Colposcopy is a detailed examination of the cervix and the vagina with the help of a tiny microscope in women. A colposcopy test is performed in women who have had an abnormal report for a PAP smear/test or are at an increased risk of developing cervical cancer. A colposcopy is also used to take a sample of tissue from the cervix or the vaginal, biopsy to study the cells under a microscope.
What is the function of Colposcopy and how does it work ?
Colposcopy is used to study the cervix and the vagina. When your gynaecologist uses the colposcope, the cervical surface and the vaginal walls can be examined very closely and carefully.
Using an adjustment knob, the colposcope’s head may be moved up and down to ensure thorough cervix examination. The two eye lenses in the head of the colposcope can be adjusted to match the eye distance of the doctor.
If in case of abnormal or atypical results of the routine Pap smear of the vagina/ cervix, a colposcopy will have to be performed in the clinical examination.
To better visualize these structures, a weaker solution of acetic acid (akin to vinegar) and/or Lugol’s Iodine can be applied to detect atypical areas.
A colposcopy to study the vagina is known as vaginoscopy.
When is colposcopy advised ?
Colposcopy is advised in women with the below mentioned conditions or problems.
- Cancer of cervix
- Cancer of vagina
- Cancer of vulva
- Precancer changes in cervix
- Precancer changes in vagina
- Precancer changes in vulva
- Abnormal Pap test
- Genital warts
- HIV infected women (as risk of developing cervical cancer is high)
- Inflammation of the cervix (cervicitis)
- Polyps in cervix
When is colposcopy not advised ?
Colposcopy is not performed in women who are pregnant, women who have any infection or inflammation (severe) of the genital area and in women during their menstrual cycle.
What are the indications for colposcopy ?
A suspicious-looking cervix, intraepithelial or confined tumour, frank invasive carcinoma on exfoliative cytology (diagnosed from smears of area), infection with cancer causing human papillomaviruses (HPV), positivity on acetic acid wash and positivity seen with Lugol’s iodine are all indications for Colposcopy.
What is the principle of colposcopy procedure ?
Your treating doctor will place a speculum (a metal instrument) in your vagina and then the colposcope (an instrument fitted with a microscope and the images of the tissues can be reciprocated on a monitor) is inserted to examine the cervix, vagina, and vulva. Before the procedure your doctor might use 3-5% acetic acid diluted solution on the walls of your cervix and vagina, as during a colposcopic examination abnormal areas are highlighted, making identification of abnormal cells easier.
How do you prepare for a colposcopic examination ?
A colposcopic examination is performed in the doctor’s office or outpatient clinic as a day care procedure. You will be asked to change into a hospital gown to facilitate the procedure. You will be asked to not engage in any sexual activity 24 hours before the procedure, not to douche and not use any tampons before the procedure. You may be asked to carry a sanitary napkin as you may have some spotting or bleeding after the test.
Who performs the colposcopic examination ?
Colposcopy is performed by a colposcopist, a gynecologist trained in colposcopy with the help of a trained nurse.
Is anesthesia administered before colposcopy ?
Anesthesia may be administered depending upon your comfort level and your doctors advise. Either local or general anesthesia may be administered.
What is the procedure of colposcopy ?
It is a must to understand the colposcopy examination and to stay assured and relaxed during the procedure. A written informed consent will have to be submitted before the colposcopic examination.
All relevant medical and reproductive history details have to be explained to your doctor.
The position for the woman undergoing colposcopy on the examination table is the modified lithotomy position on an examining table with her feet in heel rests, or legs in stirrups or knee crutches. It is essential to be relaxed as this position makes it much easier to insert the speculum and examine the vagina and cervix.
It is crucial to achieve directed biopsies, under colposcopic control, from abnormal/-suspicious areas identified in the cervix/ vagina.
Colposcopy in pregnancy requires expertise. Extra care must be taken not to injure any tissues when a digital examination or speculum insertion is performed for pregnant women.
As pregnancy progresses, cervical biopsy is associated with more severity of bleeding. Non-invasive (non-cancerous) lesions may be judged post-partum (after delivery).
Is Colposcopy painful ?
Colposcopy by itself, though slightly uncomfortable, is not more painful than a simple speculum examination. It can even be done safely on pregnant women. If an abnormal area is detected in the cervix and/or vagina, a biopsy will have to be done. The biopsy can be painful.
Can a cervical biopsy be performed with colposcopy ?
Yes, a cervical biopsy can be performed when certain abnormal or questionable cells are identified during the colposcopic examination. The tissues obtained during the biopsy are sent for a detailed pathological examination.
What are the risks and complications of colposcopy ?
Colposcopy is mainly a diagnostic procedure which is invasive hence the complications could range from, bleeding, infection, foul smell from the genitals or a whitish discharge from the vagina. Some of the symptoms might occur immediately after the procedure, but if they persist, it is important to seek immediate consultation with your specialist. If you’ve had a cervical biopsy along with colposcopy, you will have to follow precautions for a longer period of time such as avoid using tampons, sexual activity and strenuous exercising.
How is colposcopy documented ?
The colposcopic findings are to be recorded for each visit and documented watchfully by the colposcopists themselves, during or just after the examination. This record can be stored on paper or in electronic media, and forms the basis of medical record systems that are to be utilized for systematic patient care.
Variations in quality and quantity of the atypical appearances help in diagnosis of physiological, benign, infective, inflammatory and reactive changes in the cervix or vagina. The colposcopist will arrive at a diagnosis at the end of the colposcopic session in terms of normal (or negative), intraepithelial or invasive cancer, any other conditions like inflammation or if not successful, an unsatisfactory colposcopy.
Scoring or grading systems aid colposcopic interpretation and diagnosis in a more objective manner and formulate a systematic approach to colposcopy.
Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.
