Colposcopy

Colposcopy is performed in the procedure room where the doctor examines your cervix/vulva with a microscope often because your pap smear is abnormal or other clinical symptoms. The procedure involves the passing of a speculum similar to when you have pap smear and a solution is applied to your cervix/vulva to show where the abnormal cells are. A small pinch of tissue may be obtained with biopsy forceps.

As the biopsy is so small it is usually not recommended to use a local anaesthetic as the injection would be worse than the actual biopsy. If you are extremely nervous about this however, consider being accompanied by a friend and you can be provided with Temazepam as a pre-medicationif requested by either yourself or your doctor. However, this needs to be organised with my staff prior to your colposcopy appointment. It is not recommended for this procedure, except in exceptional circumstances. The procedure takes approximately 5 to 10 minutes.

Information on abnormal pap smears

At the cervix there are cells on the surface and cells within the cervical canal. The surface cells are flat and those in the canal are tall and mucous secreting. At the level of the junction the tall cells change to flat cells and this is called the transformation zone and the process is known as metaplasia. 15% of women have atypical metaplasia whilst about three percent have dysplasia or more bizarre cells. Dysplasia over two to tens years leads to pre-cancer and pre-cancer over two to five years leads to invasive cancer. In some 50% of cases however there may often be spontaneous regression. To decide where you are in this scale you need to have a colposcopic examination which often requires a small biopsy. Only some 50% of people will require treatment and this is usually done here in the rooms with the benefit of you having a pre-medication and local anaesthetic. Following treatment you will require a further pap smear in four months with view to colposcopic review in six months and then be returned to your General Practitioner.

There are three questions generally asked about this condition and they are:-

What is it?

80% of women have been exposed on the basis of DNA hybridisation or DNA probing to wart virus DNA. That is, that there is evidence of wart virus DNA in the cells shed from the genital tract. However, only 15% have atypical cells and the answer is that there must be some other trigger factors. Smoking has been included and there is a three-fold increase in severe grades of dysplasia in smokers versus non-smokers. Chronic infection may play a part. Altered immunity such as people on immunosuppressant medication and perhaps more loosely related. Stress can pre-dispose to the development of odd cells. There may be a genetic background which is a strong family history of the same. There may well be some problem within the male semen as some males have had successive partners who have ultimately developed cancer of the cervix.

Will it go away?

There is a 5% re-occurrence rate of these conditions following treatment which may relate to incomplete treatment of a new process developing because one must remember the same conditions usually persist that pre-disposed to the development of the condition in the first instance.

Where does it come from?

This is often a difficult question and until relatively recently it was emphasised that this condition is sexually transmitted. Certainly wart virus can be transmitted by intercourse but its transmission can not be prevented using barrier methods of contraception. Wart virus, we also believe however, can be transmitted by contact with any of the following:- other people's clothing, toilet seats, towels, it has been found on babies, it has been found in girls that have never had intercourse and it has been described in the nostrils and the lungs of doctors involved in treating these conditions by either diathermy or laser when the smoke that is transmitted at the time of treatment is not removed from the area by suction. Obviously this condition is not completely understood but nevertheless the main emphasis is that in the majority of instances people do not have cancer and never will have cancer but have warning signs and the aim of this information is to reassure you that with caref ul surveillance all will be well.