The pap test is a screening test, not a diagnostic test. It cannot determine if you have cervical cancer. An abnormal pap test result may mean more testing, to determine if cancer or a pre-cancer is actually present. The tests that are used include colposcopy (with or without biopsy), endocervical sampling and LEEP procedures.
Colposcopy is a way of looking at the cervix through a special magnifying device called a colposcope. It shines a light onto the vagina and cervix. A colposcope can enlarge the normal view by 2–60 times. This allows the doctor to find problems that cannot be seen by the eye alone.
The cervix is the lower, narrow end of the uterus. Cells on the cervix grow all the time, just like skin. The cells at the bottom layer slowly move to the surface. Then they shed. When the process changes in some way, cells become abnormal. The changes may go away on their own. If they don't, they may worsen and lead to cervical cancer. In most cases, these changes are found with a Pap test, which can find changes in cells of the cervix that could lead to a problem. As part of their regular health care, a Pap test will be recommended according to national guidelines or as symptoms warrant. An annual wellness exam is recommended.
Reasons for Colposcopy
A colposcopy is done when a Pap test shows changes that could lead to cancer. It provides more information about abnormal cells.
Colposcopy also may be used to further assess certain problems:
- Genital warts on the cervix
- Cervicitis (an inflamed cervix)
- Benign (not cancer) growths, such as polyps
Sometimes colposcopy may need to be done more than once. It also can be used to check the result of a treatment.
Colposcopy is done like a Pap test in a doctor's office. You may be referred to another doctor or to a special clinic to have it done. Colposcopy may involve taking pictures of your vagina and cervix. Your doctor will talk to you about it before the procedure. The procedure is best done when a woman is not having her period. For at least 24 hours before the test, it is a good idea not to:
- Use tampons
- Use vaginal medications
- Have sex
As with a pelvic exam, you will lie on your back with your feet raised and placed on foot rests for support. A speculum will be used to spread apart the vaginal walls so that the inside of the vagina and the cervix can be seen. The colposcope is placed just outside the entrance of your vagina. A mild solution will be applied to your cervix and vagina with a cotton swab or cotton ball. This liquid makes abnormal areas on the cervix easier to see.
During a colposcopy, the doctor may see abnormal areas. A biopsy of these areas may be done. During a biopsy, a small piece of abnormal tissue is removed from the cervix. The sample is removed with a special device. Cells may be taken from the canal of the cervix. Because the cells are not easy to see by the colposcope, a special device is used to scrape the cells. This scraping is called endocervical curettage (ECC).
If a biopsy was taken, it will be studied in a lab. When biopsy results come back from the lab, your doctor will discuss them with you. Depending on the results, you may need to be checked more often, or you may need further testing or treatments.
If you have a colposcopy without a biopsy, you should feel fine right away. You can do things you normally do. You may have a little spotting for a couple days.
If you have a colposcopy with a biopsy, your vagina may feel sore for 1 or 2 days. You may have some vaginal bleeding. You also may have a dark discharge for a few days. This may occur from a medication used to help stop bleeding at the biopsy site. You may need to wear a sanitary pad until the discharge stops. Your doctor may suggest you limit your activity for a brief time. While the cervix heals, do not put anything in your vagina for at least 1 week:
- Do not have sex.
- Do not use tampons.
- Do not douche.
Call your doctor right away if you have any of these problems:
- Heavy vaginal bleeding (using more than one sanitary pad per hour)
- Severe lower abdominal pain
- Bad-smelling vaginal discharge
Special Procedures: Loop Electrosurgical Excision Procedure (LEEP)
When tests show that you have abnormal cells on your cervix, your doctor may suggest the loop electrosurgical excision procedure (LEEP). LEEP is used to remove the abnormal cells from your cervix.
The cervix is covered by a thin layer of tissue like your skin. The cells that make up this tissue grow all the time. During this growth, the cells at the bottom layer slowly move to the surface of the cervix. When these cells reach the surface, they are shed as a normal process.
When this normal process is changed in some way, cells become abnormal. This condition is known as dysplasia. In mild forms, this condition may go away on its own. If it is severe or does not go away, it may lead to cancer of the cervix. Other factors such as smoking and being exposed to sexually transmitted diseases (STDs) also increase the risk of cancer of the cervix.
A Pap smear detects changes in the cervix. Other tests, such as colposcopy and biopsy, also are used.
Abnormal cells can be removed with LEEP. This allows new healthy cells to grow. LEEP is just one way to treat dysplasia. Dysplasia also can be treated with other procedures such as cryosurgery, electrocautery, laser, or cone biopsy. The decision of which method to use depends on how much cervical tissue needs to be removed and where on the cervix the abnormal cells are located.
LEEP uses a thin wire loop that acts like a scalpel (surgical knife). An electric current is passed through the loop, which cuts away a thin layer of the surface cells.
The procedure should be done when you're not having your menstrual period. This allows a better view of the cervix. In most cases, LEEP is done on an outpatient basis. It should take only a few minutes.
You may be given pain relief before the doctor begins. During the procedure you will lie on your back and place your legs in stirrups. The doctor then will insert a speculum into your vagina in the same way as for a pelvic exam.
A solution is applied to your cervix to show the abnormal cells. Colposcopy will be used to magnify the cervix during the surgery.
The loop is inserted through the vagina to the cervix. There are different sizes and shapes of loops that can be used. After the procedure, a special paste may be applied to your cervix to stop any bleeding. The tissue that is removed will be studied in a lab to confirm the diagnosis.
Although problems seldom occur with LEEP, there can be some complications. You may feel faint during the procedure or have some bleeding. There is also a risk of infection after the procedure. These complications are rare and can be treated easily. You should contact your doctor if you have any of the following:
- Heavy bleeding (more than your normal period)
- Bleeding with clots
- Severe abdominal pain
- Fever (more than 100.4°F)
- Foul-smelling discharge
It may take a few weeks for your cervix to heal. While your cervix heals, you may have:
- Vaginal bleeding (less than a normal menstrual flow)
- Mild cramping
- A brownish-black discharge (from the paste used)
For a few weeks after the procedure, you should not have sex or use tampons or douches. If you have any discomfort, your doctor may prescribe pain relief.
After the procedure, you will need to see your doctor for follow-up visits during the year. At these visits your doctor will check the health of your cervix. After 1 year, of normal results, you may return to have exams once a year. If you have another abnormal Pap smear, you may need more treatment.
By making a few lifestyle changes after your procedure, you can help protect the health of your cervix:
- Have regular pelvic exams and Pap tests
- Stop smoking—smoking increases your risk of cancer of the cervix
- If you have more than one sexual partner, limit your number of partners and use condoms to reduce your risk of STDs.