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A colposcopy is a procedure that allows the doctor to take a closer look at the cervix and vagina using a special instrument called a colposcope. It is used to check for precancerous or abnormal areas. The colposcope can enlarge the area up to 10-40 times, and some varieties of the device are able to take pictures. Thus, the tool increases the likelihood of detecting a problem and guarantees timely treatment.
What is a colposcope and how is it used?
Colposcopy is used primarily to identify areas of cervical dysplasia in women with abnormal Pap smears, and as an aid in biopsy or removal procedures, including cauterization, cryotherapy, laser vaporization, and loop electrosurgical removal.
The colposcope is a stationary, self-illuminated device that magnifies the image from 2x to 20x or higher. It is used in conjunction with a standard vaginal speculum to view the cervix, especially the transformation zone, and the vaginal mucosa. The green filter enhances visualization of blood vessels and detects abnormal (eg, punctate, mosaic, or atypical) vascular structures.
Application of a 5% acetic acid solution accentuates areas of increased cellular protein and increased nuclear density, which are likely to represent areas of squamous alteration.
A colposcopic guided cervical biopsy is a procedure where a Pap smear shows: high-grade squamous intraepithelial lesions; koilocytosis; carcinoma or carcinoma of a higher level. When smear results are inconclusive, current practitioners recommend DNA testing for HPV instead.
The colposcope helps identify abnormal areas of the cervix or vagina so that small pieces of tissue (biopsies) can be taken for further analysis. Colposcopy is used to detect or rule out the existence of any precancerous conditions in the cervical tissue. If a plain smear shows abnormal cell growth, additional testing, such as a colposcopy, is often needed.
The Pap test is a screening test that uses the cells on the outside of the cervix to clear. If abnormal cells are found, the doctor will try to find the area that produced the abnormal cells and take a sample for further study (biopsy). Only then can the most accurate diagnosis be made. A colposcopy may also be performed if the cervix looks abnormal during a routine pelvic exam. The test is recommended for women with genital warts and for daughters of diethylstilbestrol – DES (children whose mothers took DES while pregnant with them).
What does a colposcope show, colposcopy results
The colposcope helps to determine:
- abnormal cells;
- precancerous conditions of the cervix;
- cervical dysplasia;
- cervical warts;
- abnormal vascular structures.
If any abnormal areas are visible, the doctor will perform a tissue biopsy, a routine procedure that in practice takes about 15 minutes. Several samples may be taken depending on the size of the anomalous area.
The biopsy usually causes temporary discomfort and cramps that usually resolve within a few minutes. If the abnormal area extends inside the cervical canal by checking with a colposcope, cleaning may be done. Biopsy results are usually available within a week.
Colposcopy is a painless procedure that does not require any pain medication. If a biopsy is performed, there may be mild cramping or a sharp pinching as the tissue is removed. To reduce this pain, your doctor will recommend taking 800 mg of ibuprofen the day before and in the morning of your procedure (no later than 30 minutes before your procedure). Patients who are pregnant or allergic to aspirin or ibuprofen may take two acetaminophen tablets.
Precautions and risks associated with the procedure
Women who are pregnant or suspect they are pregnant should tell their doctor before starting the procedure. Pregnant women are allowed to use a colposcope if they have an abnormal Pap test. However, special precautions should be taken when performing a cervical biopsy.
The colposcope is used only in the doctor’s office, the procedure is similar to another gynecological examination.
An instrument called a speculum is used to hold the vagina open while the gynecologist looks at the cervix and vagina through a colposcope instead of just examining it.
The device is located outside the patient’s body and never touches the skin. The cervix and vagina are lubricated with dilute acetic acid (vinegar). The result will show the abnormal areas, turning them white (instead of the usual pink).
Abnormal areas can also be identified by looking for a characteristic pattern made by blood vessels. The new optical detection system used with the colposcope greatly improves the visual detection of cervical precancerous changes during the procedure.
Although the instrument itself is fairly harmless, the consequences of this procedure may include bleeding or infection (after a colposcopy). Bleeding is usually controlled with topical medication.
The patient should call their doctor immediately if any of the following symptoms begin:
- heavy vaginal bleeding (more than one sanitary pad per hour);
- fever, chills;
- unpleasant smell of the vagina;
- lower abdominal pain.
Efficiency and results of using a colposcope
The effectiveness of this tool exceeds all possible risks associated with the procedure. Timely use of the colposcope contributes to the rapid treatment of diseases of the vagina and cervix.
With the help of a colposcope, the collection of analyzes is greatly simplified. If a tissue sample indicates an abnormal growth (dysplasia) or precancerous condition, or the entire abnormal area is visible, then the doctor may destroy the tissue using one of several procedures, including those that involve heat (diathermy), extreme cold (cryotherapy) ) or laser.
Another procedure, called loop electrosurgical removal, uses low-voltage, high-frequency radio waves to absorb tissue.
If any of the abnormal tissue is within the cervical canal, a cone biopsy (removal of the cone of the cervix for examination) will be required.
If the procedure was done, then after it the vagina may be black. At the end of the sample removal from the affected area, the doctor uses Monsel’s solution to stop the bleeding. When it mixes with blood, the doctor creates a black liquid that looks like coffee grounds. It will stay on the skin for a couple of days after the procedure. It is also absolutely normal if spots remain after the colposcope.
Patients should not use tampons or put anything in their vagina for at least a week after the procedure, or until the doctor says it’s safe to do so. In addition, women are prohibited from having sex or showering for at least a week after the procedure due to the risk of infection.
If a visual examination with a colposcope shows that the surface of the cervix is smooth and pink, this is considered normal and no additional tests and procedures are needed.
If abnormal areas are found and biopsied, but the results do not show signs of cancer, precancerous condition or other disease, then this is also considered a variation of the norm.
Abnormal conditions can be seen with colposcopy and biopsy.
These include precancerous tissue changes (cervical dysplasia), cancer, and cervical warts (human papillomavirus).