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Colposcopy

Colposcopy is a simple office procedure that allows the doctor to closely examine the cervix, vagina and vulva for signs of disease. This exam takes 10 to 15 minutes and the experience of having it done is very similar to what it feels like to have a Pap smear done. However, during a colposcopy, the doctor uses an instrument called a colposcope to view the inside of the vagina, cervix and vulva (Colpo in latin means vagina, scope is a magnifying device, so your doctor can bring the cervix close to his/her eyes for more accurate exam).

Colposcopy is most often recommended after receiving abnormal results of a Pap smear to further diagnose any problems. If the doctor finds an abnormal finding during colposcopy, a biopsy or sample of tissue may be collected for testing.

Your doctor may recommend that you get a colposcopy to help diagnose many different conditions, including:

  • Precancerous changes in the tissue of the cervix
  • Precancerous changes in the tissue of the vagina Genital warts
  • Precancerous changes of the vulva
  • Inflammation of the cervix (cervicitis)
  • Genital warts

If the doctor has recently recommended a colposcopy, he or she may have a reason to believe something may not be quite right with the cervix. Some of these reasons might include:

  • Abnormal Pap results
  • The cervix looked abnormal during a pelvic exam
  • Testing positive for Human Papillomavirus, or HPV
  • Experiencing unexplained bleeding including bleeding after sexual intercourse (called post-coital bleeding)

A colposcopy can be used to diagnose cervical cancer, genital warts, vaginal cancer, and vulvar cancer, as well. Once the doctor gets the results from the colposcopy, you will be informed as to whether or not you need further testing, and what your options might be.

Colposcopy is a safe procedure that carries very few risks and side effects. Infrequent complications from biopsies taken during colposcopy occasionally occur, such as heavy bleeding, infection and pain.

Signs and symptoms that may indicate complications due to the procedure include:

  • Heavy bleeding
  • Chills
  • Fever
  • Severe abdominal pain
  • Issues with your bladder or bowel functions

Call us if you experience any of these symptoms after your colposcopy.

LEEP Procedure

LEEP is procedure that treats cervical precancerous condition and stands for “loop electrosurgical excision procedure.” The tool has a wire loop on its end that is heated through an electric current, so the doctor can remove the abnormal tissue on the cervix.

Doctors use LEEP to diagnose or treat abnormal conditions, including  precancerous cells. The procedure may be done to take a biopsy sample, which can be used to diagnose cervical cancer. LEEP surgery is typically performed if abnormal cells are found during a Pap test or colposcopy, or if the tests suggest the presence of cervical dysplasia. The procedure removes all of the abnormal tissue through an excision using a specially designed wire loop under local anesthesia.

Cervical dysplasia is often caused by an HPV infection, which is considered the main risk factor for the development of cervical cancer. While LEEP can remove all the abnormal cervical cells through an excision, it is not a cure for HPV. Even after the cells are cleared, ongoing monitoring is required to ensure that abnormal cells are treated promptly if they develop.

If you are trying to get pregnant, discuss this with your doctor before having LEEP performed, as it may affect your ability to become pregnant. You should not have LEEP if you are pregnant unless there are strong indicators of cervical cancer.

The specialist will discuss instructions prior to the procedure. Generally, it is not recommended that LEEP be performed during menstruation since bleeding makes it difficult to adequately visualize the tissue and sometimes it is difficult to distinguish your menses from LEEP procedure related bleeding that might happen as a complication.

Typically, fasting prior to the procedure is not necessary. If taking take blood thinners, it may be necessary to stop or decrease the dosage of these before the procedure.

LEEP is a minimally-invasive, brief procedure that usually takes about 10-15 minutes. You’ll lie on an exam table and the doctor will use a speculum (device commonly used during vaginal exams) to examine your vagina, just as if you were undergoing a Pap test.

A vinegary liquid may be used to clean and soak the cervix, so the abnormal cells will be easier to see. This liquid may sting a little. The doctor will then administer a local anesthetic.

The doctor will then examine the cervix and inside the vagina using a colposcope (if it was not previously done), a tool that looks like a microscope and allows the doctor to adequately see the cells up close.

 You may feel cramps or some pressure inside during the procedure. you should not experience faintness or lightheaded during the pressure; if you do, tell your doctor immediately.

You’ll be able to return home shortly after the procedure. You may have mild cramping for a day or so.  You should not experience much or any bleeding following the surgery. Your doctor will apply medicine on the excision to stop any bleeding. This medication may cause a dark coffee ground discharge and sometimes spotting for a few days.

  • Avoid douching or using tampons for at least 3 weeks. Use pads or panty-liners instead.
  • Avoid vaginal intercourse for at least 3 weeks.

 Short-term complications of LEEP include:

  • Vaginal bleeding
  • Bacterial infection
  • Cervicitis (inflammation of the cervix)
  • Endometritis (inflammation of the uterus)
  • Vaginal discharge

Serious problems and complications occur after LEEP. However, you should call your gynecologist right away if you experience any of the following:

  • Severe abdominal pain
  • Fever or chills
  • Vaginal discharge that smells foul
  • Unusual vaginal bleeding or bleeding that’s heavier than the heaviest day of your period

Hysteroscopy

Hysteroscopy is a procedure where the physician takes a camera to look inside the uterus. A hysteroscope is a thin tube with a light and camera at the end. This scope is inserted into the cervix and uterus through the vagina. A doctor will use the hysteroscope to look for anything abnormal, remove objects such as retained Intra Uterine Device, and even take samples from the uterine wall to test for conditions that will help diagnose or treat a uterine problem. Hysteroscopy is a minor, outpatient surgery which can be performed with local, regional, or general anesthesia. Sometimes no anesthesia is needed. There is little to no risk involved with this procedure for most women.

There are two kinds of hysteroscopy: diagnostic and operative. Diagnostic hysteroscopy is commonly performed on women who are experiencing heavy menstrual periods and severe cramping; or, it may be ordered if your doctor needs to know more about your reproductive health. Operative hysteroscopy can be used to correct various uterine conditions.

Common reasons for the need for a hysteroscopy are abnormal periods from heavy bleeding to prolonged bleeding, or bleeding in between your periods.

Other indications for hysteroscopy:

  • Uterine fibroids, polyps, or uterine scarring
  • Abnormal Pap test results
  • Bleeding or spotting after menopause.
  • Multiple miscarriages
  • Problems getting pregnant
  • If a tissue biopsy of the uterus is needed
  • To remove and/or replace missed IUD

If you are suffering from heavy or unusual menstrual bleeding, painful periods, contact Advanced Gynecology  Practice today.

A hysteroscopy is an outpatient surgery that is done under either local or general anesthesia. Most hysteroscopies also require medication used to dilate the cervix as well. During the procedure, the doctor will use a speculum inserted into the vagina to keep it open. Next, your doctor will gently insert the hysteroscope through the cervix into the uterus. Saline or gas will then be pushed through the hysteroscope into the uterus to expand the walls so that your doctor will have a clear view of the uterine lining and the opening of the fallopian tubes. If surgery or biopsies are required, small instruments are inserted into the uterus through the hysteroscope.

While a hysteroscopy is used to see the inside of the uterus and the opening of the fallopian tubes, sometimes your doctor will also want to view the outside of these organs. This is done through a procedure called laparoscopy, in which a laparoscope is used at the same time to view the outside of the uterus. In laparoscopy, a doctor will insert an endoscope (a thin tube attached with a fiber optic camera at the end) into your abdomen through a small incision made through or below the navel. Laparoscopy allows your doctor to view the outside of the uterus, ovaries and fallopian tubes.

Operative hysteroscopy is used to correct abnormalities that were detected during a diagnostic hysteroscopy. Diagnostic and operative hysteroscopies can be performed at the same time. During operative hysteroscopy, small instruments used to correct the condition are inserted through the hysteroscope. Hysteroscopy can be used to remove uterine polyps and fibroids, locate and remove bands of uterine scar tissue called adhesions, can determine whether a septum (a malformation of the uterus formed at birth) is present, remove misplaced IUD, and can help identify the cause of abnormal bleeding and menstrual flow.

Just like any surgical procedure, some complications may happen from a hysteroscopy, including:

  • Complications from the anesthesia
  • Infection
  • Bleeding
  • Issues as a result of the gas or fluid used to expand the uterus
  • Damage to nearby organs like the bladder, bowel, or ovaries

 

Hysteroscopy is a reasonably safe procedure and problems arise in less than one percent of cases. If you experience symptoms like a fever, severe abdominal pain, issues with your bladder or bowel functions, or heavy bleeding after the procedure, call your doctor immediately or go to the emergency room.

PAP Smear and Cervical Cancer Screening FAQ

Screening tests look for cancer cells in the cervix. The cervix is the bottom part of the uterus, where it meets the vagina.

Screening tests also look for cells that could turn into cancer, called “precancer.” They can find cervical cancer and precancer in the early stages, when it can be treated or even cured.

There are a few different ways to screen:

  • Pap test – This is sometimes called a “Pap smear.” It involves taking cells from the surface of the cervix and sending them to a lab. Then, an expert will check the cells under a microscope.
  • HPV test – HPV stands for “human papillomavirus.” Some types of this virus can cause cervical cancer. An HPV test involves testing cells from the cervix for certain types of HPV.
  • Combination test – This means doing a Pap and HPV test at the same time.

For both types of tests, your doctor will take cells from the surface of your cervix. To do this, they will gently insert a device called a “speculum” into your vagina. The device helps to push apart the walls of your vagina so that the doctor can see the cervix. Then, they will use a small tool to lightly scrape cells from the surface of your cervix. The tool looks like a small spatula or brush. This might be a little uncomfortable, but usually does not hurt.

Most experts recommend that you start having Pap tests when you turn 21. Some experts recommend HPV tests instead of Pap tests, starting at age 25. But this option might not be available in many places. Your doctor or nurse can talk to you about your options.

You should start getting Pap tests at the recommended age, whether or not you have ever been sexually active. Also, you do not need to start cervical cancer screening before age 21, even if you became sexually active at a younger age.

You do not need to do anything special to prepare. People sometimes hear that they should not have sex or put anything in their vagina for 2 days before a Pap test, but this is not necessary. Pap tests work fine even if you have had sex recently.

Your doctor might recommend scheduling your test for when you do not expect to have your period. But don’t worry if you do have your period on the day of the test. Screening can usually still be done even if you are bleeding. Your doctor can talk with you and let you know what to do.

That depends on how old you are and the results of your past tests.

  • If you are age 21 to 29, you should have a Pap test every 3 years. Or, if your doctor recommends HPV testing instead, you should have a test every 5 years beginning at age 25.

 

  • If you are age 30 or older, you can have a Pap test every 3 years. The other options are having an HPV test every 5 years or a combination Pap and HPV test every 5 years.

 

  • If you are age 65 or older, you can stop having Pap tests if:

 

  • You had Pap tests done regularly until you turned 65.

 

  • You had 3 normal Pap tests in a row, or 2 normal combination Pap and HPV tests over the past 10 years (if the most recent test was within the past 5 years).

 

  • You do not have other medical conditions that could weaken your immune system – These include taking certain medicines or having HIV.

If you have had surgery called a “hysterectomy” to remove your uterus, ask your doctor if you need to keep getting screened. After a hysterectomy, you probably do not need screening if:

  • Your cervix was removed along with your uterus, and
  • You did not have cervical cancer or precancer (sometimes called “dysplasia”) in the last 20 years before your hysterectomy

 

If you’re not sure, your doctor can help you figure out if you need to continue screening.

Yes. Getting the HPV vaccine lowers your chances of getting an HPV infection that could lead to cervical cancer. But it does not completely protect you. You should still be screened for cancer or precancer.

Abnormal Pap tests are common, and most people with an abnormal Pap test do not have cancer. If your Pap test has cells that look abnormal, your doctor or nurse can do more tests to figure out what is causing this. They will decide what to do based on your age, what your Pap test shows, and the results of any other tests you had.

Follow-up tests might include:

  • An HPV test – If you haven’t already had an HPV test, your doctor might order one. They might be able to do this on the cells already taken during your Pap test.

 

  • Another Pap test in 12 months – Sometimes, if you wait a year and have another Pap test, you could find that the abnormal cells are back to normal. You might also have an HPV test at the same time.

 

  • A colposcopy – For this test, the doctor or nurse will use a speculum to look at your cervix, just like during a Pap test. But they will look more closely using a device that looks like a microscope. It allows the doctor to see the cervix in more detail. During this test, the doctor might also take tiny samples of tissue from the cervix. This is called a “biopsy.” The tissue samples are checked in a lab.

 

If you do have cervical cancer or precancer, there are effective treatments available. If your condition was found early, there is a good chance that you can be cured.

Most people who have sex will be exposed to HPV at some point, and having HPV does not mean that you will definitely get cancer. For most people, HPV infection goes away on its own. But for some people, it does not. Long-lasting HPV infection increases your risk of cancer over time.

If your HPV test comes back positive, your doctor will talk with you about what to do. This will partly depend on whether your Pap test results were abnormal. If your HPV test is positive but your Pap test is normal, you might need to repeat the tests in 1 year so your doctor can see if anything has changed.

Fadel Azer, MD, FACOG, MIGS, is a Gynecology Specialist

With Dr. Azer’s extensive experience  in gynecological healthcare, cancer screening, and procedures, you will be receiving  individualized up to date care and treatment.

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Advanced Gynecology Practice is a specialty women’s clinic providing minimally invasive endometriosis and fibroid treatments. We are located in Lisle, Illinois, 30 minutes from Chicago and 90 minutes from Rockford.

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