Expert Gynaecology Care in line with Medical Best Practices

The next step after having an abnormal cervical smear is often a colposcopy examination. This is nothing complicated and it is just an examination of the cervix with a “telescope” that magnifies it. The magnified cervix can be examined thoroughly for any precancer changes. It takes about 5 minutes and almost similar to having a smear test at the GP surgery. The examination is done on a couch which allows the legs to be elevated.

After the speculum is inserted to locate the cervix, it is gently washed with a mild acetic acid solution to clean all the mucous away and it also shows up any precancer areas as a pale white. These areas are carefully examined and a small “punch biopsy” may be taken from this white area. This biopsy takes a fraction of a second and in most cases the patient does not feel it being taken. There can be very light bleeding if a biopsy is taken. To stop this, the area is “touched-up” with a special stick which looks like a long match-stick. The chemical at the tip of this stick stops the bleeding. It is called silver nitrate cautery. It can cause a slight stinging sensation when it is being done. Therefore, even if a punch biopsy is being taken, it is not something to be apprehensive about.

The purpose of the punch biopsy is to confirm the degree of abnormality. It does not treat the precancer. Treatment is usually carried out with a procedure called loop biopsy (or sometimes referred to as LLETZ). This is described below. A loop biopsy is usually only carried out for high grade precancer. Low grade precancer usually does not require any treatment.

This usually only takes another 5 minutes to carry out during the colposcopy examination. It is done under local anaesthetic. The local anaesthetic is usually injected into the cervix and this usually is the only painful or uncomfortable part of it. The anaesthetic is usually injected into 4 separate spots on the cervix and is usually complete within 1 minute. The subsequent procedure is not painful. A small loop of thin wire is used to scoop away a superficial portion of the cervix using a special diathermy electric current. Once the sample is scooped away, the raw edges that are bleeding are then cauterised using the same special electric diathermy.

The specimen that is scooped away is sent for further testing and usually contains all the precancer that was causing the abnormal smear. Therefore, after this procedure, there is a 90% chance that the next smear in 6 months time will be normal.