What Is the Connection between HPV and Colposcopy?

The human papillomavirus (HPV) is a sexually transmitted disease that occurs in about 40 different strains and is known to cause cervical cancer. A colposcopy is a thorough vaginal exam that involves taking samples of cells from the cervix. The connection between HPV and colposcopy is that doctors can use the exam to confirm changes in the cervical cells that have been or might have been caused by HPV.

Normally, doctors screen for diseases of the vagina, cervix and other reproductive structures through regular yearly Papanicolaou tests, or Pap tests. Doctors use long swabs to gather cell samples from the vagina and cervix. Laboratory professionals examine the cell samples to check for abnormalities. If the results are abnormal, the next step is colposcopy.

Most women fight off the HPV virus naturally. Some women’s bodies are not able to do this, and the virus lingers for years. If HPV remains in the body for extended periods, it can cause cell changes.

Doctors classify the level of cell changes on a scale of 1-5, with Level 1 being normal and Level 5 being cancer. Women who have Level 2 results generally are not asked to undergo a colposcopy, because Level 2 changes often resolve on their own as the women fight off the HPV virus or as the cervix heals from other minor injuries. Changes to the cervical cells are checked again with one or more follow-up Pap tests. Colposcopy is recommended at Level 3, because cellular changes at this level often are associated with HPV and increased cancer risk.

During a colposcopy, a physician washes the inside of the vagina and cervix with a very mild, vinegar-like solution. The acidity of the solution causes areas that have abnormal cells to turn white. The doctor then examines the white areas with a colpsoscope, which is like a microscope. A biopsy often is taken from the areas that are of concern.

HPV is an extremely common virus; roughly half of all sexually active men and women get it at some point. Of those with the virus, about 90 percent fight off the infection within two years and have no symptoms. The percentage of women in whom there is HPV and colposcopy is needed thus is fairly low, even though the virus is prevalent. Only about 1 percent of women who have a Level 3 result for a Pap test and subsequent colposcopy will develop cervical cancer within two years. The likelihood of contracting HPV and colposcopy being needed increases with increased sexual activity, however, because only sexual abstinence can guarantee that a person will not contract HPV.

The connection between HPV and colposcopy is clear, but not all women who need colposcopies have HPV. A separate HPV test is necessary to determine whether a woman has HPV. Even when a woman has HPV and colposcopy is recommended because of cervical changes, this doesn’t necessarily mean that the HPV has led to those changes, because there are other causes for cancer of the cervix. Examples of these causes include heredity, or a genetic predisposition; smoking; and extended use of oral contraceptives.