If a Pap smear is abnormal, the next step is usually colposcopy. A colposcopy is a microscopic examination of the cervix done in the office. While a Pap smear randomly samples cells, colposcopy allows the gynecologist to inspect the surface of the cervix under magnification so that the area of the abnormality can be visualized and biopsied.
No special preparation is needed.
After you are brought to the examination room, you will be asked to undress from the waist down. A speculum is placed in the vagina and acetic acid (vinegar) is placed on the cervix to enhance visualization. This will smell like vinegar and feel cold and wet, but otherwise has no effects. The physician will then look at your cervix through a microscope. If any areas of concerns are detected, a tiny sample of tissue will be removed for analysis. Local anesthetic gel will be applied to your cervix prior to a biopsy.
Most women are aware of a momentary pinch or cramp, but some women feel nothing. Medication will then be applied to the cervix to prevent bleeding. The entire procedure takes about 10 minutes.
Most women feel fine immediately after the procedure and can return to their daily routine. Some women experience cramping, but it is unusual for the cramping to be severe. Some bleeding is expected, but it is usually minimal. You may use a tampon or a pad. The medication applied to your cervix is called Monsels paste and looks like dark mustard or peanut butter. It may come out at a day or two after the procedure and is sometimes blood-tinged or dark and crusty.
If a biopsy is not required, the results of the colposcopy will be discussed with you immediately after the procedure. If a biopsy is taken, results take approximately one week. Your doctor will call you as soon as results are received. If you have not heard from us in one week, please contact us.
Possible results are as follows:
Treatment is never based on a Pap smear alone. A colposcopy is required to determine the appropriate course of action. Treatment recommendations are then determined by the extent and severity of the dysplasia.
How long does colposcopy take?
The procedure usually takes 10-15 minutes.
What if I am bleeding at the time of the procedure?
This procedure should be done when you are not menstruating. If you are having continuous bleeding or spotting (non-menstrual), check with your doctor about the best time to have your colposcopy.
What if I have a tendency to pass out?
Some women do get light-headed or pass out during any gynecologic procedure. If this is the case, please be sure to EAT PRIOR TO YOUR ARRIVAL. Inform your doctor that you have a tendency to faint. If, during the procedure, you feel light-headed, nauseated, or ill, tell your doctor immediately.
How did I get dysplasia?
Dysplasia is almost always the result of infection with a virus known as Human Papilloma Virus, or HPV. HPV is a sexually transmitted virus, which is why cervical cancer is considered to be a sexually transmitted disease.
Keep in mind that that an HPV exposure could have occurred years before dysplasia shows up and may have nothing to do with a current partner.
Almost all women with cancer have HPV, but most women with HPV never get dysplasia or cancer. HPV is extremely common; some studies show that it is present in the cervixes of almost 80% of sexually active women. There are over 100 subtypes of HPV, and some types are more likely to progress to cancer than other subtypes. It is increasingly common to check the HPV subtype of women with abnormal Pap smears to determine their risk of progression to a more serious condition. The vast majority of women with HPV don't get significant dysplasia or cancer.
High-risk HPV subtypes are more likely to progress than low-risk groups. Cigarette smoking significantly increases the risk that women will have dysplasia in the presence of HPV. Breakdown products of cigarette smoke such as nicotine have been found in cervical mucous, and are considered to be carcinogens.
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