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COLPOSCOPY

What is colposcopy?

Colposcopy is the examination of the cervix with a microscope called a “colposcope”. Colposcopy is recommended for examining the cervix when there is an abnormal smear or the presence of a persistent HPV infection. It also allows the vagina and the vulva to be examined.

While the smear is a good screening test, colposcopy enables any lesions on the cervix, vagina and vulva to be visualised and samples, called “biopsies”, to be taken of abnormal tissue. The laboratory analysis of these fragments of abnormal tissue enable a definitive diagnosis to be made and appropriate treatment to be planned.

What preparation is necessary before colposcopy?

Colposcopy cannot be carried out during the period or other bleeding. If you are tense, contact your doctor who will prescribe a relaxant before the examination to make the colposcopy proceed more smoothly. However, it is important to realise that colposcopy is a painless examination that is performed after the insertion of a speculum, which allows access to the cervix. The microscope is situated outside the vagina (approx. 30 cm away). Other than the speculum, no instrument is introduced into the vagina or the cervix during this procedure. Colposcopy is a rapid examination which lasts from 5 to 10 minutes, depending on the physician´s experience.

How is colposcopy carried out?

A speculum is inserted in the vagina to part the walls of the vagina and gain access to the cervix. The cervix is then washed with physiological serum and a solution applied to the cervix to visualise the abnormal zones, which then appear white. The colposcope is placed at the entrance to the vagina so that the cervix can be visualised at various magnifications. If this white coloration appears abnormal, the doctor takes biopsies. The biopsies are very small pieces of tissue and generally this is not painful. The tissue sample is sent to the laboratory to confirm a diagnosis and thus determine whether treatment is necessary. If the biopsy should cause any bleeding, the doctor may apply a substance or perform a cauterisation to stop the bleeding. This cauterisation can be slightly painful. If so, some bleeding can occur after colposcopy for one to two days.

What needs to be done after this examination?

Protection may sometimes be needed for the next two days as the marker solution used may cause secretions, or bleeding may result from the biopsies. Sometimes, discomfort or, exceptionally, pain may occur. You are recommended to avoid major physical exertion in the 24 hours following the biopsy, and abstinence from sex for three days is preferable. Likewise, you are recommended not to bathe for the three days following biopsies. These precautions are suggested to reduce the risk of bleeding and infection. However, the majority of women who resume their normal life after biopsies do not have any problems. Do not hesitate to contact your doctor if you have an abnormal discharge or persistent bleeding following a colposcopy.

Waiting for results and follow-up

After receiving the results of the biopsies, the doctor will contact you to advise you what to do next. Do not hesitate to contact him if you do not hear anything.

Depending on your results, the doctor will recommend that you continue with simple follow-ups or will, in some cases, ask you to make an appointment to see him for a check-up three to six months later, if the biopsy results do not reveal any abnormalities requiring treatment. He will certainly ask to see you if the abnormalities are significant or persistent.

What treatments are available?

Treatment is not always necessary and depends on the seriousness of the diagnosis. The objective is to remove the lesion observed under colposcopy, i.e. the zone containing abnormal cells, usually infected with papillomavirus. This treatment can consist of destroying the lesion if it is only on the surface and completely accessible.

If the abnormalities are in the cervix, it may be possible to excise them. Treatments are carried out under local anaesthetic, usually as an outpatient procedure. They are preferably carried out during colposcopy.

The types of treatment most often used are:

• laser therapy, which burns the surface and the entire depth of the abnormal zone;
• electro-cauterisation, in which the abnormal section is destroyed in a less defined way;
• loop electrosurgical excision procedure (LEEP) in which a cone-shaped piece of tissue containing the abnormal sectors is removed from the cervix, using an appropriately-sized loop.

Cone biopsy can be done with either a laser or a scalpel.

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