Colposcopy

What is Colposcopy? 

Colposcopy is a medical procedure utilized to examine the vagina and cervix within the female reproductive system. During this examination, a physician employs a specialized instrument known as a colposcope. 

  

The colposcope is a telescope-like device equipped with lenses and an illumination system. It is positioned at the vaginal opening and around the cervix without entering the body. This allows the physician to achieve detailed visualization of the cervix. 

 

Through colposcopy, the physician can assess the appearance, color, shape, and structure of the cervix, identifying any abnormal tissue changes, lesions, or masses. If deemed necessary, the physician may obtain tissue samples (biopsies) for further evaluation. 

 

Reasons for Colposcopy 

Early-stage cancers and abnormal cellular changes may not present noticeable symptoms. The most common symptom associated with these conditions is abnormal vaginal bleeding, which may occur in the following situations: 

 

• Between menstrual periods 

• During or after intercourse 

• After menopause 

 

Patients may also experience additional symptoms, including: 

• Malodorous vaginal discharge 
• Pelvic pain 
• Back pain (if affecting nerves or bones) 
• Hematuria or dysuria (if affecting the urinary system) 
• Swelling in the legs (if affecting the lymphatic system) 
• General fatigue and weight loss 

 

Women are encouraged to undergo routine Pap smears to screen for HPV infection. Most HPV infections are asymptomatic, leading many individuals to be unaware of their infection. However, cervical cells infected with HPV may undergo precancerous changes. Without early intervention, these changes can progress to cervical cancer, posing significant risks to a woman's health. Advanced cervical cancer may manifest as abnormal vaginal bleeding, including bleeding during menstruation, after intercourse, or postmenopausal bleeding. 

  

Abnormal Pap Smear Results 

If three consecutive Pap smear results are abnormal or indicate cellular changes, the physician may recommend an initial colposcopy. This allows for a more thorough examination of the vaginal and cervical tissues to evaluate any abnormalities. 

  

Abnormal Cervical Symptoms 

If a patient presents with symptoms related to the cervix, such as abnormal vaginal bleeding, unusual discharge, pain, or discomfort, the physician may recommend a colposcopy to determine the underlying issue. 

  

Cervical Lesions 

Colposcopy may be utilized for an initial visual assessment of cervical lesions, such as cervical intraepithelial neoplasia (CIN) or other precancerous changes. These lesions may be detected during Pap smear screening, necessitating further examination for detailed evaluation. 

  

Diagnostic Methods for Cervical Cancer 

The diagnostic methods for assessing cervical cancer typically include: 

  

• Colposcopy: The colposcope, similar to a microscope positioned near the vaginal opening, allows for a detailed examination of the cervix. This procedure is generally performed as an outpatient procedure, lasting approximately 20 to 30 minutes. 

• Colposcopic Biopsy or Targeted Biopsy: Under the guidance of the colposcopy, a small sample of abnormal tissue is excised (biopsy) and sent to a laboratory for analysis. 

• Cone Biopsy: If the area of abnormality is extensive or if abnormal cells are located high on the cervix, making visualization challenging, a conical section of tissue may be removed. This tissue is then sent to the laboratory to confirm that all cancerous cells have been excised. This procedure typically requires general anesthesia. 

 

Preparation 

• Patients may be advised to discontinue certain medications or adhere to dietary restrictions, particularly anticoagulants or non-steroidal anti-inflammatory drugs (NSAIDs). 

 

• It is important to inform the physician of any wounds or sores near the genital area. The examination should be avoided during menstruation. If a patient is currently pregnant or suspects they might be, this information should be communicated to the physician. 

  

Procedures 

• Insertion of the Speculum: The physician will use a speculum to gently insert into the vagina to examine the cervix's appearance and structure. 

• Cervical Pap Smear: Before performing the vaginoscopy, the physician may conduct a cervical Pap smear to collect a sample from the cervix for analysis of infections or abnormal cells. 

• Solution Application: To enhance visibility of any abnormal areas on the cervix, the physician may apply a special solution, which aids in detecting abnormalities. 

• Observation on TV Screen: During the examination, patients may choose to observe images of their cervix on a connected TV screen. The physician or nurse may highlight any subtle changes or abnormalities. 

• Biopsy: A small sample (biopsy) may be taken from any affected area of the cervix for further examination. 

• Patients who do not wish to view the images should inform the physician or nurse prior to the examination. The entire vaginoscopy typically takes about 10 minutes and is a relatively brief and non-invasive procedure. 

  

Follow-up and Recovery 

• After the examination, it is advisable to take time to rest and recover. Patients should avoid vigorous exercise or heavy activities on the day of the examination. 

  

• Light vaginal bleeding may occur, which is considered normal; however, if the bleeding is excessive or persists, patients should contact their physician promptly. It is recommended to use pads instead of tampons to monitor bleeding more easily. 

 

• Mild abdominal pain or discomfort may be experienced after the examination. Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can help alleviate discomfort, though consultation with a physician or pharmacist is advised prior to use. 

 

• Patients can resume their normal diet after the examination, ensuring adequate hydration and prioritizing healthy, easily digestible foods. It is advisable to avoid sexual activity for a few days after the examination to reduce the risk of infection and discomfort. 

 

• Post-procedure symptoms such as headaches, dizziness, nausea, or localized inflammation should naturally subside within a few days. Pain relievers can be taken as needed, with an emphasis on rest following the procedure. 

 

• Patients should wait until the effects of anesthesia and sedatives have worn off before consuming food to prevent choking. On the day of the procedure, it is advisable to avoid alcohol, operating heavy machinery, or driving to prevent accidents. Patients should also refrain from signing any legal documents for 24 hours following the procedure. 

 

• Patients may leave the facility once the effects of anesthesia have diminished, provided they are accompanied by an adult. 

 

• It is essential to monitor for any unusual or persistent symptoms, such as ongoing bleeding, severe abdominal pain, fever, or abnormal discharge. If any of these symptoms occur, patients should contact their physician promptly. 

 

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References

National Cancer Institute. Cervical Cancer Symptoms. Available at :

https://www.cancer.gov/types/cervical/patient/cervical-treatment-pdq

Mayo Clinic. Colposcopy. Available at : https://www.mayoclinic.org/tests-procedures/colposcopy/about/pac-20385036

National Health Service. Colposcopy - What happens on the day. nhs.uk. Available at : https://www.nhs.uk/conditions/colposcopy/what-happens/

 

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