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Thank you for everything. I really appreciate you phoning to reassure me prior to my operation.... thank you again.

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Colposcopy

colposcopy diagram
Magnifying view of cervix with colposcope

This is a 5 to 10 minute painless procedure carried out to visualise the cervix under magnification and adequate light. The colposcope is simply a special microscope which is placed about a foot away from the vagina and allows the cervix to be seen in detail. The woman lies on a couch and the legs are supported. A speculum is inserted into the vagina (exactly similar to when the smear was taken).

Normal view of cervix
Normal view of cervix

The cervix is "washed" with a little acetic acid (vinegar) using a ball of cotton and this shows up any abnormal precancerous areas within a minute as white patches. With experience it is possible to correlate the degree of precancerous change (mild/moderate/severe) according to the density of the white patches. Occasionally, the cervix will be washed with some iodine solution and this will also help to differentiate the normal from abnormal areas.

Cervix with precancerous abnormality
Precancerous abnormality shows up as white

Before the patient has the colposcopy examination, consent is obtained and there is usually a brief discussion about the possible findings and what is to be done about them. For instance, if the colposcopy referral is because of a low grade smear abnormality (borderline or mild) then prior to the examination the discussion is about taking a small punch biopsy to confirm the diagnosis. If the referral is for a high grade smear abnormality then the woman may be given the option of either having an initial small punch biopsy to confirm the diagnosis or a larger biopsy under local anaesthetic which will also act as treatment and get rid of the precancerous abnormality thus saving a second trip.

Punch Biopsy

Punch biopsy of cervix
Punch biopsy of cervix

A special long instrument is used to take a tiny "bite" from one of the abnormal looking patches. This "bite" is about the size of a pinhead, ie, small. It takes a fraction of a second and there is minimal discomfort if any. There is usually slight bleeding from the site which is stopped by applying a special chemical and some pressure with a cotton-tip bud. This biopsy is sent away to be looked at under the microscope and the results are usually available within 2 to 3 weeks.

 

 

 Loop Biopsy

In order to remove the precancerous abnormality completely a slightly bigger biopsy is taken under local anaesthetic. This procedure takes about 5 minutes and is very well tolerated by almost all patients. After identifying the abnormal areas (white patches), some local anaesthetic is injected into the cervix. This is the only aspect of the procedure that is briefly uncomfortable.

loop biopsy of the cervix
Loop biopsy of the cervix

A small loop of wire is then used to slice away a thin layer of the surface of the skin. This piece is then sent away to be looked at under the microscope and the result is usually available within 2 to 3 weeks. In the majority of cases it simply confirms the same degree of abnormality that was initially suspected in the smear, ie precancer and NOT cancer!

Immediately after the thin layer slice is taken, the raw surface is cauterised using a technique that does not hurt. The blood loss from this procedure is usually less than a syringe full. Patients are normally told that following this procedure, there is a 95% chance that the abnormal smear will have been treated. Hence there is a 5% chance that the smear will still remain abnormal! The patient is therefore advised to have more regular smears such as every year for a few years rather than every 3 years.

Loop biopsy of the cervix
Loop biopsy of the cervix

Things to avoid

After a loop biopsy you will be advised to avoid penetrative sexual intercourse for 4 weeks and also avoid the use of any tampons for a similar duration. The reason for this is to prevent any infection of the raw surface that has just been cauterised. In the event of infection taking place there is a risk of very heavy, torrential bleeding which requires urgent medical attention.

It is normal to have some mild irregular bleeding or discharge after this procedure and this can last anything from 2 to 6 weeks. It is also normal to experience mild crampy discomfort for about 24 to 48 hours which resolves with paracetamol.

Long term effects of loop biopsy

This biopsy does not cause infertility or difficulty in getting pregnant. However, large studies have shown a minimal increase in the risk of miscarriage especially if more than one loop biopsy has been carried out in your lifetime. As stated, this increased risk is minimal. The vast majority of women who have had this loop biopsy go on to have normal pregnancies.

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