What is colposcopy?
Colposcopy is a simple, fast and non- invasive procedure to view the cervix under magnification with the use of a specialised microscope. Acetic acid 3%- 5% solutions is used to soak the exterior surface of the cervix. This will cause denaturing of the proteins in the cells nucleus and, in the areas that a lesion exists- shich is usually hyperplastic- the colour turns white. The presence of hyperplastic vessels of the stroma creates on the surface of the cervix a dotting or mosaic pattern (then normal epithelium keeps its reddish, smooth surfach after the acetic acid application). The presence of atypical vessels on the cervical surface is of particular importance.
Using the Lugol solution cause the normal cervical surface to turn dark purple because the cytoplasm glucogen is stained by the solutin. On the contrary, an affected area will not change its colour because the abnormal cells lack glucogen and the colour remain almost unchanged.
Colposcopy is considered satisfactory, when we can visualise all of the transition zone. On the other hand, if part of this zone of interest is deep down in the cervical canal, then we cannot properly visualise it with the colposcope and the results need to be very carefully interpreted taking into consideration all possible risks.
When do I need to have colposcopy?
Colposcopy is a test that can prove a very helpful tool in the hands of a gynecologist in the diagnosis of lesions ofthe cervix, vagina and vulva. The commonest indication to perform colposcopy is an abnormal smear test. Colposcopy indications are presented in the table below.
| Abnormal smear test (Pap test) |
| ASC-US |
| ASC-US twice |
| ASC-US with high risk HPV types |
| ASC-H |
| LSIL |
| HSIL |
| AGC |
| Cervical lesion |
| Condyloma accuminata |
| Polyp |
| Vaginal lesion |
| Warts |
| Ulcers |
| Vulvar lesion |
| Genital warts |
| Ulcer |
| Mole concerning for melanoma |
| Follow-up LEEP, cryotherapy, cone biopsy |
| Intrauterine diethylstilbestrol exposure |
| Sexual partner with genital warts or condyloma accuminata |
| Sexual abuse |
Lately, there is much discussion about the oncogenic types HPV-DNA detection as a screening method in order to identify high- risk women. Upon the test results we can discuss about whether colposcopy is indicated or not. In any case, taking biopsies under colposcopic evaluation and to histologically examine them, is still considered the ‘gold standard’ of diagnosisn all cervical lesions.
How is the test done?
After taking your medical history, you will have to lie down on the gynecological chair, the usual way. A speculum is used in order to keep the vaginal walls apart and properly visualise the cervix. Then, the colposcope is placed exaclty opposite to the vaginal opening but outside it. The colposcope is an imaging device theat can gratly magnify the picture up to 40 times more. Using the colposcope, we can examine the cervix in full detail. Special substances are used (acetic acid, Lugol) and lighting, to discern the areas with lesions that abnormal smear test cells came from. Depending on the degree of the dysplasia, if there is any, we may offer taking a punch biopsy. If a biopsy is needed, a very small cervical sample will be gently removed. The size of the tissue removed is less than 1/ 10 the size of the tip of a pen. Subsequently, the sample will be placed into a preserving solution filled tube and sent to the lab for further examination.
Is colposcopy painful?
Colposcopy is a gynecological test that assesses the cervix, the vulva and the vagina to examine the area for any lesion that were not visible to the naked eye during the gynecological examination. The biopsy sometimes taken during colposcopy can cause discomofrt, but that lasts for only a moment. When this tiny piece of tissue is removed, some women feel nothing and others describe a “stinging”- like feeling. If you wish, you maky take a simple painkiller an hour before the procedure. Colposcopy lasts less than thirty minutes.
What happens after colposcopy?
We will discuss colposcopy findings, if a biopsy has been taken, the exact reason why this had to be done and whether there were any lesins that need to be reviewed again with a follow- up appointment. The biopsy results usually take 1- 3 to be back. We will inform you as soon as we have them.
If a biopsy has been taken, there is a chance some spotting will appear. As aprecaution, you might want to wear a pad for the next few days.
You may also notice some brown discharge mixed with some blood for the next 2- 4 days. This is not any tissue. It is a liquid used in colposcopy called ‘Monsel’ which is used to control minor bleeding.
It is also possible the discharge is black. This is common when ‘nitrate salt’ is used instead of ‘Monsel’.
If you only had colposcopy it is advisable to postpone any sexual intercourse until 48 hours later. If a biopsy has been taken, we recommend avoiding sex for one to two weeks to allow proper cervical healing. Moreover, before using any tampons, vaginal creams or suppositories get in contact with us.
When should I be worried?
You should be concerned and get in contact with us immediately if you notice:
- any kind of heavy bleeding (more than the usual period blood).
- bright red blood while not having period.
- foul smelling vaginal discharge.
- Any kind of acute abdominal pain.