Colposcopy is a diagnostic examination procedure for a close look at the cervix (outside), vagina and vulva.
In colposcopy, the doctor uses a special instrument, the colposcope.
A similar procedure is hysteroscopy, in which the inside of the cervical canal is examined by means of a hysteroscope.
Usually, colposcopy is performed to examine the vagina and cervix (cervix) if the result of the Pap test shows irregularities.
Conspicuous Pap test results are often caused by viral infections based on human papillomaviruses (HPV) or bacteria, fungi (yeast) and protozoa (Trichomonas).
Natural changes in cervical cells caused by menopause (atrophic colpitis) can also provide an abnormal result of the smear test.
In some cases, such cell changes in the cervix can develop precancerous and cancerous if not treated.
When is colposcopy performed?
Colposcopy is performed in two cases:
- to examine the cervix in case of abnormal Pap test result;
- if the cervix has an unusual appearance during the Pap test.
Even if the Pap test is negative, the doctor may order a colposcopy if the cervix looked significantly abnormal when the smear was taken.
Colposcopy is used to find out the cause of abnormalities in the cervix or a questionable result in the Pap test, so that appropriate treatment can be given.
What preparation requires colposcopy
No special preparation is necessary.
It is recommended to empty the bladder and intestines before the examination.
Before the examination:
- avoid vaginal douching;
- do not insert products into the vagina;
- abstain from sexual intercourse 24 hours before the examination;
- Doctor or nurse must be informed about pregnancy or possible pregnancy.
This examination should not be done if the woman is in a stressful phase, unless the Pap test was abnormal.
Colposcopy can also be performed in the following cases:
- at the end or beginning of the monthly cycle;
- in case of unusual bleeding.
During menstruation, colposcopy should be avoided, the middle of the cycle is ideal.
Before the examination, ibuprofen (Dolormin) or acetaminophen (Ben-u-ron) may be taken.
You should ask your doctor or nurse if and when medication can be taken.
What does a colposcopy consist of?
A colposcope is a microscope that resembles binoculars.
The instrument has different magnifying lenses.
Color filters are also available to help the doctor identify abnormalities of the small blood vessels on the cervix.
The colposcope is used to examine vaginal and cervical walls through the vaginal opening.
The doctor examines the cervix and performs a special examination.
First, the vulva and vagina are inspected and examined for genital warts and other growths. (Genital warts and condylomas are caused by the human papillomavirus, or HPV, which is sexually transmitted and can lead to cervical cancer.)
Colposcopy is a safe examination procedure in which there are no complications, except for light vaginal bleeding.
The examiner must examine in detail the boundary between the squamous epithelium and the cylindrical epithelium, because cervical cancer most often forms in this area of the cervix.
Here, two different cell types border each other (squamous cells and cylindrical epithelial cells), which normally form the lining of the endocervical canal. (This channel connects the cervix to the main part of the uterus).
Cervical cancer develops predominantly in the squamous cells and is then referred to as squamous cell carcinoma.
In colposcopy, the entire boundary between the two epithelial forms is visible only in younger women.
The reason for this is that this boundary shifts further and further up into the cervical canal after menopause.
Colposcopy is therefore often not suitable after menopause. If the boundary between the squamous epithelium and the cylindrical epithelium is not completely visible, another method of investigation may be necessary for its analysis.
What special examinations are performed during colposcopy?
There are three special examinations performed during colposcopy:
- acetic acid sample,
- use of colour filters,
- Tissue removal (biopsy) from the cervix.
Acetic acid sample
After the cervix has been thoroughly examined with the colposcope, it is rinsed with a chemical substance, it is dilute acetic acid (3% to 5%). With the acetic acid, the mucus is washed away so that the conspicuous areas become more visible with the colposcope. In addition, acetic acid makes pathological changes appear as white spots.
The areas that are colored white after acetic acid rinsing are called “vinegar-white epithelium.” Sometimes normal regions also appear as white spots, but here the edges are indeterminate and only weakly demarcated.
In contrast, significant abnormalities, such as precancerous genital warts (dysplasia) and tumors, usually have a sharp and distinct demarcation from their environment.
Use of color filters
Another part of colposcopy is the use of color filters. With their help, the doctor can better examine the small blood vessels (capillaries) in the border area between the squamous epithelium and the cylindrical epithelium.
Blue or green filtered light makes anomalous capillaries appear more clearly, usually within a vinegar-white zone.
Normal capillaries are thin and evenly spaced.
Abnormal capillaries, on the other hand, may appear as red spots (end pieces of thickened capillaries) or act like a hexagonal tile model. As cervical disease progresses, the capillaries become thicker and thicker, and the distance increases.
The disruption of the capillary pattern ranges from mild (such as the precancerous changes called dysplasia) to severe (such as stage four cancer).
As the cancer progresses, the capillaries take on strange shapes that look like punctuation marks.
In addition, a tissue sample (biopsy) can be taken in the suspicious region as part of colposcopy.
In fact, the biopsy is an essential part of the examination because the form of treatment depends on the severity of the cell change, which can be determined by a biopsy.
After colposcopy and biopsy, a chemical substance is applied to the area to prevent bleeding.
Often, during colposcopy, a scraping (tissue removal from the cervical canal) or the opening of the cervix in the uterine cavity is also performed.
Does colposcopy cause pain?
Colposcopy itself is not painful, but inserting the instruments can be uncomfortable, especially with an inflamed or tight vagina.
During the biopsy, a pinching is felt and the uterine muscles can contract and cause spasms.
It is advisable to inhale and exhale deeply for relaxation.
How long does colposcopy take?
The examination takes only 10 to 15 minutes.
Are the results available immediately?
A negative test result is communicated to the patient on the spot, but if the colposcopy is positive, the laboratory result of the biopsy must first be awaited.
Colposcopy is a safe examination procedure that involves few risks. In rare cases, complications may occur, such as:
- heavy bleeding,
- Pelvic pain.
After colposcopy, the patient must use a sanitary sanitary napkin.
For 3-5 days, weak bleeding and discharge may occur.
The escaping material is liquid and dark, sometimes green or coffee grounds-like.
The liquid is the one used during the examination.
As long as the bleeding continues, it is necessary to refrain from sexual intercourse, vaginal medications and tampons.
Results of a colposcopy, guidelines
After a colposcopy, the doctor may already have an idea of whether there are atypical cells in the cervix.
If he is not sure, a biopsy may be necessary.
In some cases, the altered cells can already be treated during colposcopy.
Results of the biopsy
If a biopsy is performed during colposcopy, the tissue sample must be examined in the laboratory.
There, the severity of the cell changes can be determined.
It may take a while for the results of the biopsy to be available.
After that, the patient discusses with the doctor. The medical term for the abnormal cell change of the cervix is cervical intraepithelial neoplasia (CIN).
A CIN is not cancer, but the atypical cells can turn into cancer cells.
In some cases, cell abnormalities occur in the glandular cells of the cervical lining. These are called cervical glandular intraepithelial neoplasia (CGIN).
CGIN is less common than CIN.
A CIN or CGIN does not necessarily mean that cancer is present or will develop.
Classification of CIN and CGIN CGIN
is usually divided into mild and high-grade dysplasia. A high-grade CGIN corresponds to a CIN III.
Physicians use the following CIN scale, ranging from I to III, to divide the altered cervical cells into degrees of severity:
CIN I Cervical intraepithelial neoplasia I
means that at most one third of the cells in the affected region of the cervix are abnormal. The specialist determines the further procedure. Therapy is not always recommended for CIN I, because in 60% of cases the cells can return to normal without treatment.
CIN II Cervical intraepithelial neoplasia II
means that up to two-thirds of the cells in the affected region of the cervix are abnormal. In stage CIN II, the affected area is usually removed.
CIN III or CGIN Cervical intraepithelial neoplasia III or CGIN
means that all cells in the affected region of the cervix are abnormal. In this case, they must be removed.
In rare cases, biopsy shows that some of the abnormal cervical cells have developed into cancer cells. If this is the case, further examinations must be carried out and the necessary treatment initiated as soon as possible.
Repetition of colposcopy
Depending on the results of colposcopy and biopsy, therapy is started immediately or a repetition of colposcopy is ordered after the following intervals:
In CIN I, colposcopy must be repeated every 6-12 months to monitor the cells and determine whether further treatment is necessary.
For CIN II or III, immediate surgery is usually recommended.
CIN and CGIN are treated in the same way.