DEAR DOCTOR K: I had an abnormal Pap smear. Now my doctor wants me to have a colposcopy. What can I expect during this procedure?
DEAR READER: Pap smears help determine if you might have cancer, or a precancerous condition, of your cervix. When a Pap smear raises such suspicions, the next step is a colposcopy.
Colposcopy is generally safe and painless. It takes about 15 to 30 minutes and doesn't require anesthesia. During the procedure, your doctor examines your vagina and cervix using a colposcope. This is a portable instrument with a light and magnifying glass.
Colposcopy basically accomplishes three things. First, it lets your doctor look directly at your cervix. Second, the light and magnifying glass let the doctor see things that the naked eye cannot. Third, it lets the doctor remove any suspicious-looking tissue.
Your doctor may ask you not to take aspirin for a week before the colposcopy, so that that you won't have excessive bleeding if tissue is removed. Don't douche or use vaginal creams or medications the day before the procedure, since that can make it harder for the doctor to get a good look at your cervix.
It's important to let your doctor know if you may be pregnant. Also, tell your doctor about all of the medications you take. Finally, don't schedule the procedure to occur when you are likely to be having your monthly period. Obviously, menstrual bleeding also can obscure the doctor's view.
Before the procedure, you will remove your clothing from the waist down. You'll be given a cloth to cover your waist and legs. Then you will lie on your back on an examination table with your legs spread, your knees bent and your heels placed in two stirrups.
Your doctor will insert a lubricated instrument called a speculum into your vagina. This holds the vaginal walls open. In some cases, your cervix and vagina may be rinsed with a vinegar solution or iodine stain to make abnormal areas easier for the doctor to see. The vinegar tends to turn any precancerous tissues white.
Next, your doctor will look through the colposcope to examine your cervix and vagina.
If the doctor sees any areas that look like they might be a precancerous condition, or cancer itself, the doctor will remove a small piece of the tissue (called a biopsy). The doctor may use a local anesthetic to numb the biopsy area. But you may experience some mild cramping or a little discomfort.
Any tissue removed during the procedure will be sent to a specialist (a pathologist) for examination. The tissue is treated with special chemicals and stains, and then examined under a microscope. The specialist will notify your doctor if any cancerous or precancerous changes are discovered.
Following your colposcopy, you can return to your normal activities right away. It is a simple procedure, and if it discovers a precancerous condition, that condition can be treated and cancer prevented.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write to Ask Doctor K, 10 Shattuck St., 2nd Floor, Boston, MA 02115.
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