Tests after an abnormal cervical screening result

Most abnormal results from screening tests show only very minor changes. These are called borderline or mild changes, or mild dyskaryosis. Many of these will go back to normal on their own, so your GP may arrange for you to have further screening tests six, 12 and 24 months later.

If you smoke, it may help if you try to give up, as it’s more likely that your cervical cells will go back to normal.

If your second screening test still shows abnormal cells, your GP or practice nurse may then arrange for you to have some further tests. Some doctors will refer you for further investigation after just one abnormal test result, however minor.

Moderate or severe changes – CIN 2 or 3

A small number of women will have moderate or severe changes (CIN 2 or CIN 3). These are known as moderate or severe dyskaryosis. If this is the case, your GP or practice nurse will suggest that you have a further test, known as colposcopy, within a few weeks.

If you need to have colposcopy, you’ll be referred to your local colposcopy unit, which is usually at a hospital outpatients clinic. You don’t normally have to stay overnight. Almost all hospitals with gynaecological units have the facilities to do colposcopy.

Colposcopy Back to top

Colposcopy shows the cervix in detail using a specially adapted type of microscope called a colposcope. It acts like a magnifying glass so that the person doing the examination can see the whole cervix clearly.

Colposcopy can be carried out by a specialist doctor or a nurse colposcopist. Doctors and colposcopy nurses follow national guidelines when deciding whether you need further tests or treatment. Before your test, you'll have a chance to discuss your screening test results and any worries that you have, with the doctors or nurses at the clinic.

You’ll be helped to position yourself on a specially-designed chair or examination table. When you are lying comfortably, the colposcopist will use a speculum, in the same way as in the screening test, to hold your vagina open. The cervix is then painted with a liquid to make the abnormal areas show up more clearly. A light is shone onto the cervix and the doctor or nurse will look through the colposcope, which stays outside your body, to examine the surface of the cervix. A small sample (biopsy) of cells may be taken from the cervix, to be looked at under a microscope.

Colposcopy takes 15–20 minutes and so is longer than the screening test. It’s not usually painful, but you may feel some pain if a biopsy is taken. The biopsy may also cause some slight bleeding for a couple of days afterwards. If the abnormal area still can’t be seen clearly with a colposcope, the colposcopist may arrange for you to have a cone biopsy (see below) or a large loop excision of the transformation zone (LLETZ)|. Sometimes these procedures are done during your colposcopy appointment.

Cone biopsy Back to top

The doctor takes a small cone-shaped section of the abnormal tissue (see diagram on next page) from the cervix to examine under a microscope. This is normally done under local anaesthetic, although sometimes a general anaesthetic may be used. Looking at the tissue that has been removed can show whether the abnormal cells are CIN 1, 2 or 3 or whether deeper levels of the cervix are affected.

Afterwards, a small pack of gauze (like a tampon) may be put into the vagina to prevent bleeding. This is usually removed within 24 hours. Some women may also have a tube (catheter) put into the bladder to drain urine while the gauze pack is in place.

It’s normal to have some light bleeding and discharge for a few days after your operation. You should avoid any sex and strenuous exercise for at least 2–4 weeks to allow the cervix to heal properly.

Sometimes a cone biopsy can make the cervix slightly weaker, which may increase the risk of miscarriage during pregnancy. In this situation, miscarriage can often be prevented by putting a stitch into the cervix during pregnancy to strengthen it. Your doctor can discuss this with you in more detail if you are concerned about possible future pregnancies. A cone biopsy will not affect your ability to enjoy sex.

The cervix can become very tightly closed after a cone biopsy, although this is extremely rare. This can make it harder for sperm to enter the womb and so can affect the chances of becoming pregnant naturally. Your cervix is not completely closed if you are still bleeding during your periods after a cone biopsy.

Large loop excision of the transformation zone (LLETZ) Back to top

During the LLETZ| procedure, a wire loop with an electric current (diathermy) is used to remove abnormal areas of tissue. This tissue is then sent to a laboratory to be checked. LLETZ is the most common treatment for CIN.