Do I Need a Colposcopy If I Have HPV?

The need for a colposcopy depends on factors such as the type of human papillomavirus (HPV) detected, your age, and the presence of atypical cervical cells.

HPV infections can sometimes cause changes in your cervix’s cells that, left untreated, may lead to cancer.

Your healthcare professional may recommend a colposcopy to examine your cervix and check for unusual cell growth or precancerous lesions.

Identifying and monitoring these changes early can help prevent the development of cervical cancer or allow for prompt diagnosis and treatment.

When will healthcare professionals recommend a colposcopy?

Several factors influence the decision to perform a colposcopy:

• Age: Older people may be more likely to undergo a colposcopy to avoid potential risks. Younger people may receive monitoring because the virus might be more likely to clear without medical treatment.
• HPV strain: The specific type of high risk HPV can affect the decision. Some strains are more likely to lead to cervical changes than others.
• Pap smear results: If your Pap smear shows dysplasia (unusual cells), doctors often recommend a colposcopy to evaluate these changes further.
• Health history: Factors such as a history of atypical Pap smears, previous treatment for cervical dysplasia, or a weakened immune system may influence the decision.
• Other risk factors: Tobacco products and certain sexually transmitted infections (STIs) can increase the risk of HPV-related complications, which may lead to a colposcopy recommendation.

Your healthcare professional can determine whether a colposcopy is necessary based on your individual situation.

What should you expect from a colposcopy?

Have the procedure when you’re not menstruating, and avoid taking vaginal medications or using creams on that area for 24 hours beforehand.

During the procedure:

1. Lie on your back with your feet in the supports, similar to a pelvic exam.
2. A doctor inserts a speculum to hold your vagina open for examination.
3. They examine your cervix using a colposcope. They may apply a solution to make areas of concern more visible.
4. They may perform a biopsy, which can cause mild cramping.

After the procedure:

• You may experience mild cramping, discomfort, and light spotting.
• Avoid vaginal penetration for a few days to reduce infection risk.
• Follow your doctor’s instructions for restarting or adjusting medications.
• Take over-the-counter pain relievers like acetaminophen, ibuprofen, or naproxen as needed.
• You can take a shower after the procedure. Ask your doctor whether a bath is OK.
• Biopsy results may take a few days to a week to become available. Follow up with your doctor as advised.

How accurate is a colposcopy?

The effectiveness of a colposcopy varies widely. Research used in a 2023 study showed that sensitivity (ability to detect disease) may range from 30% to 100% in different clinical settings.

The 2023 study looked at how well colposcopy worked to find serious cervical conditions in people who’d tested positive for HPV.

The findings showed the following:

• About 15% of the participants had severe precancer or cancer detected at the first visit or the follow-up visit.
• Colposcopy found those conditions well (about 91% accuracy).
• The procedure wasn’t as accurate at ruling out less serious conditions, with about 50% accuracy.
• Younger participants (ages 30 to 49 years old) had higher accuracy rates (about 93%) than older participants (ages 50 to 65 years old), who had about a 78% accuracy rate.
• Older participants had higher accuracy in ruling out less severe conditions.

Are other tests possible to confirm an HPV diagnosis or guide treatment?

The World Health Organization (WHO) guidelines recommend colposcopy as one option for further evaluation of HPV-positive women. Other options may include:

• Repeat testing: Depending on the specific circumstances, healthcare professionals may recommend repeating the HPV test after a certain period to see whether the infection clears.
• Pap smear: Doctors may recommend a Pap smear to check for atypical cells on your cervix. This test can help identify potential health concerns that may require further evaluation.
• HPV genotyping: This test can determine the specific type of HPV present, which may help guide further management decisions.
• Visual inspection with acetic acid: This method involves applying acetic acid to your cervix and examining it for areas that may show precancerous changes.
• HPV vaccination: When tests detect an HPV infection but no unusual cells are present, doctors may recommend vaccination to prevent future infections with high risk HPV strains.
• Clinical observation: In some cases, especially in younger people with low risk HPV types, healthcare professionals may choose to monitor the situation closely without immediate treatment.

Healthcare practices are shifting toward HPV-based screening over Pap smears because HPV tests can detect the virus before it causes cell changes, providing earlier detection.

While this change initially increases referrals for further testing, research shows that referrals decrease over time. This decrease suggests HPV-based screening may help detect and treat precancerous conditions earlier.

For instance, a different 2023 study comparing people who switched from Pap to HPV tests found that although more initially received referrals for colposcopies with HPV tests, the rates eventually matched those of Pap tests, showing stabilization.

The bottom line

When discussing the colposcopy procedure with your healthcare professional, you can ask about the steps involved, how long it might take, and whether you can expect discomfort. You can also express any concerns or fears you may have.

Remember, a colposcopy is a routine procedure that helps detect and prevent cervical cancer. It’s a proactive step in maintaining your reproductive health.