colposcopy

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Colposcopy

 

Definition

Colposcopy is a procedure that allows a physician to take a closer look at a woman's cervix and vagina using a special instrument called a colposcope. It is used to check for precancerous or abnormal areas. The colposcope can magnify the area between 10 and 40 times; some devices also can take photographs.

Purpose

The colposcope helps to 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 identify or rule out the existence of any precancerous conditions in the cervical tissue. If a Pap test shows abnormal cell growth, further testing, such as colposcopy, often is required. A Pap test is a screening test that involves scraping cells from the outside of the cervix. If abnormal cells are found, the physician will attempt to find the area that produced the abnormal cells and remove it for further study (biopsy). Only then can a diagnosis be made.
Colposcopy may also be performed if the cervix looks abnormal during a routine examination. It may also be suggested for women with genital warts and for diethylstilbestrol (DES) daughters (women whose mothers took DES when pregnant with them).

Precautions

Women who are pregnant, or who suspect that they are pregnant, must tell their doctor before the procedure begins. Pregnant women can, and should, have a colposcopy if they have an abnormal Pap test. However, special precautions must be taken during biopsy of the cervix.

Description

A colposcopy is performed in a physician's office and is similar to a regular gynecologic exam. An instrument called a speculum is used to hold the vagina open, and the gynecologist looks at the cervix and vagina through the colposcope instead simply by eye, as in a routine examination.
The colposcope is placed outside the patient's body and never touches the skin. The cervix and vagina are swabbed with dilute acetic acid (vinegar). The solution highlights abnormal areas by turning them white (instead of a normal pink color). Abnormal areas can also be identified by looking for a characteristic pattern made by abnormal blood vessels. In 2004, a study showed that a new optical detection system used with colposcopy greatly improved visual detection of precancerous changes in the cervix during the procedure.
If any abnormal areas are seen, the doctor will take a biopsy of the tissue, a common procedure that takes about 15 minutes. Several samples might be taken, depending on the size of the abnormal area. A biopsy may cause temporary discomfort and cramping, which usually go away within a few minutes. If the abnormal area appears to extend inside the cervical canal, a scraping of the canal may be done. The biopsy results are usually available within a week.
If the tissue sample indicates abnormal growth (dysplasia) or precancer, and if the entire abnormal area can be seen, the doctor can destroy the tissue using one of several procedures, including ones that use high heat (diathermy), extreme cold (cryotherapy), or lasers. Another procedure, called a loop electrosurgical excision (LEEP), uses low-voltage high-frequency radio waves to excise tissue. If any of the abnormal tissue is within the cervical canal, a cone biopsy (removal of a conical section of the cervix for inspection) will be needed.

Preparation

Colposcopy is a painless procedure that does not require any anesthetic medication. If a biopsy is done, there may be mild cramps or a sharp pinching when the tissue is removed. To lessen this pain, your doctormay recommend 800 mg of ibuprofen (Motrin) taken the night before and the morning of the procedure (no later than 30 minutes before the appointment). Patients who are pregnant or allergic to aspirin or ibuprofen can take two tablets of acetaminophen (Tylenol) instead.

Aftercare

If a biopsy was done, there may be a dark vaginal discharge afterwards. After the sample is removed, the doctor applies Monsel's solution to the area to stop the bleeding. When this mixes with blood it creates a black fluid that looks like coffee grounds for a couple of days after the procedure. It is also normal to have some spotting after a colposcopy.
Patients should not use tampons or put anything else in the vagina for at least a week after the procedure, or until the doctor says it is safe. In addition, women should not have sex or douche for at least a week after the procedure because of the risk of infection.

Risks

Occasionally, patients may have bleeding or infection after biopsy. Bleeding is usually controlled with a topical medication.
A patient should call her doctor right away if she notices any of the following symptoms:
  • heavy vaginal bleeding (more than one sanitary pad an hour)
  • fever, chills, or an unpleasant vaginal odor
  • lower abdominal pain

Normal results

If visual inspection shows that the surface of the cervix is smooth and pink, this is considered normal. If abnormal areas are found and biopsied and the results show no indication of cancer, a precancerous condition, or other disease, this also is considered normal.

Abnormal results

Abnormal conditions that can be detected using colposcopy and biopsy include precancerous tissue changes (cervical dysplasia), cancer, and cervical warts (human papilloma virus).

Resources

Periodicals

"Optical Detection System With Colposcopy Improves Cervical Cancer Detection." Cancer Weekly March 9, 2004: 51.

Organizations

American Society for Colposcopy and Cervical Pathology. 20 W. Washington St., Ste. #1, Hagerstown, MD 21740. (800) 787-7227. http://www.asccp.org.

Key terms

Biopsy — Removal of sample of abnormal tissue for more extensive examination under a microscope.
Cervix — The neck of the uterus.
Cryotherapy — Freezing and destroying abnormal cells.
DES — The abbreviation for diethylstilbestrol, a synthetic form of estrogen that was widely prescribed to women from 1940 to 1970 to prevent complications. It was linked to several serious birth defects and disorders of the reproductive system in daughters of women who took DES. In 1971, the FDA suggested it not be used during pregnancy and banned its use in 1979 as a growth promoter in livestock.
Diathermy — Also called electrocautery, this is a procedure that heats and destroys abnormal cells. It is gradually being replaced by cryosurgery, lasers, or LEEP.
Human papilloma virus — A virus that causes common warts of the hands and feet, as well as lesions in the genital and vaginal area. More than 50 types of HPV have been identified, some of which are linked to cancerous and precancerous conditions, including cancer of the cervix.
Loop electrosurgical excision (LEEP) — A procedure that can help diagnose and treat cervical abnormalities, using a thin wire loop that emits a low-voltage high-frequency radio wave that can excise tissue. It is considered better than either lasers or electrocautery because it can both diagnose and treat precancerous cells or early stage cancer at the same time.
Pap test — The common term for the Papanicolaou test, a simple smear method of examining stained cells to detect cancer of the cervix.
Speculum — A retractor used to separate the walls of the vagina to make visual examination easier.

col·pos·co·py

(kol-pos'kŏ-pē),
Examination of the vagina and cervix by means of an endoscope.
Synonym(s): cervicoscopy
[colpo- + G. skopeō, to view]

Colposcopy is used chiefly to identify areas of cervical dysplasia in women with abnormal Papanicoloau smears and as an aid in biopsy or excision procedures including cautery, cryotherapy, laser vaporization, and loop electrosurgical excision. The colposcope is a stationary instrument with self-contained lighting and magnification adjustable from 2× to 20× or higher. It is used in conjunction with a standard vaginal speculum to view the cervix, particularly the transformation zone, and the vaginal mucosa. A green filter enhances visualization of blood vessels and identification of abnormal (for example, punctate, mosaic, or atypical) vascular patterns. Application of 5% acetic acid solution accentuates areas of increased cellular protein and increased nuclear density, which are likely to represent zones of squamous cell change. Lugol solution (iodine-potassium iodide), which stains only squamous epithelial cells that have a normal glycogen content, may also be applied to delineate abnormal squamous epithelium. Colposcopically directed cervical biopsy is the procedure of choice when a Papanicoloau smear shows high-grade squamous intraepithelial lesions, koilocytosis, carcinoma in situ, or higher grade carcinomas. When smear results are ambiguous, current practice standards recommend DNA testing for HPV rather than colposcopy.

colposcopy

(kŏl-pŏs′kə-pē)
n. pl. colposco·pies
Examination of the vaginal and cervical epithelia by means of a colposcope.

colposcopy

[kolpos′kəpē]
Etymology: Gk, kolpos + skopein, to watch
an examination of the vagina and cervix with an optical magnifying instrument (colposcope). It is commonly performed after an abnormal Papanicolaou (Pap) smear to diagnose cervical dysplasia and to obtain biopsy specimens of the cervix.
enlarge picture
Colposcopy

colposcopy

Gynecology A technique in which a lighted magnifying device, a colposcope, is used to evaluate and/or assist in biopsying lesions of the uterine cervix and upper vagina, previously identified by a pap smear. See Acetowhite lesion, Cervical biopsy, CIN, HPV.

col·pos·co·py

(kol-pos'kŏ-pē)
Examination of vagina and cervix by means of an endoscope.
[colpo- + G. skopeō, to view]

colposcopy

Optical examination of the vagina and the neck of the womb (cervix). The modern colposcope is a low-power binocular microscope with a long focus. The vagina is held open with a SPECULUM. Colposcopy provides a detailed view of the structure of the surface lining and suspicious areas, from which samples can be taken, are easily seen. Colposcopy is the routine next step after a cervical smear (Pap smear) has shown some abnormality.