Colposcopy is a special examination, painless and bloodless, carried out in the office, which allows the doctor to examine the cervix in detail through a special instrument, the colposcope.
The colposcope is specially designed and equipped with high-resolution magnifying lenses (it looks like 'binoculars') and a beam of light. It has the ability to magnify, and in this way the doctor can examine in detail the external genitalia, the vagina and the cervix (the colposcope is not placed inside the vagina but at a distance from it). Thus abnormal areas, if present, are identified, and it is decided whether a biopsy will be taken or treatment will follow. All women whose Pap test is abnormal are examined colposcopically.
How should you prepare for colposcopy?
It should be mentioned again that colposcopy is a painless examination that usually lasts a few minutes. It is performed (as is the Pap test) in the week immediately after the period or the week before the period is due. It should be avoided in the middle of the cycle (ovulation) because of increased cervical mucus secretion, which often makes the examination difficult. Tampons or vaginal medication should be avoided in the last 24-48 hours before the examination. Sexual intercourse (vaginal) should also be avoided for the same period.
How is colposcopy performed?
The woman sits in the gynaecological position (as for the Pap test). A speculum is placed in the vagina and, with skilful manipulation by the doctor, the cervix is exposed. Then, using cotton wool attached to an applicator stick, a special solution (acetic acid or Lugol's iodine solution) is applied to the cervix and left to be absorbed. The action of the acetic acid begins after a few seconds, up to two minutes. What it does is concentrate the protein of the abnormal cervical cells (abnormal cells are richer in protein), with the result that they take on a characteristic white stain (acetowhite epithelium). This, together with other characteristic findings (mosaicism, punctation, atypical vessels), is evaluated by the doctor, who will decide whether to proceed with a biopsy (taken on the spot without anaesthesia) or to follow conservative management. The abnormal areas of the cervix are called dysplasias and are classified as low grade or high grade. Most low grade dysplasias regress on their own within 6 months to a year. High grade dysplasias should be treated surgically.
What is cervical dysplasia?
Abnormal areas of the cervix are described as dysplasias. They are classified by severity as low grade or high grade.
When is a cervical biopsy taken?
When the doctor sees a lesion (dysplasia) on the cervix, they may proceed to take a biopsy. Biopsies are taken from the points showing the most serious changes, placed in separate vials containing formalin and sent to a pathology laboratory to diagnose and document the severity of the lesion and at the same time decide the appropriate treatment.
What are the risks and complications of colposcopy?
There are no complications related to the colposcopic examination.
Complications related to taking biopsies are rare. Bleeding is one of them. The woman should contact her treating doctor if the bleeding is much heavier than during her period or if she soaks a sanitary pad within one hour. Other rare complications are severe abdominal pain, fever and inflammation.
What happens after colposcopy?
The doctor should explain the findings of the examination to the patient in full. If a biopsy is taken, the woman should be told that she may have a coffee-coloured discharge and perhaps a small amount of blood from the vagina for 2-3 days, and should avoid sexual intercourse and tampon use for the next 2 weeks. Finally, she should return to the doctor when the results are available to discuss how to proceed.
