Colposcopy: Indications, Benefits, Procedure, Principles, Complications, Contraindications

Colposcopy is the procedure done if there are abnormal findings in cervical screening. Colposcopy is a simple procedure to examine the insides of vagina, cervix, and vulva for any signs of the disease using an instrument called colposcope. This was first described by Hans Hinselman of Germany in 1925.

• Abnormal PAP smear
• Genital warts
• Cervicitis
• Post-coital bleeding
• Precancerous changes of cervix, vagina, vulva
• Abnormal cervical cytology
• Unexplained vaginal bleeding
• Vulvar or vaginal neoplasia
• H/o of Intra-utero DES exposure
• High risk for HPV DNA
• Sexual partners with genital tract neoplasia
• Positive screening test by Cervicography or speculoscopy
• CIN 1 ,CIN 2 or CIN 3 on cytology
• Lugol’s Iodine and acetic acid positive on visual inspection

• Detection of invasive cancer
• Squamocolumnar junction localization
• Identification and evaluation of genital tract diseases

• Avoid doing Colposcopy if menstruation is present.
• Avoidance of sexual intercourse two or three days prior to colposcopy.
• Avoid vaginal creams, douches, tampons and also concomitant medications which increase the chances of bleeding.

1. Saline Technique:

   This is used to study the vessels more clearly and this has to be applied before application of acetic acid.

2. Acetic Acid Test

   This helps in coagulating and clearing the mucus. This helps in differentiation of abnormal cytology.

3. Lugol’s Iodine Test

   Iodine is glycophillic and is taken up by mature squamous metaplastic epithelium and not by the cancerous cells. The routine use of Lugol’s Iodine is recommended as it may help in diagnosing missed out lesions during examination.

Procedure of colposcopy is explained to the patient and the doubts of the patient are cleared, and an informed consent is obtained. Relevant medical history and pregnancy history is obtained. Patient is examined by manual examination before colposcopy.

During the colposcopy procedure, the subject lies down in lithotomy position. The doctor inserts a vaginal speculum to hold the vagina in place and get a clear view of cervix. The cervix is examined using low power of the colposcope. The abnormal cytology is checked (if any) and culture or PAP smear is obtained (if necessary for confirmatory diagnosis). The colposcopy procedure is then continued with application of saline, 5% acetic acid and Lugol’s Iodine in the same order to the cervix to detect abnormal cytology.

The cervix is scanned with the light from colposcope, moving from lower magnification to higher magnifications. The examination findings are noted down, during the colposcopy procedure. The cervical biopsy or endocervical curettage is performed (if necessary). Cervical biopsy is usually painless, but sometimes cramping may be experienced by the patient while performing cervical biopsy. Vaginal biopsy is usually done using a local anesthetic to avoid any pain sensations.

The pressure is applied to the bleeding site to stop bleeding (if biopsy is performed). The speculum inserted is removed and checked for bleeding sites, and vaginal walls, vulva, vagina, cervix, perineum and perianal areas are inspected.

The patient is observed until she is fully recovered and then discharged. Colposcopy procedure takes around 5-10 minutes to complete. The findings seen during colposcopy are discussed with the patient along with follow-up details.²

• Normal activities can be resumed
• Do not exercise 1 day post colposcopy
• Inform the doctor regarding the intake of concomitant medications.
• Pain medications are allowed.
• Bleeding is seen for about 1-2 days post colposcopy procedure.
• No sexual intercourse for 1 week following colposcopy procedure
• Do not use tampons or douches for 1 week following colposcopy procedure.

• Non cooperative patient
• Menstruation present
• Active Cervicitis present
• Post-menopausal women who are not on estrogen.

The complications are minimal but the below mentioned are rare complications of Colposcopy procedure:

• Vaginal bleeding lasting for more than 2 weeks.
• Fever, chills and pelvic pain
• Infection with foul smelling discharge from vagina

If any of the above complications are seen following colposcopy, contact your doctor immediately for further evaluation.

References