The cervix is that part of the uterus (womb) that is partly protruding into the vagina and is visible to your doctor during an internal pelvic examination. The word 'cervix' is derived from the Latin word which means neck and is also sometimes referred to as the neck or the mouth of the womb. A biopsy is a procedure where is small piece of tissue is removed to accurately identify or to treat a specific medical problem.
When should I get a biopsy?
The most common problem that leads to cervical biopsies is abnormal cells on a cytology (Pap) smear. (See article on Pap smears) If these abnormalities are persistent, or of a serious nature your doctor may want to do a procedure that is called colposcopy. Colposcopy is a systematic examination of the outer part of the cervix with a colposcope. A colposcope is a kind of telescope that magnifies the cervix to make abnormalities easier to locate and biopsy. During the colposcopy the doctor may apply solutions to stain the abnormal cells to make it easier to visualise. If the abnormality is identified, a biopsy is usually taken.
Different types of biopsy:
In case of a visible growth on the cervix or when the doctor unsure if there is a problem a very small piece of tissue (the size of a freckle) is pinched off. This sample is sent for further testing.
If there is a larger lesion on the cervix, or if it is deeper into the cervix, the doctor may decide to do a cone biopsy. The shape of the tissue removed is like that of an ice cream cone - therefore called cone biopsy. These biopsies are done under local, regional or general anaesthetic depending on the facilities available, and the specific procedure. There are different ways to cut the tissue. It may be done with a scalpel (also called a cold knife cone) and is done in theatre under anaesthesia. Another method is to use an electric wire loop (called a loop procedure) and is often done under local anaesthesia.
How to prepare for a biopsy
- Inform the doctor of any allergies including allergy to latex.
- Menstruation is usually not a problem, but inform your doctor if you have heavy bleeding on the day of the procedure. Sometimes the procedure will be postponed.
- Inform your doctor if there is a vaginal discharge. In case of a significant infection the doctor may choose to first treat the infection and postpone the biopsy.
- A biopsy is generally not done during pregnancy. Ask for a pregnancy test before the biopsy if there is any doubt.
- Empty your bladder before the examination.
Are there any risks?
- A biopsy is a safe procedure.
- After the biopsy you may experience some bleeding or bloody discharge, but this should not be more than a normal menstruation. Contact your doctor if there is unusually heavy bleeding.
- Infection of the biopsy site may cause a foul-smelling discharge. Other signs of infection are fever and lower abdominal pain. This will start a few days after the biopsy and requires treatment with antibiotics. Some doctors routinely give a course of antibiotics after a cone biopsy.
What should I do know after the biopsy?
- Bring a sanitary towel to use after the procedure. There may be a discharge or some bleeding after the procedure
- Ask the doctor about sexual intercourse and the use of tampons after the procedure. If a cone biopsy was done, you may have to wait for two to four weeks to allow the cervix time to heal.
- Most biopsies cause minimal discomfort. If there is pain after the procedure (usually mild cramping pain) simple analgesics such as paracetemol should be adequate. If you experience severe pain, you should inform your doctor.
- The menstrual cycle may be disturbed for the first month after the biopsy.
- The results of the biopsy are important. Ask your doctor how long the test on the tissue will take and if you should contact the surgery after a certain time to get the results.
- The follow-up after a biopsy will depend on the results of the test. If a serious problem is found, you will be asked to return to the doctor for discussion of the further management.
- If a cone biopsy was done, most doctors will make a follow up appointment in four to six months to repeat a cytology smear (Pap test) or colposcopy.