Colposcopy is a gynecological procedure to closely examine the cervix, vagina and vulva for any signs of dysplastic changes. It is performed with the help of a special instrument known as a colposcope. Colposcope, which is a large electric microscope resembling binoculars provides a magnified and illuminated view of these structures.
Why Colposcopy is Performed?
Colposcopy is usually done after an abnormal Pap test result or when the cervix is abnormal looking at the time of Pap smear collection even though the Pap smear result is negative. It can also be performed if one experiences post-coital bleeding or visible abnormal growth on cervix, vagina or vulva.
The patient should inform the doctor whether she is pregnant or not before getting colposcopy done, should avoid getting it done at the time of her periods. She should avoid tampons, douching, sexual intercourse or any vaginal suppositories 1 to 2 days prior to the procedure.
It is used to diagnose abnormal or precancerous changes in the cervix, vagina or vulva, genital warts and cervicitis (inflammation of the cervix). Colposcopy requires special tests including acetic acid wash, color filter use and biopsy (sampling) of the tissues.
How is Colposcopy Done?
Colposcopy is performed in a doctor’s office and usually takes about 10 to 20 minutes. It is done in the same manner a pelvic exam or Pap smear is performed. The patient will lie on the exam table with feet resting in the stirrups. A speculum is inserted into the vagina to open it up for better visibility. The colposcope will be placed a few inches away from the vulva and the vaginal walls and cervix will be magnified and illuminated for examination. After examining the cervix, acetic acid is used to wash away any mucus from the cervix so that the abnormal cells are stained white. Iodine solution can also be used for normal cells to stain brown and abnormal cells will be in contrast to the normal cells that facilitates the exam. Blue or green color filter can also be used to highlight abnormal capillaries inside the abnormal cells. Finally, biopsy is done to remove a small part of the abnormal tissue. Depending on the site, the biopsy can be taken either from cervix or the vagina. The biopsy sample will be sent for further examination. After biopsy a topical chemical will be applied to avoid bleeding.
What to Expect After Colposcopy?
After colposcopy, the vagina may feel sore for a day or two. If biopsy is done then light bleeding or spotting may be noted. The individual should use a pad, panty-liner or a tampon, unless the doctor or nurse tells otherwise. If biopsy is performed then vaginal sex should be avoided for a few days to help the biopsy site heal faster. If no biopsy was performed then normal activity can be carried out after colposcopy including sexual intercourse.
If one is pregnant, it is safe to get colposcopy, but it is better avoided during pregnancy and deferred for a later date as in pregnancy there is a greater chance of heavy bleeding due to increased blood supply in the cervix.
Risks of Colposcopy
Generally, colposcopy is a safe procedure with very few risks. There are rare complications during biopsy procedure including heavy bleeding, infection or pelvic pain. If one notices heavy bleeding or fever/chills or severe abdominal pain then one should call a doctor immediately.
Colposcopy results could be normal or abnormal. If they are normal additional testing will be done or follow up Pap smear will be advised. If the biopsy result is abnormal then further treatment modalities will be opted depending upon the dysplastic (pre-cancerous) tissue changes or cancer progression.
Broadly the treatment can be classified into two types:
Ablation or Destruction of the Tissue: This includes CO2 laser photoablation and cryocautery.
Resection or Removal of the Tissue: This includes LEEP (loop electrosurgical excision procedure), cold knife conization and hysterectomy. LEEP is the most popular treatment for precancerous dysplasia. Most of the cases of cervical cancer and severe cases of dysplasia are treated with hysterectomy.
Both type of treatments cure about 90% of dysplasia and 10% have recurrence of abnormality after treatment.