can't get away from it. You know there's no, you know you're sort of, you're under a general anaesthetic, you don't care whether your legs are akimbo and everybody is staring but when you're actually there it's sort of a little bit more embarrassing really.
Kim describes her experience of colposcopy.
During the colposcopy examination, women sit on a special type of chair which has padded supports where they can rest their legs. The chair is then tilted backwards. Several women we talked to felt embarrassed that they had to undress and have their legs on the padded supports, but many found the nurses and doctor put them at ease and explained what they were doing at each stage of the procedure. Many women said the examination was not as bad as they had imagined, others said it was worse than they expected.
The colposcopy examination was much better than Laura had expected.
The colposcopy examination and biopsy was different to what she expected and she felt traumatised.
I didn't approve of it but because the consultant, well I think you've got no choice. I was in there for about 45 minutes and then things the consultant said to me they was going to do turned out wrong. Because what he said to me was I didn't see what I had done and I had to get undressed behind the screen and then there was three consultants in the room and one nurse, me and my partner. He said he'd give me a little spray to numb the area which also was a lie because it turned out to be an injection which I'm not keen on but it was done anyway. It lasted about 20 minutes, he took a biopsy and told me to stay off my feet for a couple of days, come and get the result in 4 weeks which I was so traumatised by I didn't turn up for the results.
Solutions of iodine and acetic acid are applied to the cervix, which are used to highlight the abnormal cells on the cervix. Some women said they felt a stinging sensation, others said they did not feel anything when these liquids were applied.
She did not feel any discomfort when the iodine solution was put on her cervix.
Yes the nurse did pretty much actually yeah she did she said "Right this is what I'm going to be doing now” and, that's when she said "because you can have a look," and I was going "No it's okay." She did, she did explain what she was doing now and that she was, that's right yeah because she said "Right I'm going to be colouring," they use some sort of dye so that the abnormal cells stand out, they must catch the colour so that you can actually see them. So that's what she said "I'm putting some dye on," she said "it may a sting a bit," which it didn't at all, which was quite a relief. I thought I don't ever remember stinging and it didn't, so that wasn't a problem.
At some colposcopy clinics, women can choose to view the examination on a TV screen. This was reassuring for some women and enabled them to take their mind off the procedure. Others chose not to look at the screen. One woman found it upsetting.
Some women did find it painful to have a biopsy taken; others experienced only a little discomfort or none at all.
Having a biopsy taken was painful.
Oh it's so difficult because you're trying to remain relaxed because you've got to be relaxed. At the same time you feel so wound up and tense and you know that it could hurt, you don't know whether it's going to hurt. And I just thought, I just want to grab somebody and hang onto them, so she was just sort of holding onto my hands sort of looking up at the ceiling.
But you can just feel, you know things inside you sort of, it was like a really bad period pain but not, because my usual period pains seem to go sort of across the abdomen, this seemed to go right through you, you know right up you. And I think oh it was just not nice. Yeah it was just, and even though the colposcopist had said you know "It won't hurt because the cervix area doesn't really have that many nerve endings," you still can feel that sort of part of you is being taken out. Well I was quite sensitive and oh that hurts. And she said "Oh well I can't do another one then, if that hurt then it would hurt even more to do another one."
Yes and then you sort of, and everything then taken out and you feel quite tender because you've been held open really and that was uncomfortable. But at least they give you time sort of, and it only took 10 minutes but it just felt forever.
She did not feel any discomfort or pain when her biopsy was taken.
She was going to take away the piece of skin, flesh, whatever you want to call it. So muscles all tensed back up again thinking this is it, I'm going to feel this, she's going to cut me and I'm going to feel it but she sprayed some mild anaesthetic on it and I didn't feel a thing. It was over and done with. She said "It is so minute," she said "I can hardly see it," because the nurse had the jar there ready for it to go into liquid and preservative or whatever. I didn't look, I couldn't bear to look but she said it is so minute and that was the end of it.
A spray is sometimes used to numb the area before taking the biopsy and some women found this painful or uncomfortable. After the biopsy several women said they had some bleeding for a short while and a few experienced cramps. This is normal and women advised others to take sanitary towels to the appointment.
After their appointment several women felt emotional, others felt relieved and positive. A few women mentioned that it was helpful to have someone accompany them to their appointment.
She felt drained physically and emotionally for a few hours after her colposcopy examination.
Apart from weak, you know I'd been sort of so on edge for so long and that sudden rush of emotion I came home, had a cup of tea, I mean the pain just continued for so, it was like you know just a period pain that just went on for an incredibly long time. So a couple of Neurofen and I just felt so tired so I just went to sleep, slept for four hours, woke up and felt really drained physically, emotionally. So I just watched TV, It was so dull you know Ready, Steady, Cook that kind of, and I thought I really must eat something. And that was the other thing there was no sort of, you just, I didn't want to eat, didn't really want to drink anything, wanted to just vegetate and not thinking about anything else.
Explains that she felt very emotional after her first colposcopy examination.
Afterwards I drove, I drove there, I had a car and I drove there and when that was over, even though it wasn't too bad when I got back to the car I was like in shock I think and I sort of burst into tears and I was sitting at the steering wheel going "I can't drive," and I was shaking. Only because I find it, it's quite invasive and it's quite a traumatic thing and because I'm so sort of prudish and squeamish and it's all sort of, it's quite an emotional thing even though nothing really horrible happens it's just suddenly it sort of hits you I think but I wasn't actually that bad the second time I think.
At the colposcopy examination, “The doctor may be able to tell you what is wrong and what treatment, if any, is needed. But often, especially if you have had a biopsy, you will not be given a definite diagnosis immediately after the examination. It will take a week or two before you get the results of the biopsy". (NHS Cancer Screening Programme – The Colposcopy Examination 2012).
For more information on CIN see our section ‘Cervical abnormalities: CIN3 and CGIN'.
Last reviewed October 2015.
Last updated October 2015.