Colposcopy: when the Pap test is abnormal

Why do I have abnormal cells?

Abnormal cells may be caused by the human papilloma virus (HPV). HPV tests are not done automatically.

Why do a colposcopy?

A colposcopy is a procedure to learn more about any anomalies detected in a Pap test, including:

  • Non-suspect cells for which no further action is required
  • Abnormal cells that require monitoring but not immediate treatment because these lesions will likely disappear on their own
  • Abnormal cells that require immediate treatment

How is a colposcopy done and what should I monitor afterward?

A colposcopy allows the physician to examine the cervix with a microscope. Applying vinegar increases the contrast between abnormal cells and normal cells. When a zone is deemed abnormal, the physician may do a biopsy, which involves taking a tissue sample of the cervix. The doctor may also do a curettage inside the cervix to obtain additional information that will help determine any further treatment required. The sensation you experience during a colposcopy may be similar to that experienced during the Pap test. In the event that a biopsy or curettage is performed, you may feel cramps similar to menstrual cramps. Minor bleeding is also possible.

If you undergo a biopsy or curettage, you should not use tampons or insert anything in the vagina until the bleeding stops. You might also have an abnormal discharge after a solution is applied to control bleeding. Plan to use a sanitary pad.

What happens after the colposcopy?

Test results are usually available within a maximum period of four weeks. You will receive a phone call from a nurse at the clinic to inform you of your doctor’s decision regarding what action to take. All patients will receive a call, even if your results are normal. If you do not receive news in the two months following your colposcopy, you should call us.

Depending on the results and the condition of your cervix during the colposcopy, the doctor may recommend one of the following:

  • Nothing more, as you do not need a further check-up or treatment
  • Monitoring via colposcopy, to ensure the stability or healing of abnormal cells
  • Treatment, because the cells are sufficiently worrisome to warrant treatment

How the treatment will proceed

Several types of treatments are available for abnormal cells that must be removed. The one you undergo depends on your case and which treatments are available in your area.

Loop Electrosurgical Excision Procedure (LEEP)

LEEP is one of the more common treatments, involving a small metal wire that uses a weak electric current to remove abnormal cells. The treatment takes about ten minutes. You should not insert anything in the vagina for a month afterward. It is normal to experience a liquid discharge from the vagina, along with minor bleeding that can be as abundant as your period for up to ten days.

Laser

The part of your cervix containing the abnormal cells is frozen via an injection similar to what a dentist uses for your teeth. The laser is then used to burn off the abnormal cells.

Cryotherapy

A freezing probe is placed on the cervix for about five minutes, in order to kill the abnormal cells by freezing them.

Cold knife conization (scalpel)

This is a surgical treatment performed in a hospital operating room under general anesthesia. A scalpel is used to remove a cone-shaped sample of tissue from the cervix. Among other reasons, this technique is used when the abnormal cells are found inside the cervix.

What should I watch for after the treatment?

You should call the clinic or go to the emergency if you have any of the following symptoms:

  • Pain that is not relieved by acetaminophen or ibuprofen
  • A vaginal discharge that contains pus or is bad-smelling
  • Blood clots
  • A temperature of more than 38.5 °C

What happens after my treatment?

If you undergo LEEP or cold knife conization, the tissue sample is sent to a laboratory for analysis.

In the case of LEEP or cold knife cone biopsy, the doctor will see you again six weeks after your treatment, to ensure proper healing and discuss the results with you. One or more follow-up colposcopies will often be required. Retreatment is rare, but possible.

It is important to show up for these appointments, to ensure that no precancerous cells were overlooked and you are fully cured.

What if it is cancer?

It is very unlikely but not impossible that an abnormal Pap test result is confirmed to be cancer. If the results of your colposcopy indicate cancer, you will be referred to a gynecologic oncologist for treatment.

Other resources:
Public education Web site of The Society of Obstetricians and Gynaecologists of Canada

Public education Web site Web of the Society of Canadian Colposcopists

This leaflet was inspired by the brochure from the Society of Obstetricians and Gynaecologists of Canada