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Colposcopy Clinic FAQ

Why have I been referred to the Colposcopy Clinic?

Your physician has referred you to the Colposcopy Clinic because you have Dysplasia on your Pap Smear. The appointment will be a gynecological examination with a colposcope and a Pap smear. A cervical biopsy may or may not be performed. The appointment will last approximately 15 minutes. There is no preparation required for a colposcopy.

What is dysplasia?

Dysplasia is the presence of abnormal growth in the cells on the surface of the cervix. There are many levels of abnormality. The level of abnormality determines what type of follow-up is recommended or if treatment is necessary. For more information, consult the Guide to Cervical Dysplasia.

The following table lists all types of abnormality that may be found on a Pap smear or on a cervical biopsy.

ASC-US (atypical squamous cells of undetermined significance)	ASCUS may be caused by dysplasia but could be caused by infection, irritation or thinning of the vaginal tissue after menopause
LSIL (low grade squamous intraepithelial lesion)	Mild dysplasia and cellular changes associated with HPV
ASC-H (atypical squamous cells, cannot exclude high grade intraepithelial lesion)	Some abnormal cells. May be caused by moderate to severe dysplasia
HSIL (high grade squamous intraepithelial lesions)	Moderate to severe dysplasia, precancerous lesions
AGC (atypical glandular cells)	Some abnormal cells of glandular type may arise from inside the cervical canal
Adenocarcinoma in-situ	Pre-invasive cancer that involves only the surface cells
Carcinoma or malignant cells	Cancer

What causes dysplasia?

The Human Papilloma Virus (HPV) causes most abnormal Pap smears.

Human Papilloma Virus (HPV) – is a common virus related to those that cause warts on the hands and plantar warts on the feet. Genital HPV may affect skin of the vulva, vagina, or cervix. The virus can cause changes in the appearance of these skin cells. Most women with HPV have normal Pap test results. However, a few types of genital HPV may cause pre-cancers or cancers to develop.

There are more than 100 types of HPV. 30 types are spread through sexual contact. Condoms do not guarantee protection against HPV

There is no cure for HPV. Most HPV infections will go away on there own. Some may persist and need to be treated.

What is a colposcopy?

A colposcopy is a procedure to identify the abnormality. The physician will use a colposcope to examine your cervix, vagina, and vulva. The colposcope is a binocular microscope that magnifies the cervix under a beam of light. The colposcope does not come into contact with your body. The Pap test is repeated. A 3% acetic acid solution (vinegar) is applied to the cervix. This solution dehydrates the cells, making the abnormality more visible under the colposcope.

It may or may not be necessary to do a biopsy. The biopsy may also cause a small amount of bleeding and/or cramping. After a biopsy, it may be necessary to wear a sanitary napkin for a few days. The colposcopy usually takes five to ten minutes to complete. You will be able to watch the procedure on a monitor.

Who will be present during the colposcopy?

A physician and a nurse will be present during the colposcopy. Occasionally, there is one additional person. This person can be a medical student, a resident, or a fellow. There will never be more than one extra person present during the coplopscopy.

Can dysplasia be treated?

Most dysplasia does not require treatment. In the majority of women, dysplasia goes away on it’s own. Treatment will likely be recommended if you have HSIL or moderate to severe dysplasia. Mild dysplasia can also be treated if it persists over a period of 2 years or more

Treatments

LEEP Loop Electrosurgical Excision Procedure)
LEEP is designed to treat and/or diagnose women who have had abnormal pap test results and/or biopsy of the cervix. LEEP is the cutting and coagulation of abnormal tissue in the cervix. LEEP uses an electric current that passes through a thin wire loop and acts like a scalpel (surgical knife) to cut away a thin layer of surface cells from the cervix. This procedure is done at the Clinic under local anesthetic. Treatment is scheduled in advance and is not done at the same time as the Colposcopy appointment. For more information, consult the Guide to LEEP Treatment (Loop Electrosurgical Excision Procedure).

Cone Biopsy
A cone biopsy is the removal of the abnormal cells with a scalpel (knife) while under general anesthetic in the operating room. This is a day procedure.

Laser Treatment of the Cervix
Laser treatment of the cervix is a procedure in which the physician uses a laser beam to vaporize abnormal cells of the cervix.

What is the follow-up for dysplasia?

The type of follow-up will depend on the findings at the time of the colposcopy. For LSIL or mild changes: the recommended follow-up is nine months. If HSIL or moderate to severe dysplasia is diagnosed a LEEP/Laser or Cone Biopsy may be recommended and scheduled at the next available appointment.

Still have questions? Check out these Web sites for more information.

Sunnybrook Health Science Center www.colposcopy.com/
HPV Info (SOGC): www.hpvinfo.ca/hpvinfo.html
Sexuality and U sexualityandu.ca/eng/teens/STI/whatarethey_hpv.cfm
Society of Obstetricians and Gynaecologists of Canada sogc.medical.org/
American Society for Colposcopy and Cervical Pathology www.asccp.org/patient_edu.shtml
Medline Plus www.nlm.nih.gov/medlineplus/
National Cervical Cancer Coalition www.nccc-online.org/