Colposcopy

What is colposcopy?

Colposcopy is a crucial diagnostic procedure used worldwide to closely examine the cervix, vagina, and vulva for signs of abnormalities or diseases. 

Women are referred to colposcopy for diagnostic purposes when Pap smear/HPV screening tests are abnormal.

Colposcopy is performed globally as a pivotal tool in women's health, primarily for the detection of cervical abnormalities and early signs of cervical cancer. 

It involves the use of a colposcope — a specialised magnifying instrument—to examine the cervix vagina, and vulva more closely for any signs of abnormalities, such as precancerous lesions or cervical cancer.

Why is a colposcope important?

• Early detection of cervical abnormalities.

• Evaluation of abnormal Pap smear results.

• Identification of precancerous lesions and early-stage cervical cancer.

• Monitoring treatment effectiveness for certain conditions.

Colposcopy procedure

1. Patient preparation:

   • Prior to colposcopy, the patient will be reminded not to have sexual intercourse or insert tampon in the vagina for the past 24 hours. Right before the procedure, the patient will be asked to empty their bladder.

   • It is essential to inform your doctor about any allergies, medications, or pregnancy.

   • The patient is positioned on the examination table, similar to a pelvic exam, lying supine in lithotomy positions.

2. Equipment setup:

   • The colposcope is positioned at the end of the examination table.

   • A speculum is inserted into the vagina to provide a clear view of the cervix.

3. Application of acetic acid (vinegar):

   • A solution of acetic acid (vinegar) is applied to the cervix using a cotton swab or spray.

   • This solution helps highlight abnormal areas by causing them to turn white.

4. Examination of the cervix:

   • The doctor examines the cervix through the colposcope, which magnifies the view.

   • The colposcope does not enter the body and remains positioned outside the vaginal opening.

5. Use of colposcopic filters:

   • Colposcopes often have filters to enhance specific features, such as blood vessels or the appearance of abnormal tissue.

6. Recognition of abnormal areas:

   • The doctor looks for abnormal patterns, colors, or blood vessel changes on the cervix.

   • Any suspicious areas are closely examined for potential biopsy.

7. Biopsy procedure (if necessary):

   • If abnormalities are identified, a biopsy may be taken for further examination.

   • Local anesthesia may be applied to minimise discomfort.

   • Several types of biopsies may be performed, including punch biopsy or endocervical curettage.

8. Cervical mucus and cell sampling:

   • The doctor may also collect samples of cervical mucus or cells for laboratory analysis.

   • These samples help assess the presence of infections or abnormal cell changes.

9. Patient education and discussion:

   • Throughout the procedure, the doctor communicates with the patient, explaining findings and addressing any concerns.

   • Patients are encouraged to ask questions and participate in the decision-making process.

10. Post-procedure care:

    • After the colposcopy, the speculum is removed.

    • Patients might experience mild cramping or spotting, and they are advised to rest for a brief period.

    • Information about potential side effects and when to seek medical attention is provided.

11. Follow-up and results:

    • The doctor discusses the findings with the patient.

    • If a biopsy was performed, results are typically available within a few days to a couple of weeks.

    • Follow-up recommendations, such as additional testing or treatments, are discussed based on the results.

FAQ

Is colposcopy painful?

Colposcopy itself is not typically painful. However, some women may experience mild discomfort or a sensation of pressure when the colposcope is positioned. If a biopsy is taken, there might be a brief pinch or cramp. To minimise discomfort, it is essential to communicate with your doctor and inform them of any concerns.

Do I have cancer if I need a colposcopy?

Having a colposcopy does not necessarily mean you have cancer. It is typically recommended if you have an abnormal Pap smear result or if you have tested positive for high-risk strains of human papillomavirus (HPV), which is a common sexually transmitted infection that can lead to cervical cancer.

Do I need a colposcopy if I have HPV?

If you have HPV, particularly high-risk strains, a colposcopy will be needed to further evaluate the health of your cervix and determine if any abnormal cells are present. This does not automatically mean you have cancer, but rather it allows for a closer examination to detect any potential abnormalities early on, which can be crucial for effective treatment and management.

How long does a colposcopy take?

The duration of a colposcopy can vary, but on average, the procedure takes around 15 to 30 minutes. Factors influencing the time include the extent of examination needed, whether a biopsy is performed, and the patient's individual circumstances.

Are there any risks associated with colposcopy?

Colposcopy is generally considered a safe procedure. However, there is a slight risk of bleeding or infection if a biopsy is taken. In rare cases, some individuals may experience an allergic reaction to solutions used during the procedure. It is crucial to discuss any concerns or medical history with your doctor beforehand.

When is colposcopy recommended?

Colposcopy is often recommended when there are abnormal results from a Pap smear or HPV test. It is also used to investigate other symptoms such as unexplained vaginal bleeding, persistent pelvic pain, or unusual changes observed during a physical examination.

How to prepare for colposcopy?

Preparation for colposcopy typically involves avoiding vaginal intercourse, douching, and using tampons for a specific period before the procedure. Inform your doctor about any medications you are taking, and if you are pregnant or suspect you might be pregnant.

What happens after a colposcopy?

After the procedure, you may experience mild spotting, and it is advised to refrain from heavy lifting and vigorous physical activity for a short period. Your doctor will discuss the findings with you and recommend any necessary follow-up, such as additional tests or treatments. It's important to adhere to any post-procedure instructions provided.

Can I drive myself home after colposcopy?

In most cases, you should be able to drive yourself home after a colposcopy, as the procedure itself does not usually cause impairment. However, if you receive sedation or feel uncomfortable, it's advisable to arrange for someone to drive you home.

How often is colposcopy needed?

The frequency of colposcopy depends on individual health circumstances. It is typically recommended when there are abnormal cervical screening results. Your doctor will determine the appropriate timing for follow-up based on your specific situation.

Does colposcopy diagnose cancer? 

Colposcopy itself is not a diagnostic tool for cancer but rather a method to identify abnormalities that may warrant further investigation. If suspicious lesions are found, a biopsy may be performed, and the collected tissue will be examined to determine if cancer is present.

As technology advances and healthcare infrastructure improves, the global community continues to strive for better accessibility and effectiveness in colposcopy services, ultimately promoting women's health on a broader scale.