Colposcopy is a key diagnostic component of the cervical screening programme. As a sample taker, it is essential to understand its purpose, along with referral procedures and guidelines, to ensure women are managed appropriately and in a timely manner.
Women whose screening test result recommends referral to colposcopy must be referred directly by the clinically responsible doctor to a colposcopy service within 10 working days of receipt of the screening test result and recommendation.
If a person needs to attend colposcopy, CervicalCheck will recommend the colposcopy service that you should refer them to.
We will recommend the service:
- nearest to your clinic or practice
- where they will receive the quickest available appointment
If you are referring the person to a private colposcopy service, please be aware that this is not managed by CervicalCheck and we will not have visibility of the referral.
A colposcopy is simply a more detailed examination of the cervix. Instead of looking at the cervix with the naked eye, special magnifying binoculars are used to see if treatment is needed.
The colposcope is a stereoscopic low power microscope used to visualise the cervix and other parts of the lower genital tract, aided by a powerful light to illuminate the area being examined. It may be used to detect an abnormality, to determine the extent of the lesion and the severity of the lesion, and to guide biopsy from the most appropriate area. Excisional and ablative treatments of cervical precancerous cell changes are performed under colposcopic visualisation
There are 15 colposcopy clinics located in Ireland:
- Cork
- Donegal - Letterkenny
- Dublin - Coombe
- Dublin - National Maternity Hospital
- Dublin - Rotunda
- Dublin - Tallaght University Hospital
- Galway
- Kerry
- Limerick
- Louth
- Mayo - Castlebar
- Sligo
- Tipperary - South Tipperary, Clonmel
- Waterford
- Wexford
Patients who have an abnormal screening test result
- Any HPV positive result with abnormal cytology
- Second consecutive HPV positive and cytology (whether abnormal/NAD)
- After one HPV positive and cytology NAD if HIV+, on renal dialysis, or pre/post -transplant
- Three consecutive indeterminate/unsatisfactory screening test results
If there is a suspicion of cancer of the cervix on examination, a direct referral to colposcopy is needed. This can be done by phoning the colposcopy clinic and discussing your clinical concern and followed up by completing the Referral to Colposcopy form.
To access the CervicalCheck Results and Recommendations table please click here
When a screening test result carries a "refer to colposcopy" recommendation, CervicalCheck will send a partly pre-filled colposcopy referral form to the practice where the screening test was taken. CervicalCheck will recommend the colposcopy service nearest to your clinic/practice. However, it is important to remember you can refer to any colposcopy clinic of the woman’s choosing by completing the form and sending it to your chosen clinic.
To access the Colposcopy referral form, click here.
The waiting time for an alternative unit may be longer than for the one recommended by CervicalCheck.
The woman will get notification of the recommendation to refer to colposcopy along with her results letter. The GP surgery must also contact the woman regarding the referral to colposcopy.
This form must be completed by the contracted doctor (CRD) within 10 working days of the receipt of the test result. Every referral made must include a copy of the cervical screening test result including cytology report if available.
To access further information on referral to Colposcopy click here.
Electronic referral is currently available in six of our CervicalCheck colposcopy clinics, Kerry, Wexford, Rotunda, Coombe, NMH and Louth. It is hoped this will be rolled out nationally in the near future and you will receive communication from CervicalCheck when you can refer electronically in your area.
It is imperative to include a copy of the full screening result with the electronic referral in order to prevent delays for service users, ensure a robust process and allow optimum use of resources.
If there is a suspicion of cancer of the cervix phone the Colposcopy Clinic and inform them of referral. Send a completed Colposcopy referral form to the Colposcopy Clinic which can be downloaded from the CervicalCheck website. To access the Colposcopy referral form, click here.
Follow up with a phone call to the colposcopy clinic to ensure they received the referral.
Do not proceed with a screening test if cervical cancer is suspected. Instead, make an urgent referral to colposcopy. Screening tests are not diagnostic, and if there is suspicion of cervical cancer, a screening test is not appropriate in such cases.
A copy of the relevant screening test result (HPV and cytology) report must accompany the colposcopy referral form. The full report should be included, not a summary report which is generated from some GP IT software systems.
CervicalCheck assigns your practice/clinic to one of the 15 colposcopy services which will be the recommended clinic for all referrals to colposcopy recommendations issued to your clinic. If the patient wishes to attend a different clinic to the one the programme identifies, the CRD (Clinically Responsible Doctor) needs to identify the clinic of choice on the completed colposcopy referral form and direct the referral to that clinic. The waiting time for an alternative unit may be longer than for the one recommended by CervicalCheck.
To access the Colposcopy referral form, click here.
Yes, if a patient meets the criteria for colposcopy, they should be referred to the colposcopy
clinic even if they are pregnant. Please ensure that the clinic is informed on the referral if they are pregnant or send additional correspondence to this effect if referral form has already been sent. The aim of colposcopy during pregnancy is to rule out invasive disease. Biopsy or treatment is deferred until after delivery unless suspicious for invasion.
The colposcopy clinic will determine the best time to see the woman based on the information you provide. Therefore, it is important to include the EDD (expected date of delivery), if known, as this will help the clinic schedule an appropriate appointment.
Yes, contact the Colposcopy Clinic, explain the situation, follow up with a letter to the colposcopy clinic outlining the patients details and reason for referral. An appointment will be given for the screening test to be performed in the Colposcopy screening Clinic.
All sample takers should adopt the principles of trauma-informed care when offering and providing cervical screening for women. Many women with a history of trauma such as sexual abuse may not disclose this to their sample taker, so it is important to recognise the signs and symptoms of trauma. Signs can include anxiety, fear, nervousness or someone who doesn’t attend for appointments. A safe, trusted environment is important, and communication is key to ensure the woman feels safe. Asking the woman if she would like to bring a support person, is there an appointment time that suits them best, would they prefer the doctor or nurse to take the test. It is important to ask the woman what can be done to make the procedure easier for them and reinforce to the women that she is in control of the examination and can stop at any time. This helps to empower the woman and may help towards a successful screening experience. A referral can be made to a Sexual Assault Treatment Unit (SATU) for appropriate care. There are 3 clinics presently taking cervical screening tests with more to follow. Prior to referral, phone your nearest SATU to check if they accept patients for cervical screening.
Click here to view Webinar on Trauma informed care.
The Colposcopy clinic may be contacted, the situation explained and followed up with a letter to the Colposcopy Unit outlining the patients details and reason for referral. An appointment will be given for the Screening test to be performed in the Colposcopy Screening Clinic.
Any queries about obtaining an appointment in this circumstance please email the Access Officer at: access@cervicalcheck.ie.
No. If the cervix appears normal and the patient is due for screening, a screening test should be performed. Consideration should be given to performing additional diagnostic tests to identify a cause for persistent unexplained symptoms. Referral to the nearest Ambulatory Gynae or Gynae clinic may be required for evaluation of persistent unexplained symptoms. Please refer to CervicalCheck Clinical Guidance Note: Management of abnormal bleeding or other symptoms of cancer
When a recommendation to refer to colposcopy is issued, and the referral is made to a private rather than public colposcopy service, please be aware that this is not managed by CervicalCheck, and we will not have visibility of the referral.
Unless you inform CervicalCheck of the private referral, a failsafe letter will be issued 1 month after the original notification to refer to colposcopy was received.
The waiting times for colposcopy appointments at CervicalCheck colposcopy units are closely monitored for adherence to the Programme Standards as follows:
| Urgent (clinical suspicion of cancer) |
2 weeks |
| High grade cytological changes |
4 weeks |
| Low grade cytological changes |
8 weeks |
| Persistent HPV with normal cytology |
8 weeks |
It can be helpful to reassure women that they will be seen within these time frames by certified and quality-assured teams in CervicalCheck colposcopy units, and that their care there will follow clear protocols and algorithms managed by CervicalCheck. CervicalCheck has no oversight of the quality of care delivered in private colposcopy settings.
To access information regarding responding to failsafe requests click here.
If the result of the private screening test recommends referral to Colposcopy which is in line with a CervicalCheck referral to colposcopy recommendation (HPV primary Screening: Eligibility Framework) , complete a referral form and forward it to one of the 15 programme colposcopy clinics after discussion with the patient. Please be aware that a Private Colposcopy Clinic is not managed by CervicalCheck, and we will not have any details on our register related to the private test laboratory or result.