“We treat people, not just problems.”
John L. Pfenninger, M.D.
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Colposcopy is a relatively painless thirty-minute office procedure for examining the female cervix when an abnormal Pap smear has been detected or there has been exposure to genital warts. This is done using a special microscope called the colposcope, which we have in our office. It usually cannot be done if you are flowing heavily on your period, but if you are only spotting, keep your appointment.
Colposcopy identifies areas on the cervix which might be causing the abnormality on the Pap smear and which may be considered premalignant (precancerous). The changes may vary from mild to severe. If left alone, these changes may revert to normal, may stay the same, or may progress to malignancy (cancer) over a period of years. After proper evaluation, these abnormal cells can usually be treated with a freezing technique called cryocautery or with surgical removal. In certain cases, laser therapy may be recommended. In this way, cancer can usually be prevented. As with any procedure, there is no guarantee that the doctor can always eliminate the precancerous area. Therefore, close follow-up is always needed. If you are found to have a premalignant lesion, there is about a 1% lifetime chance of developing cancer even after treatment. PLEASE FOLLOW YOUR DOCTOR’S RECOMMENDATIONS FOR FOLLOW-UP.
Research has shown that infection with the human papilloma virus is closely associated with cancer of the cervix. This is the same virus that causes warts in the genital areas, including inside the vagina and on the cervix. The medical term for these warts is condyloma accuminata. These lesions are very contagious and are passed readily by sexual intercourse. It is rare that people can be infected in other ways than through sexual contact. These wart viruses can remain dormant or inactive for up to 20 years after initial infection. If there is evidence of infection in the female (seen by an abnormal Pap smear or obvious warts around the genitals), then the male sexual partner(s) is also infected. In some instances, it may be advised that the man be examined. That procedure is called androscopy. A separate handout is available which describes androscopy. Men may need to be treated if they have warts or have symptoms. If you have already had unprotected sex with your partner, a condom (rubber) is not necessary for future sex with the same person.
DESCRIPTION OF PROCEDURE (Colposcopy)
This procedure will take 30 minutes. You will be asked to undress from the waist down and will be draped appropriately. You will be asked to lie back and put your feet in stirrups just like when you had the Pap smear taken. You may want to take (4) 200 mg ibuprofen (Advil, Nuprin, etc.) two hours before your appointment time, but do not take any aspirin.
The speculum will be inserted and the Pap smear will be repeated.
The doctor will then look through the fancy microscope (colposcope) at the cervix and note if there are any abnormalities. He will next stain the cervix with a vinegar douche. This makes abnormal cells turn white. If such changes are seen, the doctor will take a small biopsy of these areas. This is generally not painful. (The biopsies are very small, about 2-3 mm [1/8 inch].) If a biopsy is taken, it does not mean you have cancer. It only means there are abnormal cells that need closer inspection. The biopsies will be sent to the hospital laboratory for further evaluation. The hospital laboratory will bill you separately for looking at those biopsies. Because the biopsies are so small, there are very few complications from this procedure except possibly some spotting.
The final step is to do a scraping inside the cervix. This is called an endocervical curettage (ECC). This will cause cramping. This part of the procedure lasts only 15-20 seconds. Many women find it helpful to take four (4) 200 mg ibuprofen (Advil, Nuprin, etc,) two hours prior to the procedure to decrease this cramping. Occasionally there will be some spotting afterwards for several days. Bring a sanitary pad with you to the office.
No time off work is needed except for the time in the doctor’s office. Normal activities, including sex, may be resumed. As long as you are with the same partner, condoms are not needed. Depending on the results of the biopsies and the ECC, which take about a week to return, your physician will advise you on the treatment of your condition. Remember to have your partner screened, too. If we do not call you within 2 weeks, please call our office for results.
There have been about 90 different types of warts identified. They are all numbered. Types 6, 11, 16, and 18 are the most common warts in the genital area. Patients often ask if these warts can be transmitted to the hands, feet, etc. Generally this does not happen. Genital warts for some reason stay in the genital area and usually are not transmitted to other parts of the body. Only 20% of these warts can be seen with the naked eye. The remaining 80% need to be stained to be seen and properly evaluated.
Unfortunately, once someone has the wart virus in the vagina or rectum or on the penis, it is almost impossible to totally eliminate it. Treatment can put them in “remission”, but they can come back anytime. THE CERVIX IS AT VERY HIGH RISK OF DEVELOPING CANCER IF EXPOSED TO THE WART VIRUS SO IT MUST BE EVALUATED AND TREATED IF THERE ARE SIGNIFICANT CHANGES THERE. THERE IS A 99% CHANCE OF CURE/PREVENTION IF THE CERVIX IS TREATED IN TIME. Since the warts can come back into the vagina anytime, you can spread the disease anytime. Most experts strongly recommend that you remain monogamous. This means that you have intercourse with only one partner - the same partner - the rest of your life. As long as you are with the same partner, you do not need to use condoms. You already have whatever he’s got. Using condoms does not cut down on reinfection if you are with the same partner. However, if you have a new partner, then you can “catch” new and different types of viruses, so a condom is necessary. Remember, though a condom provides protection, it never makes sex “totally safe.”
We now know too that, if you smoke, your chance of developing cervical cancer is markedly increased. Even if your partner smokes, your risks go up! You must stop smoking, and your sexual partner should too. Also, diet is very important. You should eat at least five servings of vegetables and fruits every day. A handout is available from the receptionist regarding this. Many authorities now also suggest extra vitamins with folic acid and antioxidants.
Remember that even after you are treated, you will need 3 or 4 Pap smears during the next 12 months, and then Pap smears at least every year for the rest of your life. Your doctor may also recommend periodic colposcopy since we know that the Pap smear may miss up to 25% of lesions on the cervix. You should notify any new sexual partners that you have been treated for condyloma.
Copyright, 2011. John L. Pfenninger, M.D. Colp Pt Ed/jw/11/10