Colposcopy and Abnormal Pap Smears

Published 27th October 2021 | Dr Ujwala Parashar

A pap smear or “pap test” involves your gynaecologist taking a sample of cells from your cervix which are then sent for laboratory testing. It is a screening test used to detect cervical cancer and is an important part of ensuring women’s gynaecological health. Recent guidelines recommend that women aged between 25 – 75 years have a pap smear every 5 years.

What does a pap test detect?

A pap test is used to detect abnormal cells in the cervix so treatment can be provided before these cells become cancerous. It is also used to detect HPV (human papilloma virus). 

HPP is a common, sexually transmitted virus that often has no symptoms, however it is a serious condition that causes cancers of the cervix, vulva, vagina, penis and anus. High risk HPV strains 16 and 18 are known to be the cause of up to 80% of cervical cancers in women.

What is a colposcopy?

A colposcopy is used to check for any changes in the health of your cervix, vagina, and vulva. A colposcope is a specialised instrument that looks like a pair of binoculars with a bright light. 

The colposcope allows your gynaecologist to have a magnified view of the surface of your vagina and cervix and identify any cancerous cells, or abnormal cells that may become cancerous - as well as other conditions such as genital warts and polyps or inflammation of the cervix.

Why is a colposcopy recommended?

Your gynaecologist will usually recommend a colposcopy if you have returned an abnormal pap test result. 

If you have been advised of an abnormal pap test result - Don’t panic! An abnormal pap smear does not mean you have cervical cancer, but it may indicate any of the following:

  • Dysplasia. These are abnormal cells that may be precancerous.
  • Atrophy or vaginal dryness. This is particularly common after menopause.
  • An infection or an inflammation.
  • An STD such as Herpes or Trichomoniasis.
  • Human Papilloma virus infection (HPV).
  • Recent sexual activity.

Other reasons you gynaecologist may recommend a colposcopy include:

  • If you have had unusual or unexplained bleeding.
  • Bleeding after intercourse.
  • If you have an abnormal lump or growth on your cervix or vagina.

What happens during a colposcopy?

A colposcopy usually takes between 20 – 30 minutes. During a colposcopy you will be lying down on the examination table and your heels placed in stirrups. Dr Parashar will insert a speculum into your vagina which opens it up to give her a clear view of your cervix. Your cervix and vulva are then lightly wiped and cleaned with a mild vinegar and coated with an iodine solution which turns healthy cells a brown colour.

The colposcope is then placed between your legs close to your vagina and she is able to examine your cells. If she finds any areas that need further investigation during the colposcopy, a tiny piece of tissue will be removed for biopsy testing at the laboratory.

Although a colposcopy may feel awkward and uncomfortable, it is generally not painful.

How should you prepare for a colposcopy?

Speak to Dr Parashar prior to the procedure and ask her to discuss the benefits and risks of a colposcopy and why it is being recommended. If you know you are pregnant but haven’t advised this, please do so before a colposcopy. A colposcopy is usually performed when you have not had menstrual bleeding for 24 – 48 hours. 

In the 24 – 48 hours prior to your colposcopy, you will need to prepare as follows:

  • Don’t have vaginal sex.
  • Cease using vaginal medicines, creams, or douche.
  • Don’t use tampons or place other products in your vagina.

You will also need to advise your doctor in advance of your colposcopy if you are taking any preventative medication for blood clots including aspirin, warfarin, heparin and clopidogrel as these medications can increase bleeding if a biopsy is performed during the colposcopy.

What happens after the colposcopy? 

Colposcopy without a biopsy

If you have had a colposcopy without a biopsy, you can carry on after the procedure with your normal activities immediately. 

Colposcopy with a biopsy

If you have had some tissue removed for a biopsy, you may have some cramps or soreness which can be relieved with over the counter pain medication. It’s also normal to experience some bleeding and a slight vaginal discharge for between 5 -6 days after the procedure.  If your doctor uses a liquid bandage solution, you may experience a brown or black vaginal discharge that looks like coffee grounds, but this should resolve in a few days.

If you have had a biopsy with your colposcopy, you will advised not to have sex for 48 hours after your procedure.

After your colposcopy, you should not insert tampons or other products in your vagina such as creams, douches or tampons. You will also need to not undertake heavy exercise and cease using lubricants or other products. You will be able to shower but advised not to have a bath or a swim.

When can I return to work after a colposcopy?

In most cases, women are able to return to work or go back to school immediately after a colposcopy.

What can go wrong with colposcopy?

There is a very low risk of infection or heavy bleeding from a colposcopy, however you should contact your gynaecologist if you experience:

  • Symptoms that persist after 5- 6 days; or they worsen.
  • You have a fever.
  • A bad smelling vaginal discharge.
  • Severe pelvic pain.
  • Heavy bleeding lasting longer than 5 days.

What happens when the colposcopy biopsy results are returned?

The biopsy will allow your doctor to categorise the cell changes in your cervix as:

  • Low-grade
  • Moderate – high grade

If the results from the biopsy are unclear you may need further tests, but often no further action is needed. If the changes are moderate to severe, you may need further treatment and she will discuss these details with you.

Specialist gynaecological care

If you have had an abnormal pap smear result, a colposcopy is the next step needed on your care journey. As a qualified gynaecologist and obstetrician, Dr Parashar is certified in the use of colposcopy and an expert in the identification of abnormal cells. She will be able to discuss this procedure with you and depending on the biopsy results, can provide any further treatment you may need.

Please ask your family doctor for a referral and call our team on 1300 811827 to arrange for an appointment. You can be sure we will take the time to ensure you understand all aspects of colposcopy and that you will be cared for each step of the way.

Dr Ujwala Parashar, Obstetrician & Gynaecologist

Sam Samant

Dr Ujwala Parashar is a highly trained female obstetrician and gynaecologist with over 15 years of professional experience and training, practicing in Sydney's North Shore and Barangaroo. If you would like more information on conception, or if you are seeking obstetric options and advice, please contact us or call 1300 811 827 to arrange a consultation with her.