Everything you need to know about colposcopy, if it hurts and why you need it

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A colposcopy is a procedure that many women are probably unfamiliar with until their doctor has told them they need one. But don’t worry.

It’s a procedure that allows your doctor to visually examine the cervix, vagina, and vulva. It is usually done in the doctor’s office and is done after an abnormal Pap test, which typically indicates the presence of cervical dysplasia. Cervical dysplasia, or precancerous lesions, involves abnormal cells growing on the surface of the cervix. Without treatment, these cells can lead to cervical cancer.

The news that you need a colposcopy to examine precancerous cells can be scary and alarming.

“However, it is important to remember that most people with cervical dysplasia will not get cancer, especially if they are diagnosed and treated early,” says Andreea Newtson, MD, Nebraska Medicine’s gynecologic oncologist. “Cervical cancer has a well-defined natural history and is slow growing. We understand how it progresses so we know when to do and follow up on the appropriate screening to prevent it from becoming cancer.”

A colposcopy helps diagnose and prevent cancers of the cervix, vagina, and vulva. It is performed by brushing vinegar on the surface of the cervix and vagina (or vulva if there is concern about vulvar dysplasia). Dysplastic cells turn white when in contact with vinegar. Your doctor will then look for these white lesions when examining the cervical area with an instrument called a colposcope. If white lesions are found, a tiny biopsy of the lesion is taken to confirm if they are precancerous.

“Because the cervix has no pain receptors, the procedure doesn’t require anesthesia or numbing of the area,” says Dr. Newton. “However, the biopsy may cause some uterine cramping and, in rare cases, dizziness or light-headedness may occur.”

Not everyone who has an abnormal Pap test is automatically a candidate for this procedure. “The decision to have a colposcopy is based on several factors, including your history of dysplasia, your most recent Pap test, and your HPV status,” says Dr. Newton.

Along with regular Pap tests, one of the other most important steps you can take to prevent cervical cancer is getting the Gardasil vaccine, if you’re eligible, says Dr. Newton. Men and women can take Gardasil from the age of 11 up to the age of 45, although it is most effective if taken before the age of 26.

“The Gardasil® vaccine protects against high-risk strains of the HPV virus,” explains Dr. Newton. “Certain strains of the HPV virus can cause dysplasia, cancer and genital warts. HPV can also cause cancer of the head and neck, vulva, vagina, penis, and anus. Populations with high intakes of the HPV vaccine have greatly reduced rates of cervical cancer. It’s one of the few vaccines we have that can actually prevent cancer.”

Having HPV is nothing to be ashamed of. “The virus is like a cold of the cervix,” says Dr. Newton. “The CDC estimates that almost all sexually active men and women will get HPV at some point in their lives.”

HPV becomes more of a concern as you age because your body loses some of its ability to fight it off, increasing the risk that it could lead to cervical cancer, she explains.

Even if you are receiving the Gardasil® vaccine, Dr. Newston for continuing to have regular Pap tests as there is still a risk of contracting HPV even with the vaccine.

“Nobody should get cervical cancer anymore,” says Dr. Newton. “The rate of cervical cancer has fallen significantly in the United States, largely due to more women getting regular Pap tests and the introduction of the Gardasil® vaccine, which protects against high-risk strains of HPV. But we still have work to do. Vaccination rates are very low and have fallen even further during the pandemic, as have Pap visits. Cervical cancer still kills too many women and shouldn’t even exist.”

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