Colposcopy
Encyclopedia
Colposcopy is a medical diagnostic
procedure to examine an illuminated, magnified view of the cervix
and the tissues of the vagina
and vulva
. Many premalignant lesion
s and malignant
lesions in these areas have discernible characteristics which can be detected through the examination. It is done using a colposcope, which provides an enlarged view of the areas, allowing the colposcopist to visually distinguish normal from abnormal appearing tissue and take directed biopsies
for further pathological examination. The main goal of colposcopy is to prevent cervical cancer
by detecting precancerous lesions early and treating them. The procedure was developed in 1925 by the German
physician Hans Hinselmann, with help from SS Dr. Eduard Wirths
.
A specialized colposcope equipped with a camera is used in examining and collecting evidence for victims of rape and sexual assault.
abnormality on their pap smear
s. Other indications for a woman to have a colposcopy include:
Many physicians base their current evaluation and treatment decisions on the report "Guidelines for the Management of Cytological Abnormalities and Cervical Cancer Precursors", created by the American Society for Colposcopy and Cervical Pathology, during a September 2001 conference.
(number of prior pregnancies), parity
(number of prior deliveries), last menstrual period, contraception use, prior abnormal pap smear results, allergies, significant past medical history, other medications, prior cervical procedures, and smoking history. In some cases, a pregnancy
test may be performed before the procedure. The procedure is fully described to the patient, questions are asked and answered, and she then signs a consent form.
A colposcope is used to identify visible clues suggestive of abnormal tissue. It functions as a lighted binocular microscope
to magnify the view of the cervix, vagina, and vulvar surface. Low power (2× to 6×) may be used to obtain a general impression of the surface architecture. Medium (8× to 15×) and high (15× to 25×) powers are utilized to evaluate the vagina and cervix. The higher powers are often necessary to identify certain vascular patterns that may indicate the presence of more advanced precancerous or cancerous lesions. Various light filters are available to highlight different aspects of the surface of the cervix. Acetic acid
solution and iodine
solution (Lugol's or Schiller's) are applied to the surface to improve visualization of abnormal areas.
Colposcopy is performed with the woman lying on her back, legs in stirrups
, and buttocks at the lower edge of the table (a position known as the dorsal
lithotomy position
). A speculum
is placed in the vagina after the vulva
is examined for any suspicious lesion
s.
Three percent acetic acid
is applied to the cervix using cotton swabs. Areas of acetowhiteness correlate with higher nuclear density. The transformation zone is a critical area on the cervix where many precancerous and cancerous lesions most often arise. The ability to see the transformation zone and the entire extent of any lesion visualized determines whether an adequate colposcopic examination is attainable.
Areas of the cervix which turn white after the application of acetic acid or have an abnormal vascular
pattern are often considered for biopsy
. If no lesions are visible, an iodine
solution may be applied to the cervix to help highlight areas of abnormality.
After a complete examination, the colposcopist determines the areas with the highest degree of visible abnormality and may obtain biopsies from these areas using a long biopsy instrument, such as a punch forceps or SpiraBrush CX. Most doctors and patients consider anesthesia
unnecessary; however, some colposcopists now recommend and use a topical anesthetic
such as lidocaine
or a cervical block
to decrease patient discomfort, particularly if many biopsy samples are taken.
Following any biopsies, an endocervical curettage
(ECC) is often done. The ECC utilizes a long straight curette
or a cytobrush (like a small pipe-cleaner) to scrape the inside of the cervical canal. The ECC should never be done on a pregnant woman. Monsel's solution is applied with large cotton swab
s to the surface of the cervix to control bleeding. This solution looks like mustard
and turns black when exposed to blood. After the procedure this material will be expelled naturally: women can expect to have a thin coffee-ground like discharge for up to several days after the procedure. Alternatively, some physicians achieve hemostasis with Silver Nitrate.
(HPV) is a common infection and the underlying cause for most cervical dysplasia. Women should be counseled on the benefits of safe sex for reducing their risks of contracting and spreading HPV. One study suggests that prostaglandin
in semen
may fuel the growth of cervical and uterine tumours and that affected women may benefit from the use of condom
s.
Smoking predisposes women to developing cervical abnormalities. A smoking cessation
program should be part of the treatment plan for women who smoke.
Treatments for significant lesions include cryotherapy
, loop electrical excision procedure
(LEEP), and laser
ablation.
Medical diagnosis
Medical diagnosis refers both to the process of attempting to determine or identify a possible disease or disorder , and to the opinion reached by this process...
procedure to examine an illuminated, magnified view of the cervix
Cervix
The cervix is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall...
and the tissues of the vagina
Vagina
The vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. Female insects and other invertebrates also have a vagina, which is the terminal part of the...
and vulva
Vulva
The vulva consists of the external genital organs of the female mammal. This article deals with the vulva of the human being, although the structures are similar for other mammals....
. Many premalignant lesion
Lesion
A lesion is any abnormality in the tissue of an organism , usually caused by disease or trauma. Lesion is derived from the Latin word laesio which means injury.- Types :...
s and malignant
Malignant
Malignancy is the tendency of a medical condition, especially tumors, to become progressively worse and to potentially result in death. Malignancy in cancers is characterized by anaplasia, invasiveness, and metastasis...
lesions in these areas have discernible characteristics which can be detected through the examination. It is done using a colposcope, which provides an enlarged view of the areas, allowing the colposcopist to visually distinguish normal from abnormal appearing tissue and take directed biopsies
Biopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
for further pathological examination. The main goal of colposcopy is to prevent cervical cancer
Cervical cancer
Cervical cancer is malignant neoplasm of the cervix uteri or cervical area. One of the most common symptoms is abnormal vaginal bleeding, but in some cases there may be no obvious symptoms until the cancer is in its advanced stages...
by detecting precancerous lesions early and treating them. The procedure was developed in 1925 by the German
Germany
Germany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...
physician Hans Hinselmann, with help from SS Dr. Eduard Wirths
Eduard Wirths
Eduard Wirths was the Chief SS doctor at the Auschwitz concentration camp from September 1942 to January 1945...
.
A specialized colposcope equipped with a camera is used in examining and collecting evidence for victims of rape and sexual assault.
Indications
Most women undergo a colposcopic examination to further investigate a cytologicalCytopathology
Cytopathology is a branch of pathology that studies and diagnoses diseases on the cellular level. The discipline was founded by Rudolf Virchow in 1858. A common application of cytopathology is the Pap smear, used as a screening tool, to detect precancerous cervical lesions and prevent cervical...
abnormality on their pap smear
Pap smear
The Papanicolaou test is a screening test used in to detect pre-cancerous and cancerous processes in the endocervical canal of the female reproductive system. Changes can be treated, thus preventing cervical cancer...
s. Other indications for a woman to have a colposcopy include:
- assessment of diethylstilbestrolDiethylstilbestrolDiethylstilbestrol is a synthetic nonsteroidal estrogen that was first synthesized in 1938. Human exposure to DES occurred through diverse sources, such as dietary ingestion from supplemented cattle feed and medical treatment for certain conditions, including breast and prostate cancers...
(DES) exposure in utero, - immunosuppressionImmunosuppressionImmunosuppression involves an act that reduces the activation or efficacy of the immune system. Some portions of the immune system itself have immuno-suppressive effects on other parts of the immune system, and immunosuppression may occur as an adverse reaction to treatment of other...
such as HIVHIVHuman immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
infection, or an organ transplant patient - an abnormal appearance of the cervix as noted by a primary care provider
- as a part of a sexual assaultSexual assaultSexual assault is an assault of a sexual nature on another person, or any sexual act committed without consent. Although sexual assaults most frequently are by a man on a woman, it may involve any combination of two or more men, women and children....
forensic examination done by a Sexual Assault Nurse Examiner
Many physicians base their current evaluation and treatment decisions on the report "Guidelines for the Management of Cytological Abnormalities and Cervical Cancer Precursors", created by the American Society for Colposcopy and Cervical Pathology, during a September 2001 conference.
Procedure
During the initial evaluation, a medical history is obtained, including gravidityGravidity
In medicine, gravidity refers to the number of times a woman has been pregnant, regardless of whether the pregnancies were interrupted or resulted in a live birth....
(number of prior pregnancies), parity
Parity (medicine)
In biology, parity is a technical term that refers to the number of times a female has given birth to a fetus.It can lead to some ambiguity for events occurring between 20 and 24 weeks, and for multiple pregnancies.-Enumeration:...
(number of prior deliveries), last menstrual period, contraception use, prior abnormal pap smear results, allergies, significant past medical history, other medications, prior cervical procedures, and smoking history. In some cases, a pregnancy
Pregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
test may be performed before the procedure. The procedure is fully described to the patient, questions are asked and answered, and she then signs a consent form.
A colposcope is used to identify visible clues suggestive of abnormal tissue. It functions as a lighted binocular microscope
Microscope
A microscope is an instrument used to see objects that are too small for the naked eye. The science of investigating small objects using such an instrument is called microscopy...
to magnify the view of the cervix, vagina, and vulvar surface. Low power (2× to 6×) may be used to obtain a general impression of the surface architecture. Medium (8× to 15×) and high (15× to 25×) powers are utilized to evaluate the vagina and cervix. The higher powers are often necessary to identify certain vascular patterns that may indicate the presence of more advanced precancerous or cancerous lesions. Various light filters are available to highlight different aspects of the surface of the cervix. Acetic acid
Acetic acid
Acetic acid is an organic compound with the chemical formula CH3CO2H . It is a colourless liquid that when undiluted is also called glacial acetic acid. Acetic acid is the main component of vinegar , and has a distinctive sour taste and pungent smell...
solution and iodine
Iodine
Iodine is a chemical element with the symbol I and atomic number 53. The name is pronounced , , or . The name is from the , meaning violet or purple, due to the color of elemental iodine vapor....
solution (Lugol's or Schiller's) are applied to the surface to improve visualization of abnormal areas.
Colposcopy is performed with the woman lying on her back, legs in stirrups
Stirrup (disambiguation)
A stirrup is a metal loop supporting the foot, fastened to a saddle on a riding animal.Stirrup may also refer to:* Baseball stirrups, a type of socks worn by baseball players...
, and buttocks at the lower edge of the table (a position known as the dorsal
Dorsum (biology)
In anatomy, the dorsum is the upper side of animals that typically run, fly, or swim in a horizontal position, and the back side of animals that walk upright. In vertebrates the dorsum contains the backbone. The term dorsal refers to anatomical structures that are either situated toward or grow...
lithotomy position
Lithotomy position
The lithotomy position is a medical term referring to a common position for surgical procedures and medical examinations involving the pelvis and lower abdomen, as well as a common position for childbirth in Western nations...
). A speculum
Speculum (medical)
A speculum is a medical tool for investigating body cavities, with a form dependent on the body cavity for which it is designed. In old texts, the speculum may also be referred to as a diopter or dioptra...
is placed in the vagina after the vulva
Vulva
The vulva consists of the external genital organs of the female mammal. This article deals with the vulva of the human being, although the structures are similar for other mammals....
is examined for any suspicious lesion
Lesion
A lesion is any abnormality in the tissue of an organism , usually caused by disease or trauma. Lesion is derived from the Latin word laesio which means injury.- Types :...
s.
Three percent acetic acid
Acetic acid
Acetic acid is an organic compound with the chemical formula CH3CO2H . It is a colourless liquid that when undiluted is also called glacial acetic acid. Acetic acid is the main component of vinegar , and has a distinctive sour taste and pungent smell...
is applied to the cervix using cotton swabs. Areas of acetowhiteness correlate with higher nuclear density. The transformation zone is a critical area on the cervix where many precancerous and cancerous lesions most often arise. The ability to see the transformation zone and the entire extent of any lesion visualized determines whether an adequate colposcopic examination is attainable.
Areas of the cervix which turn white after the application of acetic acid or have an abnormal vascular
Blood vessel
The blood vessels are the part of the circulatory system that transports blood throughout the body. There are three major types of blood vessels: the arteries, which carry the blood away from the heart; the capillaries, which enable the actual exchange of water and chemicals between the blood and...
pattern are often considered for biopsy
Biopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
. If no lesions are visible, an iodine
Iodine
Iodine is a chemical element with the symbol I and atomic number 53. The name is pronounced , , or . The name is from the , meaning violet or purple, due to the color of elemental iodine vapor....
solution may be applied to the cervix to help highlight areas of abnormality.
After a complete examination, the colposcopist determines the areas with the highest degree of visible abnormality and may obtain biopsies from these areas using a long biopsy instrument, such as a punch forceps or SpiraBrush CX. Most doctors and patients consider anesthesia
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
unnecessary; however, some colposcopists now recommend and use a topical anesthetic
Topical anesthetic
A topical anesthetic is a local anesthetic that is used to numb the surface of a body part. They can be used to numb any area of the skin as well as the front of the eyeball, the inside of the nose, ear or throat, the anus and the genital area. Topical anesthetics are available in creams,...
such as lidocaine
Lidocaine
Lidocaine , Xylocaine, or lignocaine is a common local anesthetic and antiarrhythmic drug. Lidocaine is used topically to relieve itching, burning and pain from skin inflammations, injected as a dental anesthetic or as a local anesthetic for minor surgery.- History :Lidocaine, the first amino...
or a cervical block
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
to decrease patient discomfort, particularly if many biopsy samples are taken.
Following any biopsies, an endocervical curettage
Curettage
Curettage, in medical procedures, is the use of a curette to remove tissue by scraping or scooping.Curettages are also a declining method of abortion. It has been replaced by vacuum aspiration over the last decade....
(ECC) is often done. The ECC utilizes a long straight curette
Curette
A curette is a surgical instrument designed for scraping biological tissue or debris in a biopsy, excision, or cleaning procedure. In form, the curette is a small hand tool, often similar in shape to a stylus; at the tip of the curette is a small scoop, hook, or gouge...
or a cytobrush (like a small pipe-cleaner) to scrape the inside of the cervical canal. The ECC should never be done on a pregnant woman. Monsel's solution is applied with large cotton swab
Swab
Swab may refer to:* Cotton swab, comprising a small wad of cotton on the end of a short rod* A nautical term for a yarn mop**By extension, a low-ranking sailor...
s to the surface of the cervix to control bleeding. This solution looks like mustard
Mustard (condiment)
Mustard is a condiment made from the seeds of a mustard plant...
and turns black when exposed to blood. After the procedure this material will be expelled naturally: women can expect to have a thin coffee-ground like discharge for up to several days after the procedure. Alternatively, some physicians achieve hemostasis with Silver Nitrate.
Complications
Significant complications from a colposcopy are not common, but may include bleeding, infection at the biopsy site or endometrium, and failure to identify the lesion. Monsel's solution and silver nitrate interfere with interpretation of biopsy specimen, so these substances should not be applied until all biopsies have been taken. Some patients experience a degree of discomfort during the curettage, and many experience discomfort during the biopsy.Follow up
Adequate follow-up is critical to the success of this procedure. Human PapillomavirusHuman papillomavirus
Human papillomavirus is a member of the papillomavirus family of viruses that is capable of infecting humans. Like all papillomaviruses, HPVs establish productive infections only in keratinocytes of the skin or mucous membranes...
(HPV) is a common infection and the underlying cause for most cervical dysplasia. Women should be counseled on the benefits of safe sex for reducing their risks of contracting and spreading HPV. One study suggests that prostaglandin
Prostaglandin
A prostaglandin is any member of a group of lipid compounds that are derived enzymatically from fatty acids and have important functions in the animal body. Every prostaglandin contains 20 carbon atoms, including a 5-carbon ring....
in semen
Semen
Semen is an organic fluid, also known as seminal fluid, that may contain spermatozoa. It is secreted by the gonads and other sexual organs of male or hermaphroditic animals and can fertilize female ova...
may fuel the growth of cervical and uterine tumours and that affected women may benefit from the use of condom
Condom
A condom is a barrier device most commonly used during sexual intercourse to reduce the probability of pregnancy and spreading sexually transmitted diseases . It is put on a man's erect penis and physically blocks ejaculated semen from entering the body of a sexual partner...
s.
Smoking predisposes women to developing cervical abnormalities. A smoking cessation
Smoking cessation
Smoking cessation is the process of discontinuing the practice of inhaling a smoked substance. This article focuses exclusively on cessation of tobacco smoking; however, the methods described may apply to cessation of smoking other substances that can be difficult to stop using due to the...
program should be part of the treatment plan for women who smoke.
Treatments for significant lesions include cryotherapy
Cryosurgery
Cryosurgery is the application of extreme cold to destroy abnormal or diseased tissue. The term comes from the Greek words cryo and surgery meaning "hand work" or "handiwork"....
, loop electrical excision procedure
Loop electrical excision procedure
The loop electrosurgical excision procedure is currently one of the most commonly used approaches to treat high grade cervical dysplasia discovered on colposcopic examination. In UK it is known as "large loop excision of the transformation zone" . The procedure has many advantages including low...
(LEEP), and laser
Laser
A laser is a device that emits light through a process of optical amplification based on the stimulated emission of photons. The term "laser" originated as an acronym for Light Amplification by Stimulated Emission of Radiation...
ablation.
External links
- Colposcopy and Treatment of Cervical Intraepithelial Neoplasia: A Beginner's Manual (IARC Screening Group)
- American Society for Colposcopy and Cervical Pathology
- Jo's Trust Details about what colposcopy involves from the UK's leading cervical cancer charity Jo's Trust.
- Women & Babies Colposcopy and gynaecology procedures undertaken by the Women & Babies Consultants.