Colposcopy
A colposcopy is a simple, close-up look at the cervix, usually recommended after a Cervical Screening Test shows a change that needs a further look. Dr Anu Mahadik performs colposcopy at Westmead and Kogarah and explains each step, so you know what to expect. An abnormal screening result is common and, in most cases, is nothing serious.
Overview
What a colposcopy is
A colposcopy lets a doctor look closely at the cervix using a colposcope — a lit magnifying instrument that works a bit like a pair of binoculars. The colposcope stays outside the body and does not touch you; it is only used to look. During the check, the doctor can see whether there are any changed cells on the cervix and where they are.
Most people have a colposcopy because a Cervical Screening Test has picked up the human papillomavirus (HPV) or a cell change that needs a closer look. It is worth remembering that an abnormal screening result does not mean cancer. It usually means an HPV infection or some early cell changes have been found, and many of these clear or settle on their own.
Dr Anu Mahadik talks through the result with you first, so you understand why a colposcopy has been recommended before anything happens.
From screening
From a screening result to a colposcopy
The Cervical Screening Test (CST) replaced the older Pap test. For most people it is done every 5 years, and it checks a sample of cells for HPV — the virus that causes almost all cervical cancers. If you have had an abnormal result before, you may be asked to test more often.
How the sample is taken
There are two ways to do the test, and both are accurate at detecting HPV. You can collect the sample yourself, using a simple swab in the vagina, or a doctor or nurse can take the sample from the cervix with a speculum. Self-collection has been an option for everyone eligible since 2022. If a self-collected sample shows HPV, a follow-up sample from the cervix is often needed to guide the next step, and sometimes that is a colposcopy.
What the result means
If HPV is found, the sample is also checked for changes in the cervical cells, and the result is sorted into a risk level. This is what decides whether a colposcopy is needed.
- Low risk — HPV was not found. The next test is usually in 5 years, unless something changes before then.
- Intermediate risk — HPV was found, but not type 16 or 18. If there are no high-grade cell changes, no treatment is needed; the test is repeated in 12 months to see whether the body has cleared the infection. If HPV is found again, a colposcopy is usually the next step.
- Higher risk — HPV type 16 or 18 was found, or there are high-grade cell changes. A colposcopy is recommended, and sometimes a biopsy at the same time.
A colposcopy can also be recommended to look into symptoms rather than a screening result — for example, unexplained bleeding between periods, bleeding after sex, or bleeding after menopause. If you are past menopause and have new bleeding, it is worth getting checked; you can read more on the menopause page.
The colposcopy
What happens during a colposcopy
A colposcopy is done in the rooms and usually takes about 10 to 15 minutes. You lie back on a chair with supports for your legs, and a speculum is used to gently open the vagina so the cervix can be seen — the same instrument used for a screening test.
The doctor then looks at the cervix through the colposcope. A liquid is usually applied to the cervix, which helps any changed areas show up more clearly. It may feel cool but does not hurt. Most people feel little more than they would during a screening test, though some feel mild discomfort.
If the cervix looks clear, you will usually be asked to have another screening test in about 12 months. If a changed area is seen, the doctor may take a small sample (a biopsy) to check it, or talk with you about treatment.
Biopsy
If a biopsy is needed
A biopsy can be taken during the same appointment as the colposcopy. A small sample of tissue is taken from the changed area of the cervix and sent to a laboratory to be examined. This can cause brief discomfort — often a cramp similar to period pain — and you may have some light spotting or brownish discharge for a few hours afterwards. It can help to bring a sanitary pad.
After a biopsy
The results guide what happens next, and your doctor will usually arrange a follow-up to talk them through. To lower the small risk of bleeding or infection while the area heals, your doctor will give you advice for the first day or two, which usually includes:
- avoiding sex for 1 to 2 days
- avoiding vigorous exercise for about 24 hours
- avoiding swimming, baths and spas for 1 to 2 days (showering is fine)
If a higher-grade change is confirmed on the biopsy, a treatment called LLETZ may be recommended.
LLETZ
Treatment with LLETZ
LLETZ stands for large loop excision of the transformation zone. It is a common way to remove high-grade cell changes from the cervix before they can develop further. A thin, heated wire loop is used to remove the small area of changed cells, and that tissue is also sent to the laboratory to be checked. In many cases, the changed cells can be removed in one procedure.
LLETZ can be done under local anaesthetic, or under general anaesthetic in theatre as a day procedure. Your doctor will talk through which option suits you.
After a LLETZ
It is normal to have some cramping and light vaginal bleeding for a few days, and some people notice spotting for up to 3 to 4 weeks. To let the cervix heal and lower the risk of infection, the usual advice is to:
- avoid sex for 4 to 6 weeks
- avoid tampons for 4 to 6 weeks
Contact your doctor if bleeding gets heavier, lasts longer than a few weeks, or has an unpleasant smell, as this can be a sign of infection. A follow-up screening test is arranged afterwards to make sure the change has been fully treated.
Common questions
Colposcopy — common questions
No. An abnormal result almost always means HPV or an early cell change has been found, not cancer. Many of these clear on their own. A colposcopy is a way to look more closely and work out whether anything needs treatment.
HPV (human papillomavirus) is a very common virus, spread through skin-to-skin genital contact. Most people who are sexually active will come into contact with it at some point, often without knowing, because it usually has no symptoms. In most cases the body clears it within a year or two. Only when certain types stay for a long time can they cause cell changes on the cervix that, if left alone, may slowly develop further.
High-grade changes (sometimes called HSIL) are moderate to severe changes in the cells of the cervix. They are not cancer, but they are the changes most worth treating, because cervical cancer usually develops slowly, over about 10 years, when high-grade changes are left untreated. Treating them is a way of preventing that.
Most people find it similar to a screening test. A speculum is used to see the cervix, and a liquid is applied to highlight any changed areas, which may feel cool but does not hurt. Some people feel mild discomfort. It usually takes about 10 to 15 minutes.
It is best not to have the colposcopy during your period, and to avoid sex, tampons or vaginal creams for a day or two beforehand, as these can affect the view. Your rooms will let you know if there is anything specific to do. It is fine to bring someone with you.
Yes, a colposcopy can be done safely during pregnancy if it is needed. A biopsy is usually avoided unless there is a clear reason, and treatment such as LLETZ is normally put off until after the birth. Dr Mahadik will explain what is recommended in your situation.
It may cause brief discomfort, often a cramp like period pain, and you may have some spotting or brownish discharge for a few hours afterwards. Taking your usual pain relief beforehand can help.
A follow-up is usually arranged within a couple of weeks to talk through the results. What happens next depends on what the biopsy shows — for some people that means a treatment called LLETZ if a higher-grade change is confirmed.
LLETZ can be done under local or general anaesthetic. With local anaesthetic the area is numbed, so you should not feel pain during it. With general anaesthetic you will be asleep and will not feel anything. Either way, you may have some cramping and light bleeding for a few days afterwards, and following the after-care advice helps you heal and lowers the risk of infection.
Yes. A referral from your GP is needed to see Dr Mahadik as a specialist, and it also means Medicare rebates can apply. Your GP can refer you to Dr Mahadik at either location.
Fees depend on the appointment and whether a procedure is needed. The rooms can give you a clear estimate before your visit, including which part Medicare covers. Please contact the rooms for current fees.
Take the next step after your screening result
An abnormal result is unsettling, but a colposcopy is a straightforward next step, and in most cases the news is reassuring. Dr Anu Mahadik will look closely, explain what she finds, and talk you through any treatment if it is needed.
