Colposcopy
Colposcopy is a diagnostic procedure that involves examining the uterine cervix using a specialized microscope to identify and biopsy any abnormal tissue. It is typically performed following an abnormal Pap test or a positive HPV test, as well as in certain cases of cervical anomalies. Patient preparation for colposcopy includes avoiding vaginal insertions, sexual intercourse, and specific medications for 48 hours prior to the exam. The procedure itself lasts about 10 to 15 minutes and includes staining the cervix with acetic acid and iodine to highlight abnormal areas.
Post-procedure, patients may experience mild cramping and dark vaginal discharge, especially if biopsies are taken, and should avoid sexual activity and douching for a period of time. While the risks are minimal, any heavy bleeding or unusual discharge warrants immediate medical attention. Approximately 40% of colposcopy results show no abnormalities, but abnormal findings can indicate varying degrees of cervical dysplasia or even early-stage cervical cancer. Treatment options for significant abnormalities may include procedures like loop electrosurgical incision or cryotherapy. The reliability of colposcopy can vary between healthcare providers, prompting the development of standardized guidelines by the American Society for Colposcopy and Cervical Pathology to enhance consistency in care.
On this Page
Subject Terms
Colposcopy
ALSO KNOWN AS: Colposcopy-directed biopsy
DEFINITION: A colposcopy is a diagnostic procedure in which the uterine cervix is examined using a microscope and any abnormal tissue is biopsied.
Cancers diagnosed:Cervical cancer or its precursor, (CIN)
Why performed: Colposcopy is performed as a follow-up to an abnormal Papanicolaou test (Pap test), also called a Pap smear, or after a positive Human papillomavirus (HPV) test. It is also performed on a patient exposed to diethylstilbestrol (DES), with repeated inflammation of the cervix or an abnormal-appearing cervix, or with repeated atypical squamous cells of undetermined significance (ASCUS).
Patient preparation: Patients should avoid placing anything in the vagina for forty-eight hours before the exam, including medicines for vaginal yeast infections, douches, and spermicides, and should abstain from sexual intercourse. The physician will provide specific instructions. Some physicians advise patients to take an over-the-counter pain medication, such as ibuprofen or acetaminophen. The procedure should be scheduled when the patient is not menstruating.
Steps of the procedure: Colposcopy takes ten to fifteen minutes in the office. The patient lies on an exam table in the same position as for a Pap smear. A speculum is used to open the vagina and view the cervix. The physician uses a cotton swab to stain the cervix with acetic acid (vinegar solution) and iodine. The physician examines the cervix using a microscope placed about thirty centimeters from the vagina and notes variations in the normally smooth, pink appearance of the cervix, including areas of disordered growth of cells (dysplasia), abnormal patterns of blood vessel growth (punctation), and the acetowhite areas (patches of tissue that are white after staining with acetic acid). Biopsies of abnormal areas are taken using biopsy forceps and sent to a laboratory for examination by a pathologist.
After the procedure: The patient may feel mild cramps or pinching and may have dark-colored vaginal discharge after the procedure if biopsies are taken. The physician may recommend that the patient avoid activities such as sexual intercourse, treating for vaginal yeast infections, and douching after the exam.
Risks: There is little risk associated with this procedure. However, heavy vaginal bleeding, foul-smelling discharge, or a high fever should be reported to the physician.
Results: Around 40 percent of colposcopy results indicate no abnormalities. A normal cervix is smooth and pink with no unusual patterns of blood vessels, turns dark with iodine staining, and has only mild acetowhite areas. Abnormal cervical tissue is rough or “humped up,” intensely acetowhite, includes patterns of blood vessel growth described as “punctation” or “mosaic,” and is iodine-negative (yellow). Biopsy results indicate the severity of cell abnormalities using grade I, II, or III cervical intraepithelial neoplasia (CIN). In addition to CIN I, CIN II, or CIN III, biopsy results may reveal the presence of stage 0 cancer called carcinoma in situ (CIS). A CIN I finding indicates mild dysplasia, which often resolves independently. It may be followed by a colposcopy or Pap smear. CIN II, CIN III, and CIS indicate moderate dysplasia, severe dysplasia, and early cervical cancer, respectively. These are usually treated using a loop electrosurgical incision procedure (LEEP) or cone biopsy to remove abnormal cells. The cells may also be destroyed with liquid nitrogen in a cryotherapy or laser surgical procedure.
Studies show that colposcopy reliability between medical professionals is generally poor. The American Society for Colposcopy and Cervical Pathology (ASCCP) published colposcopy standards in 2017 to address the widely varying training and procedural processes between providers.
Bibliography
"Colposcopy—Directed Biopsy." MedlinePlus, 2022, medlineplus.gov/ency/article/003913.htm. Accessed 20 June 2024.
"Colposcopy—Directed Biopsy." Mount Sinai, 10 Jan. 2022, www.mountsinai.org/health-library/tests/colposcopy-directed-biopsy. Accessed 20 June 2024.
"Colposcopy." Mayo Clinic, 11 May 2024, www.mayoclinic.org/tests-procedures/colposcopy/about/pac-20385036. Accessed 20 June 2024.
Cooper, Danielle B., and Charles J. Dunton. "Colposcopy." National Library of Medicine, 12 Nov. 2023, www.ncbi.nlm.nih.gov/books/NBK564514. Accessed 20 June 2024.
Perkins, Rebecca B., et al. “Summary of Current Guidelines for Cervical Cancer Screening and Management of Abnormal Test Results: 2016-2020.” Journal of Women's Health, vol. 30, no. 1, 2021, pp. 5-13. doi:10.1089/jwh.2020.8918.
Stuebs, Frederik A., et al. “Accuracy of Colposcopy-Directed Biopsy in Detecting Early Cervical Neoplasia: A Retrospective Study.” Archives of Gynecology and Obstetrics, vol. 299, no. 2, 2019, pp. 525-532. doi:10.1007/s00404-018-4953-8.
"When Cervical Screening Test Results Are Abnormal." American Cancer Society, 30 July 2020, www.cancer.org/cancer/types/cervical-cancer/detection-diagnosis-staging/screening-tests/abn-pap-work-up.html. Accessed 20 June 2024.