Examination and treatment of changes in the cells of the cervix
Changes in the cells of the cervix (the neck of the uterus) do not cause any symptoms. Cell changes can be detected by a cervical screening test (Pap test, also known as the smear test). Some of the cell changes can, if left untreated, lead to cervical cancer.
Colposcopy is an outpatient endoscopic examination of the cervix, vagina and vulva. The most common reason for having a colposcopy is that the abnormality in the cells that was detected by a cervical screening test (Pap test) has not healed by itself. Sometimes it is worth performing colposcopy already on the basis of one abnormal Pap test result.
Colposcopy can also be used to examine other symptoms in the vulva and the vagina.
The examination takes about a half an hour. A pelvic exam speculum (the usual gynaecological examination instrument) is used as an aid. Possible changes in the skin and mucous membrane are examined through a special microscope called a colposcope. If necessary, small samples of tissue (biopsies) are taken. The examination may cause mild pain but usually no pain medication or anaesthesia is necessary.
AFTER THE PROCEDURE
The patient can go home straight after the procedure. There may be a small amount of bloody discharge from the vagina during the week following the procedure. The patient may also have a slight pain in the lower abdomen for a few days.
The biopsy results are ready within 1–2 weeks, and a time is arranged for a phone call to discuss the results. The doctor will advise whether there is a need for further treatment or follow-up on the basis of the biopsy results. If necessary, conization by the loop electrosurgical excision procedure (LEEP) is performed as a further treatment. Small changes in the cells heal by themselves, and therefore further treatment is not always necessary. Since the human papilloma virus (HPV) is the most common cause of the changes, follow-up is always important after colposcopy.
Conization by the loop electrosurgical excision procedure (LEEP), performed with the aid of microscopic examination, removes the abnormal area of cells in the cervix. The most common reason for LEEP conization is cell changes caused by the human papilloma virus (HPV).
BEFORE THE PROCEDURE
The patient can eat normally before the procedure. If possible, the procedure is performed during the week following the patient’s period.
The patient can take some suitable, non-prescription painkillers about an hour before arriving at the clinic. For example 800 mg of ipuprofen (two 400 mg tablets of Burana or Ibumax) and/or 1 g of paracetamol (two 500 mg tablets of Panadol or Paratabs).
The procedure is performed under local anaesthesia on an outpatient basis and it takes about half an hour. The cervix is numbed using a small needle. The procedure is aided by endoscopy of the cervix (colposcopy). A thin wire loop is used to remove a piece of tissue, 2–3 cm in diameter and 0.5–1 cm thick, from the cervix. During the procedure the patient may feel some pain in the lower abdomen, resembling period pain, but can go home immediately after the procedure.
AFTER THE PROCEDURE
After LEEP conization, there will be a discharge of tissue fluid and blood from the wound for about a week. There may be a small amount of discharge for even longer depending on the size of the treatment area. Gradually a scab will form in the treatment area, and when it becomes detached, it may cause a heavier bloody discharge to occur 1–2 weeks after the procedure. The next period may also be heavier than usual.
In order to prevent excessive discharge and infections, sexual intercourse, swimming and the use of tampons is prohibited until the next period.
Pain resembling period pain may occur in the lower abdomen. Non-prescription painkillers can be taken according to the manufacturer’s instructions.
The removed tissue is sent to a pathologist for examination and the results are ready within 1–2 weeks.
The doctor will inform the patient about the results in the agreed manner. A plan for the necessary follow-up will be made on the basis of the pathologist’s report.
The most common complication after LEEP conization is a heavy or prolonged bloody discharge from the cervix. If the discharge becomes clearly heavier than menstrual bleeding or it is accompanied by pain, a bad smell or a high temperature, the patient should contact the treating unit or Anneli Kettunen at Clinic Helena.