Colposcopy

Colposcopy is the direct magnified inspection of the surface of a womans genital area, including the cervix, vagina, and vulva, using a light source and a binocular microscope - a colposcope. It is used to evaluate potentially cancerous areas, typically after an abnormal cervical smear. A biopsy of an abnormal area may be taken during the procedure. Colposcopy also can be used to detect inflammatory or infectious changes, harmless growths, and assess traumatic injuries to the lower genital tract.

• The patient should not have the examination if they are menstruating.
• Sexual intercourse, vaginal medications, and tampons should be avoided for 24 hours before the examination.
• Recommend simple analgesia 1 hour before the procedure. Paracetamol, aspirin or ibuprofen may be used, but NSAIDs may increase bleeding from the procedure due to these drugs' anti-platelet effect.

The patient sits in a reclining chair in lithotomy position. A speculum is inserted to visualise the cervix. The cervix is stained with acetic acid in the area of the Transformation Zone (T.Z.)to identify the site, grade and shape of the abnormal area of cells. The solution is applied using a long-handled cotton bud. Abnormal dyskaryotic/dysplastic cells will stain white; generally, the more dense the white area becomes, the higher the grade of abnormality.
A water-based solution of iodine is then gently applied to the rest of the cervix to identify the complete area of abnormality. With iodine, the normal cells stain jet black and the abnormal cells stain yellow.
There is usually good correlation between the abnormality suggested by the cervical smear and the appearances seen through the colposcope.^2,3 In cases of doubt a small biopsy can be taken from the worst looking area for analysis. This is carried out using special biopsy forceps which remove a small fragment of tissue with minimal discomfort.
Women who have an obvious abnormality at colposcopy, or who have a positive biopsy result will proceed to treatment. The most common form of treatment in the UK is called LLETZ (Large Loop Excision of the Transformation Zone). Treatment by LLETZ can take place at the end of the colposcopy examination during the same clinic visit, or treatment may be carried out at a later visit.

The procedure is relatively safe. Most commonly occuring risks include bleeding, infection, and pelvic or abdominal pain. Colposcopy during pregnancy may cause complications with the pregnancy, including early labour.

• Following the colposcopy, the patient should wear a sanitary pad.
• Small amounts of bleeding may occur for 3-5 days.
• Dark fluidlike material may be seen on the pad, sometimes green, or resembling coffee grounds. The fluid is that used during the exam.
• The patient should avoid sexual intercourse, vaginal medications, or tampons until the bleeding stops.