Punch biopsy impacts cervix? Colposcopy question

[Pregnantpolly]

Hi
Right, I overthink everything so...
2015 I had abnormal cells on cervix so was invited for colposcopy. It took mere minutes and no issues. I believe I had a punch biopsy back then and it was grand so nothing further.

I keep seeing things that say many miscarriages in 2nd trimester are due to insufficient cervixes and any surgery on cervix may cause this.

Have any of you previously had a punch biopsy? It didn't come up in my midwife appointments and only from talking to someone else pregnant so kind of worried.

I did prior to 2 pregnancies plus lletz ( might have wrong spelling) and all was fine.
It never crossed my mind whether it could be an issue.

Hi, I had a punch biopsy for sever grade cells followed by cold coagulation to remove. I was told that a LLETZ procedure can slightly increase your risk of miscarriage (but the risk really is tiny) but that the biopsy in itself does not. Mention it in your booking in appt with the midwife to make them aware if you do go ahead with LLETZ.

I discussed it in great depth with them as I had already had three losses at that point which is why they assessed and deemed cold coagulation a good solution for me. I'm now 38 weeks pregnant with no problems.

I also had a punch biopsy and on baby number 2 since having it and no problems. The midwives never mentioned anything when i told them about it .
I hope all these positive outcomes stops you worrying

Sorry just seen your treatment was a while ago. I just meant mention it to your midwife

Not a people during pregnancy here either.

Colposcopy and LLETZ around 11 years before pregnancy

No evidence of lunch biopsy having any long term effects that I'm aware of. My background is, trained as a health researcher, many years involvement in maternity support groups with special interest in pregnancy complications & I had a punch biopsy followed by laser ablation on my cervix, so I was motivated to read up on this & had access to all I needed. My conclusion was that the risks were only related to the method of removal of abnormal cells; I don't recall ever seeing any suggestion that the punch biopsy caused long term damage. It's generally the size of the head of a match so not big enough to impact the functioning of the cervix. On the other hand, where abnormal cells have been removed, if a large cone biopsy or a large LLETZ excision is performed then there is a higher risk of cervical incompetence. But this is a very different procedure from a punch biopsy. On the other hand, laser ablation of abnormal cells has on occasion been associated with cervical stenosis, ie scar tissue causing the cervix to be slow to dilate in labour. This is rare, but slightly more common with laser rather than LLETZ. My understanding is that laser ablation is less common nowadays though.
On a personal note, after punch biopsy and laser ablation, I got pregnant about 4 months later and went on to have a large family, all straightforward term births. I did have some miscarriages too, but they happened when the embryos died in first trimester and I only got signs of miscarriage some time later, so nothing to do with the cervical procedure.
Good luck with your pregnancy. It really does not sound like you have anything to worry about.

@DivorcedAndDelighted thanks. I appreciate having research behind it.
I like knowing stats. I'm glad all my Athens IDs have expired otherwise I'd be down a worm hole.

Hi I don’t know the ins and outs but for reassurance I have had a punch biopsy and didn’t need further treatment after this and have 3 kids following this all carried to term with no cervix issues whatsoever. No miscarriages either x

I was literally about to make a thread about this... I had LLETZ in January this year and now pregnant for the first time, a little curious about what has happened to other people who have had the procedure.

I'll of course mention it to my midwife but after anecdotal stories too

@crazy4cats tell your midwife at booking in and they’ll refer you for a cervical scan :)

it’s an internal ultrasound (/Dildocam!) - not painful at all, they don’t even use a speculum. If your cervix is deemed a suitable length then that’s the end, if it’s too short then they will put a stitch in. If you’re a bit borderline then they’ll just monitor the length and take action if it becomes necessary.

I had my cervical scan at about 13 weeks.

Thank you! As it happens I got my 6 month follow up letter a few days before my BFP so I was due to go in anyway. I don’t like the sound of a stitch though, I hope it doesn’t come to that!

@crazy4cats if you managed a LLETZ under local, I’m sure a stitch would be nothing!

btw I was worrying about all this so called the midwives before my booking in and she said it was uncommon to get a stitch. Unless you’ve had multiple LLETZ or had to have a really deep one, it’ll probably be fine.

I have no idea how much they took from me, but my cervix was still over 4cm and the minimum required is something like 2.5cm

@crazy4cats you really are unlikely to be at any increased risk unless you had a large excision for CIN Grade 3, and your notes will have made it clear if this happened. LLETZ is usually carried out under local anaesthetic, and it is very very rare to need cervical cerclage (a stitch) as a result, so honestly, unless you were told you had a large excision, it's not worth wasting any time worrying about.
In 2015 there was an expert conference on the effect of treatment for CIN on subsequent pregnancy at which they reviewed and discussed research and experience. The conclusion was that a large excision, 15mm or more, did increase the risk of preterm birth, but for smaller excisions the rate was no different from normal. I believe it would have been made clear to you if you had a large excision, but to put your mind at rest, maybe see if you've had a letter from the colposcopy clinic confirming what they did and what the lab report found? If you don't have this letter, they will have sent a report to your GP so you can ask your practice for it.
@Pregnantpolly have a look at that link - it is nice if you're into research.

I don’t really know where else to go about this. It seems I might find some help here. I feel really traumatised by my colposcopy app yesterday. And today I feel really low tearful and depressed. I am not sure if it’s expected. But i went to my colposcopy yesterday alone after the lab had referred me following pap. It was all clear, no abnormal cells. But positive for hpv. I think this is 3rd year of it being positive. So I thought it’s just for closer look. I arrived and male doctor collected me from reception. I wasn’t expecting a man so asked to repeat his and he abruptly pointed at name of folder seeming angry. I said I was taken back because I wasn’t expecting a male doctor. He said I could ask for female doctor in a softer tone. Inside was female nurse so I went along. Anyway he checked my cervix and I could see on screen too and said everything looks fine nothing there. Then continued and said maybe there is slight old region but not cancer and muttered to nurse biopsy. I felt myself totally voiceless as they continued and asked if this would affect me getting pregnant because my age I want to have a child soon. He said no and rapidly continuing nurse telling me to look away from screen and distracting me with questions about my job. I said I want to look at screen and I did, I saw that he was taking lots of bits from random areas that looked totally healthy, like the neck of my cervix which he said and I saw was totally perfect. Then all I saw was blood and cutting lots of areas, he seemed so aggressive and he kept telling me to look away from screen, nurse saying it looks much bigger on screen etc. I said I would rather look because I felt so uncomfortable and it all felt like it was done to me. All today I have been crying because it all felt so intrusive and I felt it to be unnecessary and uncontested. At the end he said it will likely come back clear and he will discharge me. But I am so worried about the scarring it might all cause and risks for future pregnancies given my age (39). Also I’ve read it too much tissue it could mean shortened cervix and cervical incompetence etc. I just feel given my age i feel it might have increased my risk of infertility unnecessary. I couldn’t sleep
all night a feeling of overstimulated stomach making me feel jumpy inside. Also all today I have been in bed, tearful, weakness in legs and feeling my legs tingly and shivery and lower back pain. Is there a way I could check to see what he has done? Like will it show up in another colposcopy if I went private? Also will it cause scarring and damage?
He gave a leaflet at the end saying it was ‘cervical biopsy’ but from what I saw I feel he took lots of tissue and I still don’t understand why… I feel so helpless and powerful and really low. Like my insides have been damaged without my consent and really worried about my fertility as well and impact of my mental health. I wonder if any ideas to help me with this?

@Pregnantpolly
@DivorcedAndDelighted
I don’t really know where else to go about this. It seems I might find some help here. I feel really traumatised by my colposcopy app yesterday. And today I feel really low tearful and depressed. I am not sure if it’s expected. But i went to my colposcopy yesterday alone after the lab had referred me following pap. It was all clear, no abnormal cells. But positive for hpv. I think this is 3rd year of it being positive. So I thought it’s just for closer look. I arrived and male doctor collected me from reception. I wasn’t expecting a man so asked to repeat his and he abruptly pointed at name of folder seeming angry. I said I was taken back because I wasn’t expecting a male doctor. He said I could ask for female doctor in a softer tone. Inside was female nurse so I went along. Anyway he checked my cervix and I could see on screen too and said everything looks fine nothing there. Then continued and said maybe there is slight old region but not cancer and muttered to nurse biopsy. I felt myself totally voiceless as they continued and asked if this would affect me getting pregnant because my age I want to have a child soon. He said no and rapidly continuing nurse telling me to look away from screen and distracting me with questions about my job. I said I want to look at screen and I did, I saw that he was taking lots of bits from random areas that looked totally healthy, like the neck of my cervix which he said and I saw was totally perfect. Then all I saw was blood and cutting lots of areas, he seemed so aggressive and he kept telling me to look away from screen, nurse saying it looks much bigger on screen etc. I said I would rather look because I felt so uncomfortable and it all felt like it was done to me. All today I have been crying because it all felt so intrusive and I felt it to be unnecessary and uncontested. At the end he said it will likely come back clear and he will discharge me. But I am so worried about the scarring it might all cause and risks for future pregnancies given my age (39). Also I’ve read it too much tissue it could mean shortened cervix and cervical incompetence etc. I just feel given my age i feel it might have increased my risk of infertility unnecessary. I couldn’t sleep
all night a feeling of overstimulated stomach making me feel jumpy inside. Also all today I have been in bed, tearful, weakness in legs and feeling my legs tingly and shivery and lower back pain. Is there a way I could check to see what he has done? Like will it show up in another colposcopy if I went private? Also will it cause scarring and damage?
He gave a leaflet at the end saying it was ‘cervical biopsy’ but from what I saw I feel he took lots of tissue and I still don’t understand why… I feel so helpless and powerless and really low. Like my insides have been damaged without my consent and really worried about my fertility as well and impact of my mental health. I wonder if any ideas to help me with this?

@Saraa39 just want to reply quickly and to send you a hug. Sounds like an unpleasant experience where you wanted to be more involved in the decision about what biopsies were taken and why. Sounds like also maybe you'd have liked to be asked for explicit informed consent, but weren't. It's horrible to feel that things are being done to you without you really knowing why, and that you're not being treated as a partner in the decision making process. It may be worth contacting your local PALS at the hospital to talk this through, or alternatively write to the gynaecology department saying that you had an upsetting experience and you'd like to discuss it with someone. This doctor might improve his practice if you do. However I really don't think this is likely to have impacted the function of your cervix, because there is very good evidence that this only happens with large biopsies, typically a cone biopsy. They don't do those unless there is very obviously something seriously wrong. You'd have been told. So while you suffered poor treatment, I don't think you need to stress yourself by worrying that it's caused permanent damage. But asking for an independent review from the gynaecology department may help to to understand what was done and why.
Sending hugs.

Colposcopy and lletz. Saw the consultant and get got out my notes, she was not even remotely worried. it was fine. I would suggest speaking to your midwife if you are worried

I had 3 punch biopsies. 2 the month before I conceived... iam 24 weeks and all good so far!
I don't think it affects the cervix.