At our colposcopy unit and center for vulvovaginal disease (Dysplasiezentrum Hamburg) we see women with abnormal cells in routine cervical screening (abnormal pap smear or HPV test) for further diagnostics and treatment. Furthermore, we are specialized to diagnose and treat dermatologic disease that manifest in the vulovaginal area such as lichen sclerosus, erosive lichen planus, lichen simplex chronicus or eczema and (pre) cancerous lesions of vulva and vagina.
You may be referred for a colposcopy if cells in your screening sample at your gynecologist were abnormal. The purpose of a cervical smear test is to detect any abnormal or pre-cancerous changes many years before they can cause serious problems! Abnormal smears are common and this does not mean that you have cancer!
We know, that most of these cell changes return to normal without treatment. However, if some cell changes are left untreated over years they could eventually turn into cervical cancer.
Colposcopy (the colposcope is like a magnifying glass) is a simple procedure used to look at the cervix, vagina and vulva. With colposcopy and a small biopsy we can confirm or exclude if cells at the cervix are abnormal and if you need preventative treatment – large loop excision of the transformation zone (LLETZ) – to remove them. LLETZ is a simple outpatient procedure that can be performed under a short general or local anesthesia.
Cervical cell changes
Cervical Intra-epithelial Neoplasia, more commonly referred to as CIN, is the medical term for cervical cell changes which are categorized from I-III. Cell changes at the cervix, but also vulva and vagina are mostly caused by the human papillomavirus (HPV). Most people will get some type of HPV infection during their lives. It is very common and you can get HPV from any kind of skin-to-skin contact of the genital area, not just from penetrative sex.
HPV viruses are categorized in “low risk” and “high risk” types. In most cases your body will get rid of HPV without it causing any problems. But sometimes HPV can stay in the tissue for a long time. Only „high risk“ HP viruses (e.g. type 16,18 , 31, 33, 45, 52,58) can cause severe dysplasie or cervical cancer if the infection persists for a long time and remains untreated. Women who smoke are known to be at greater risk of developing CIN than non-smokers. Low-risk HPV (e.g. typ 6,11) can cause condyloma but no severe dysplasia or cancer.
(Pre)cancerous lesion of vulva and vagina are called vulvar/vaginal intraepithelial squamous cell lesion (VIN/VaIN). They often cause unspecific symptoms like itching, burning or pain.
If an abnormality is detected, a small sample of tissue (biopsy) will be taken from the surface of the cervix. You may or may not feel a slight discomfort when the biopsy is taken. However, most women are surprised how little they feel. In the vulva/vaginal area local anesthesia is applied before the biopsy will be taken. Your doctor will call you to discuss the results of the biopsy with you.
Classification of cervical squamous intraepithelial lesion (CIN)
- CIN I: mild epithelial dysplasia, high rate of spontaneous regression without any treatment.
- CIN II: moderate epithelial dysplasia, still spontaneous regression in up to 50% of cases. Further procedure also depending on age. Regular monitoring at the colposcopy clinic necessary.
- CIN III: severe epithelial dysplasia, in the majority of cases preventative treatment is necessary to remove the cells (large loop excision of the transformation zone (LLETZ)).
Pregnancy does not prevent you from attending a colposcopy appointment, as a colposcopy examination will not harm a pregnancy in any way.
Please postpone your colposcopy examination if you have your menstruation (periods).