Colposcopy is the examination of the cervix under magnification. The colposcope itself is very similar to the light source you’ve seen in your physician’s office when you had your Pap test. The only difference is that the colposcopy has a stronger light source, and a couple of lenses that enlarge your tissues enough for us to be able to see any abnormality. Consider it to be a microscope of sorts.
We use acetic acid (vinegar) to help point to which cells may be the reason of your abnormal Pap test. We may then take a biopsy from your cervix to confirm what we saw. There is hardly any more pain or discomfort than what you feel during your regular Pap test.
We may ask to see you in colposcopy for many different reasons. The most common is abnormal cells in your pap. Other reasons may include having a lesion (usually polyp) on your cervix or the skin on your genital area. If you have warts we will see you for a treatment there as well. Some women may complain of a white area on the skin (Lichen Sclerosis), redness or a burning sensation, or vaginal pain.
The procedure is usually done in the outpatient clinics in the Oshawa Hospital (Lakeridge Health Oshawa). This is on the second floor. Use the escalators in the main hallway, turn right, and at the ‘cage’, you will see the sign “Colposcopy”. You will need to register in the cage. DO come about 20 minutes or so before your appointment in case there is a waiting list for registration.
If at all needed, we use local freezing. The procedure hardly takes more than 10-15 minutes, but your stay in the hospital can be an hour or so. You need to change, wait to be seen, etc. You usually will not need an accompanying person for a routine exam. If you were booked for a LEEP procedure, however, we recommend that you have someone with you. This is just in case you do not feel well after the procedure. Again, there is hardly any pain involved there.
If we take a biopsy, we usually use a mustard colored paste called Monsel’s solution to prevent possible bleeding. This turns to a brownish-blackish color when it mixes with blood. If this stains your underwear, you will not be able to wash it off, and this is why we recommend you use a pad after the procedure. Actually, there are pads in the changing room and the washroom in the colposcopy area. You should not have intercourse or insert a tampon for 2-3 days after a biopsy to give your cervix enough time to heal.
LEEP: If you have abnormal cells on your cervix, you need a treatment. The options include laser treatment, freezing and LEEP. The option we offer in Oshawa is the LEEP, short for Loop Electrosurgical Excision Procedure. The idea behind it is that if we leave the abnormal cells long enough you carry the risk of them developing into cancer. If we take them out, you heal by growing a new stack of cells that are clear of abnormalities.
The procedure takes about 10 minutes of preparation and 8 seconds to do (or nearly so…). We use a special coated blue speculum to see your cervix. Local freezing is used, more so to prevent from bleeding than to actually numb pain. Again the procedure is mostly pain free. At the end of the procedure, we use the Monsel’s solution, and recommend you insert nothing in the vagina for three weeks. The only exception is a special cream that will may prescribe for you to use in the vagina for two weeks after the procedure. When you start being sexually active, we recommend your partner uses condoms for the first three weeks, even if you were not using condoms before the procedure.
If we take a biopsy (including after a LEEP), you need to know the result. I always ask you to come and see me in the office to review the result of the biopsy and plan what we need to do next, if anything.
Follow Up Care
It is important to note that I will probably need to see you again in colposcopy on a later date for follow up. General rules are as follows.
If you had a normal pap and normal biopsy on your first visit, all you will probably need is a Pap every year.
If your biopsy came back with low level change (LSIL), or ASCUS, we will probably see you in Colposcopy in 6 months for a follow up.
If your biopsy came back with high level change (HSIL) you will need to have a LEEP treatment to your cervix. This is done in the hospital, and on the next available date. On follow up, we will see you in colposcopy after 3 months to check how your cervix is healing, and then every 6 months for 4 visits.
In all cases, you need to book your own colposcopy visits in the hospital. They will call you back with a date and time. They will not remind you of the appointment.
Most of the changes that cause the abnormal cells in the cervix are caused by HPV. Read the link about HPV on our website.
LS (Lichen Sclerosis)
Lichen Sclerosis or LS is a rather common and underdiagnosed skin condition. It can happen at any age, as early as 20.
It is a subtle disease that usually is not diagnosed early as most women will have no symptoms or no complaints early on. Wome who do complain can have burning, burning with urination, itching or feels different down there. In many cases, patient self diagnose themselves with yeast infection, get a treatment, and are usually frustrated that either the yeast infection does not go away, or keep on coming back.
Well, if yeast treatment does not make it go away, it is not a yeast infection.
LS is a skin condition. It is not cancer, and is not caused by an infection. It just happens. It is usually a long lasting condition that needs treatment for a long period of time.
Presentation can be, nothing, as mentioned before, and you are only diagnosed when you see a gynecologist for any other reason. Or you may have the local itch, burning, etc. Sometimes, you may have a white patch of skin. Again, some other change may be in the form of disappearing labia. The skin changes have an effect like an "iron, or ironing the structures down there". Some women complain of burning and discomfort with intercourse.
If left long enough, the skin changes can cause tightening up of the vaginal opening, when intercourse become difficult. In extreme cases, urination can be an issue, result in recurrent bladder infections.
Treatment is usually in the form of creams that are used locally. There are a few medications that can be applied, and a few regimens. Your treatment schedule will change over time, depending on how you initially presented, and how you responded to treatment.
Sometimes in long standing cases and with vaginal tightening, laser treatment is needed to open things up.
Very rarely, and if left untreated, LS can be associated with cancer. While this is rare, may be in the 2-3 % range, we hope you never leave it long enough for any cell changes to happen.