Gynaecology
Why do I need a colposcopy and possibly treatment to my cervix?
Your recent cervical screening test (smear test) showed:
- Evidence of the human papillomavirus (HPV)
- Some abnormal cells on your cervix
We know that this can feel worrying. We hope this leaflet will help you to understand what will happen during your clinic visit, so that you will feel less worried and anxious about it.
Will I need treatment?
When you come to the colposcopy clinic, the doctor or nurse colposcopist will look at the neck of your womb. This is your cervix. It is at the top of your vagina.
If we find some small changes, then we will take a sample of your cervix. This is called a biopsy. We will send the sample to be looked at more closely. What treatment you need will depend on the results of this.
If we find more severe (what we call “high grade”) changes that could lead to cancer, then we may offer you a treatment called LLETZ. We can do this treatment on that day. Occasionally, this treatment is not appropriate, even if you have severe changes. If this happens, we may offer a biopsy instead.
What is LLETZ
LLETZ stands for Large Loop Excision of the Transformation Zone.
Pre-cancerous cells are called cervical intra-epithelial neoplasia (CIN). There are different grades of CIN. CIN1 are mild changes. CIN2 and CIN3 are more severe.
LLETZ aims to stop these cells turning into cancer by taking out the part of your cervix that they are on. We do this using a small fine wire loop heated by electricity.
The section we remove is only as big (in depth and width) as it needs to be. LLETZ also gives us a sample of your cervix. We can look at this in a lab to make sure that all the abnormal cells have been removed. We can also check that there was no cancer on your cervix.
LLETZ is a cure for 95 in 100 people the first time we do the treatment. A small number of women need more treatment.
Will I need anaesthetic?
Most people will have a local anaesthetic. This numbs your cervix. Very occasionally, people need to come into hospital for a day to have the procedure under a general anaesthetic. (This is where you are asleep).
If you have local anaesthetic, you can still drive a car afterwards. But most people bring a friend or relative with them to take them home in case they feel unable to drive themselves.
What are the risks?
The potential risks of LLETZ are very small. We will tell you more about them when you come to clinic. They are:
Bleeding: You may bleed during the treatment. This is rarely (about 1 in 100 people) heavy. If you bleed heavily once you are at home after your procedure, please call us on the number at the end of this leaflet. If it is outside office hours, contact your local Accident and Emergency (A&E).
Infection: If you have heavy vaginal bleeding, which may be smelly, in the 28 days after your procedure, you may have a minor infection. This is unlikely (around 1 in 50 people). Other signs of infection are:
- smelly vaginal discharge
- pain in your lower abdomen (tummy)
- a temperature or fever
- feeling generally unwell
If you think you may have an infection, contact your GP. You may need antibiotics. You can also call the Advice Line on telephone: 01642 287668 Monday to Friday, 9am to 5pm
Cervical Stenosis: This is a narrowing of the cervix canal. It happens to around 1 in 50 people after LLETZ. It is more likely to happen if you have been through the menopause.
In younger women, it can cause:
- your periods to stop
- you to bleed less on your period, but with more abdominal (tummy) pain
If you are concerned, please contact your GP for advice. Stenosis can be treated if it causes problems with your periods.
Will I still be able to get pregnant?
It is very unlikely that treatment for abnormal cells will affect your ability to get pregnant in the future. Most people under 40 years old have an LLETZ treatment of less than 10mm in depth. A single treatment of this depth is not linked to infertility or pregnancy complications.
If you need a deeper LLETZ, or more than one LLETZ treatment, there is an increased future risk of:
- miscarriage between 12 to 24 weeks of pregnancy
- preterm labour (your baby being born between 24 and 37 weeks of pregnancy)
(The increase is from 7 in 100 to 9 in 100 if you have an LLETZ of 10 to 15mm)
If you get pregnant in the future, this risk may be lowered through monitoring, support and treatment. But it is very important to treat abnormal cells. They may also cause pregnancy complications if they are untreated. We make sure that we consider your future fertility as part of your care.
What is the risk of doing nothing?
Abnormalities could turn into cancer over time if we do not treat them. We recommend that all women who have, or are suspected of having, high grade pre-cancerous changes (CIN3 and some CIN2 subtypes) have treatment.
Consent
We will ask for your written consent to:
- examine your cervix
- give you a local anaesthetic
- give you the treatment we have described
We will only do this when we are sure we have given you all the information you need and that you understand it.
About the procedure
The information in the rest of this leaflet applies to procedures that we do in the outpatient department using a local anaesthetic. If you will need general anaesthetic, we will discuss this with you and give you more information in clinic.
What happens when I come for treatment?
You may find it helpful to take simple pain relief tablets, such as ibuprofen or paracetamol, about 1 hour before your appointment.
You are welcome to bring a supportive friend or relative with you. They may be able to stay with you during the procedure if you wish and if this is appropriate. The actual treatment usually takes about 15 minutes, but you should allow about 1 hour for the whole visit.
Before the colposcopy examination, we will ask you to undress from the waist downwards. We will give you a sheet to cover yourself, but you may like to wear a loose skirt or dress to make things easier. If you have vulval, clitoral or labial piercings, you will need to remove them or put tape over them. We will help you to position yourself on the examination couch.
We will then do the colposcopy examination. The colposcopist may ask permission to take a photograph of your cervix. This is for your medical record. We will give you an injection of local anaesthetic directly into your cervix. This should make the area numb very quickly. You may feel a stinging sensation when we give you the anaesthetic, but you should not feel any pain. You may feel a mild period-like discomfort during the actual treatment.
You may feel slightly light-headed. This is because of the adrenaline in the local anaesthetic. It may make your legs shake or your heart race. Please do not be alarmed. This reaction is normal and will only last for a few minutes.
We will encourage you to talk during the procedure. We want you to feel as comfortable as possible.
Preparing for the treatment often takes longer than the treatment itself, which is usually 2 to 3 minutes. The machines used may be noisy. This is normal, so please do not be alarmed.
What happens after treatment?
Most people like to go straight home and rest for the remainder of the day.
Work
Most people feel well after 24 hours. They usually do not need to take any extra time off work. But if your job requires you to be very physically active or lift heavy objects, you should think about taking a couple of days off or asking your manager about doing lighter work.
Bleeding and discharge
You may have some bleeding or watery vaginal discharge. This may not start straight away. It may last for 4 weeks. The discharge may be light. For example, you may have spotting that is quite watery with some fresh blood in it. Or it may be as heavy as a period with small clots. You may need 4 to 5 pads (sanitary towels) per day.
If you are bleeding more than this, or if the blood is smelly, you may have an infection. Contact a GP. You should also contact a GP if:
- You are passing large blood clots
- you are worried in any way
If you need help more quickly, go to your local A&E. You can also call us for advice if it is during office hours.
While you are bleeding after your procedure, you should use pads and not tampons. This helps to reduce the risk of infection. It also allows the cervix to heal as quickly as possible. Your next period may be slightly heavier than usual, and you may pass some clots. This is normal. It will sort itself out over the next couple of months. Again, you should use pads rather than tampons.
Pain
You may feel mild pain after the procedure. It may feel similar to period pains. Pain relief that you can buy over the counter, such as paracetamol or ibuprofen, should help.
Is there anything I should or should not do after my treatment?
You should avoid having sexual intercourse for 4 weeks after your treatment. This gives your cervix time to heal.
You can carry on with most of your normal everyday activities as usual. But you should avoid using swimming pools, spas and hot tubs for at least 4 weeks or until the discharge stops. You should also avoid strenuous exercise, heavy lifting, or anything that means you have to bounce (like trampolining or horse riding), for 4 weeks. You can have baths or showers. But do not try to clean (douche) inside your vagina.
Do not use:
talcum powder
vaginal deodorants
heavily perfumed soaps
bubble baths
They can cause irritation and increase the risk of infection.
You should not drink alcohol if you are taking pain relief. A glass of wine or other small amount of alcohol is fine, if you are not taking medication. We also advise against smoking. Smoking increases the risk of:
- infection after your procedure
- HPV infection remaining, even after the abnormal cells have been treated
- abnormal cells coming back in the future
If you would like help with stopping smoking, please visit this website: www.stopsmokingsouthtees.co.uk
You should avoid travelling to another country for 4 weeks after LLETZ treatment. This is because if you get complications and need medical treatment, it may not be covered by your holiday insurance. If you do go abroad in the next 4 weeks, you should mention the treatment to your insurer. This will make things easier if you need to make a claim.
If you have any travel plans or holiday arrangements in the next few weeks, talk to your colposcopist. It may be possible to postpone the treatment until after your holiday. You can also call us for advice before your appointment.
How will I get the results?
We will send you a letter as soon as we know your results. This is usually within 4 weeks of your procedure. This letter will tell you about:
- your biopsy results
- the follow-up we recommend for you
Sometimes, it may be better to phone you to talk about your results or further treatment. Please let us know if you would rather not receive a phone call in this case.
Will I have more appointments in the future?
Yes. It is important to have follow-up appointments after you have had LLETZ treatment. Your next cervical screening test will be about 6 months after your procedure. Your GP or practice nurse will usually do this. You and your GP will receive a reminder letter. Make sure that your contact details are up to date with your GP and on the NHS app.
If there is no evidence of the HPV virus at this test, you will go back to routine screening. You will not need to have a smear test for another 3 years. If we find high risk HPV, we will ask you to come back to the colposcopy clinic. This is so we can assess your cervix further.
There is a small chance that abnormal cells may come back, but if you come for cervical screening when we ask you to, we can find these cells and deal with them quickly.
If we make a colposcopy clinic appointment for you, it is very important that you come to it. If you cannot come for any reason, please let us know. Then someone else can use the appointment time and we can make another appointment for you.
Useful websites
You can find more information about cervical screening and colposcopy on these websites. They also have information in different languages.
www.bsccp.org.uk/women
www.cancerscreening.nhs.uk/cervical
www.informedchoiceaboutcancerscreening.org
www.cruk.org/about-cancer/cervical-cancer/getting-diagnosed/screening
www.healthtalk.org/introduction/cervical-screening
More information and contact details
We hope this leaflet was helpful. If you need any more advice or information, please ask the clinic staff. We are here to help you. We are happy to help with any concerns or worries.
You can contact a Nurse Colposcopist through the Colposcopy Advice Line. You should also call this number if you need to change your appointment.
Contact Information
If you require further information please contact us on:
Colposcopy Advice Line
Telephone: 01642 282790 Monday to Friday, 9am to 5pm
Email: [email protected]
Patient Experience
South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.
This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.
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