INFORMATION FOR PATIENTS HAVING COLPOSCOPY

You are one of a special group of women who have a report of an inconclusive or abnormal PAP smear. About 3% of all women will develop these changes in a lifetime. You have been advised to have a colposcopy performed for more evaluation.

1. What is a Pap smear? A pap smear is a routine screening test done by your provider during a pelvic exam. The surface of the cervix (mouth or neck of the womb or uterus) is scraped with a spatula and the scraped-off cells from the cervix are fixed on a glass slide. This slide is called a pap smear and is sent to a special lab where it is processed and evaluated by highly trained technicians and doctors. By improvement in technique, the pap smear has become very sensitive in picking up early changes in the cervix. Consequently, we have many more patients with inconclusive or abnormal pap smears to evaluate than we had just a few years ago.

2. Does a report of inconclusive or abnormal pap smear mean you have cancer? Almost never!! The pap smear will detect early abnormal changes in the cells of the cervix long before cancer develops. This is the purpose of the pap smear. The majority of patients referred to the colposcopy clinic have a final diagnosis of either “mild to moderate dysplasia” or “normal” cervix. Mild to moderate dysplasia means that there are early changes in the cells of the surface layer of the cervix, which have a potential for developing into cancer many years from now. A few patients will have a diagnosis of carcinoma-in-situ. This condition is a little more advanced than severe dysplasia, but does not mean invasive cancer. It, too, has a potential for developing into invasive cancer, if left untreated.

3. How do you get a diagnosis or know what’s wrong? Specially trained providers use an instrument called a “colposcope” to examine your cervix carefully. The colposcope is similar to a microscope. It is attached to a floor stand and magnifies the cervix under a powerful beam of light. By using this instrument, the doctor can locate any suspicious areas on the surface of the cervix that are not visible to the naked eye. The provider will take small tissue samples (biopsies) from these areas. The specimens are sent to the pathology lab for processing and evaluation. Upon receipt of results of biopsy, you will be contacted by your provider who will then read the report and discuss the treatment advised.

4. Does a colposcopic examination cause pain? No. There is no pain associated with this examination.

5. Does taking a “small sample” of the cervix cause pain? Yes, though discomfort is probably a better word. Such discomfort is generally minimal and lasts only a few minutes. One of the biopsies includes going into the cervical canal and can cause cramps.

6. Are there any complications after cervical biopsy? Generally, complications are rare. You will have vaginal spotting of blood for a few days. Rarely, you may bleed heavier than a menstrual period within a few hours after having the biopsy. You should call your provider if you bleed excessively- more than one sanitary napkin/tampon per hour.

7. Will I be restricted in my activities after a cervical biopsy? No. You can carry on your normal activities, although you should avoid intercourse for 14 days while the cervix is healing.

8. What is a “mild to moderate” dysplasia diagnosis on a cervical biopsy? “Mild to moderate” dysplasia is the earliest abnormal change in the cells within the surface layer of the cervix. It has potential, if left untreated, of progressing to a more severe change after several years.

9. What is Carcinoma-in-situ? Carcinoma--in-situ is a more advanced lesion, affecting the cells within the surface layer of the cervix. However, it is not a true cancer. But if left untreated, it has the potential for developing into cancer. If you have carcinoma-in-situ you will be referred to a gynecologist for further treatment.

10. Can “mild to moderate” dysplasia be treated in the office? and how? The majority of patients with “mild to moderate” dysplasia can be treated with cryosurgery. This method is a way of treating the cervix. Because the abnormal cells are found in the surface layers of the cervix, the freezing technique destroys the surface layer, which is cast off. The cervix then will produce a new surface layer of normal cells. Think of the freezing as similar to a burn on the skin of your hand (without the pain). The surface layer is destroyed and cast off like a blister; then a new “skin” replaces the old.

11. Is cryosurgery painful? Generally not. It can cause mild cramping. Occasionally, it is accompanied by a temporary feeling of lightheadedness and flushing.

12. How long does it take? About ten to fifteen minutes in the examining room.

13. Does it ever have to be repeated? Yes. A second treatment is necessary in 10 to 20% of cases, if the changes persist.

14. What are the after effects of cryosurgery? You will have a very watery vaginal discharge for 2 to 6 weeks. This may be mixed with some blood. You may need to use many sanitary napkins during these first few weeks. However, cryosurgery will not affect your menstrual cycle or cause infertility. Complete healing of the cervix takes about 3 months.

15. Are there any restrictions to activities? You can carry-on your normal activities; however, you should avoid intercourse or douching for at least 2 weeks during the time of heavy watery discharge. The cervix is undergoing a healing process. Irritation to this area should be avoided, as bleeding can occur.