First of all, try not to be afraid. You will be ok. We’ve known patients to panic, rush to the internet, and Google anything and everything that could possibly be wrong with them. The truth is, the unknown is far scarier than what will probably happen next.
If you do have some sort of an abnormal result from your Pap test, your next step will probably be a minor procedure called colposcopy with cervical biopsies. This is a quick and minor procedure so there is rarely any need for anesthetic.
When you enter the exam room for your procedure, you’ll probably see a lot of equipment that will look unfamiliar. What is all that stuff?
The largest instrument that looks like a microscope on wheels is just that. It’s called a colposcope, and it allows us to visualize your cervix and vagina magnified.
There may be some metal instruments and small brushes on the table nearby. We use these to take the biopsy. We literally pinch and cut off a small piece of your cervix or take a sampling of your cervix with a brush that we rotate back and forth over the area of concern. There’s also an instrument that we use to do a thing called an “EEC” or “endocervical curettage.” This is often the very last part of the procedure where we scrape some cells from your cervical canal. We always want to be sure that you do not have abnormal cells hiding in a canal which is not visible.
Why do you smell vinegar in the room? We use acetic acid – essentially vinegar – which we apply to your cervix with a large Q-tip swab. The acetic acid makes the abnormal areas really stand out under a green filtered light that helps guide us right to the abnormal areas. Often, you may feel slight burning when the acetic acid is applied to your cervix.
There will also be some small bottles containing clear liquids and one containing something that looks like mustard. The clear solutions are the bottles where we’ll put your cervical biopsy specimens to send them to the pathology lab, to be prepared and read under the microscope by the pathologist.
The mustard-like solution is called Monsel’s solution. Once we do the biopsies, there will be small areas of bleeding at the biopsy sites. We apply the solution with a large Q-tip to make the bleeding stop. This solution turns black and grainy. So do not be alarmed if you pass brownish/blackish discharge along with some blood after the procedure. On occasion, the solution forms almost like a scab over the cervix, and it may fall out of your vagina as a large chunk. Again, don’t be afraid. This is normal.
The procedure itself is very quick and straightforward, much like a regular gynecological examination. The speculum that we always use to do your Paps will be used in your vagina so we can see your cervix. Light will be turned off in the exam room so that we can use a green light to visualize your cervix. Often there will be silence as we study your cervix looking for abnormal areas, so we tell our patients that silence does not mean that we’re seeing something terrible……we’re just concentrating.
After the procedure, you may have some minor cramping. Please take over the counter ibuprofen for this if needed. You may also take over the counter pain meds an hour before the procedure. As mentioned previously, you may have light bloody/brownish/blackish/grainy discharge for a couple of days.
What’s not normal: Vaginal bleeding like a period, persistent or increasing lower abdominal pain, fever, or malodorous vaginal discharge. Please call your gynecologist if you experience any of these symptoms.
There’s always art to medicine, so your own gynecologist may have her own way of doing things. Be sure to ask if you have any questions or concerns.
More often than not, these biopsies show nothing of immediate concern, although you’ll probably be asked to follow-up with your OB/GYN more frequently in the next year to keep an eye on things. So don’t be afraid to go in to your OB/GYN’s office to follow up on an abnormal Pap result. You don’t want to postpone and end up dealing with the potential of cancer down the road.