Your colposcopy appointment

There are many reasons why you may have been referred to colposcopy. You might have had:

• An abnormal smear test result – or the result didn’t give enough information.
• An unusual looking cervix.
• Bleeding when having sex.
• Cervical polyps. 

Contact the clinic if:

You need to change your appointment.

• Your period is due at the time of your appointment. However, it is usually possible to attend even if you have a period. If you are taking the combined oral contraceptive pill, you could take packs back-to-back without a break, to avoid having a period if you would prefer.
• You are pregnant. Colposcopy examination is safe in pregnancy and is usually done at 14 and 28 weeks; biopsy or treatments are rarely needed in pregnancy.
• You are being treated for a vaginal infection.
• You have concerns because of a past experience with this type of examination.

Your smear test may have shown HPV which is a very common virus.

HPV affects areas like the cervix, vagina, vulva, anus, mouth, and throat. Most people get it at some point, and it usually clears up on its own within two years. Smoking can make it harder for your body to clear HPV, as it weakens the immune system.

HPV spreads through sexual contact, which can feel worrying or embarrassing but it’s very common. 8 in 10 people get it at some point in their lives. It lives on the skin and is hard to fully avoid.

There are over 200 types of HPV. Most don’t cause problems, but around 14 types (called high-risk HPV) are linked to cancer. Others may cause skin issues like warts.

We don’t normally do a colposcopy if you are bleeding heavily because we cannot see the cervix clearly. We can usually do the colposcopy if bleeding is light. Please phone to chat to our colposcopy office if you are concerned.

• We may see no cell changes. If this happens, you will be advised to have a smear test repeated either with your GP or in the colposcopy clinic. This can be between 6 months and 3 years later depending on your case.
• We might see some minor cell changes and will take 1-2 small punch biopsies (pinches of tissue). You won’t normally need any anaesthetic. You should avoid sexual intercourse (sex), using tampons, soaking for a long time in the bath, and excessive exercise for up to 3 days. Lightwalking and going back to non-strenuous work is usually fine. You may have light bleeding for a few days and 1 in 20 women have some mild pain that should settle with simple painkillers.
• In some cases you will be offered a treatment (see LLETZ treatment below)
• The colposcopist will write to you and your doctor with the results and advice on what to do next. The letter can take up to 6 weeks to arrive.

CIN has 3 grades (levels):

• CIN 1 (low grade) means that one third of the thickness of the cervix is affected. It usually goes back to normal on its own. You will have a further smear test with your GP in 12 months. If this shows it is not improving you may be offered treatment.
• CIN 2 (high grade) means that two thirds of the thickness of the cervix is affected. It goes back to normal in around 50% of women. It can be monitored and treated depending on your case and your preference.
• CIN 3 (high grade) means the cell changes are the full depth of the affected area of the cervix. We usually treat CIN 3.
• CGIN is named after the area of the cervix that is affected - the gland cells found inside the cervical canal. It is not cervical cancer. We usually treat CGIN.
• Very rarely will a biopsy show cell changes that have already developed into cancer.

If your colposcopist sees some high-grade changes, they may advise you that you should have this treated that day. The treatment is called Large Loop Excision of the Transformation Zone (LLETZ).

Cervical ectropion is where the thin layer of cells that normally line the inside of the cervical canal appears on the outside of the cervix. This is not dangerous. These cells are more fragile and cause vaginal discharge or bleeding, especially with sexual intercourse. It is particularly common in women who take the combined oral contraceptive pill and is rare in women after the menopause. In most cases, cervical ectropion goes away on its own. Only women with symptoms need to consider treatment for an ectropion.

Cervical polyps are very common. Most of the time they are harmless, but they can cause bleeding symptoms. These can be removed easily in the clinic and sent to the laboratory for assessment.

Not usually. It depends on the results of your smear test and colposcopy. If there is clear evidence of moderate to severe cell changes you may be offered treatment straight away – called LLETZ. If the changes are mild we may take a small biopsy first and decide if treatment is needed later.

LLETZ stands for Large Loop Excision of the Transformation Zone.

• We use a local anaesthetic on your cervix. This works very quicky.
• Once the area is numb, we use a thin, electrical, wire loop to remove the cell changes and seal the area.
• We will make sure the wire doesn’t hurt you by putting a pad on your thigh before treatment.
• We also circulate cool air to stop anything heating up too much.
• The procedure is very safe and will take around 15 minutes.
• Some women need this done with general anaesthetic (you will be asleep). We will discuss this with you if needed.

If you have a coil and are due for a loop excision (LLETZ) you should avoid sexual intercourse (sex) or use barrier contraception (like condoms) for 7 days before treatment. This is just in case the coil needs to be removed and can’t be replaced.

The colposcopist can often move the coil threads aside to perform LLETZ without removing it. Occasionally, the threads may be trimmed during the procedure, which can make them harder to find later. If needed, your GP can refer you to have the coil removed or replaced.

In rare cases, the coil may need to be taken out before LLETZ. If that happens, a new coil can sometimes be fitted during the same visit. If not, you’ll need to use another form of contraception (like condoms) until the cervix heals - this usually takes 4 - 6 weeks (FSRH Guidance 2023).

The local anaesthetic usually stops LLETZ being painful – but the injection can be a bit sore. Some women have period type pains for a couple of days but this can be helped with simple painkillers like paracetamol or ibuprofen.

LLETZ treatment is generally very safe, but, as with all surgery, there can be complications. Half of all women who have a LLETZ will have on average 10 days of both bleeding and discharge. This can be moderate to heavy. Most women have discomfort for around 2 days after this procedure. Bleeding is more likely after treatment if you get an infection in the treated area on your cervix. The treated area takes up to 4-6 weeks to heal.

To keep the risk of infection as low as possible, we recommend that you:

• Avoid sexual intercourse and using tampons for 4 weeks.
• Avoid swimming for 2 weeks.
• Go easy on exercise for 2 weeks .
• Take a shower rather than soak in the bath for 2 weeks.

Signs of infection include discharge that smells or heavy bleeding (heavier than a normal period). You should contact the colposcopy team or gynaecology ward and ask for a review in case you need antibiotics. In very rare cases, if the bleeding is severe, women will need admission to hospital. Bleeding can also occur a couple of weeks after treatment. 

Some women notice a change in the timing and length of their periods after their colposcopy. There is also a small risk that, as the cervix heals, the channel into the womb gets more narrow. This makes it difficult for the blood to escape when you have a period. The medical term for this is stenosis.

Following LLETZ treatment you can drive as usual, resume normal activities including very light exercise (walking), and consume alcohol in moderation.

Damage to other tissues is very rare.

A standard LLETZ (less than 15mm deep) isn’t linked to a higher risk of preterm labour or waters breaking early. Some studies suggest a small increase in miscarriage risk before 20 weeks, but this remains uncertain and uncommon.

Larger or repeat treatments may increase the chance of premature birth. If this is a concern for you, your colposcopist will be happy to talk it through.

Please note that most travel insurance companies may not provide you with health insurance following this procedure. You may wish to rearrange your colposcopy treatment (LLETZ) appointment if you are going on holiday or flying within 4 weeks of the treatment date.

This hospital usually offers LLETZ for women who need treatment for cervical cell changes. Other treatments may be available in the future.

If you are having treatment, you are welcome to bring someone with you so that they can support you and take you home after the procedure. We recommend that you take it easy for the rest of the day.

You can return to work the following day as long as it does not involve lifting heavy objects or doing any strenuous activity.

The removed tissue/cells are sent to the laboratory for examination. We do not give results over the phone, but we will send a letter to you and your GP with the results. This is usually within 4-8 weeks of the appointment. Sometimes, more treatment is needed, and we may ask you to return to the colposcopy clinic to talk through your choices.