Colposcopy is a procedure that allows a physician to examine a woman's cervix and vagina using a special microscope called a colposcope. It is used to check for precancerous or abnormal areas.
Colposcopy is used to identify or rule out the existence of any precancerous conditions in the cervical tissue. If a Pap test shows abnormal cell growth, colposcopy is usually the first follow-up test performed. The physician will attempt to find the area that produced the abnormal cells and remove it for further study (biopsy) and diagnosis.
Colposcopy may also be performed if the cervix looks abnormal during a routine examination. It may be suggested for women with genital warts and for diethylstilbestrol (DES) daughters (women whose mothers took the anti-miscarriage drug DES when pregnant with them). Colposcopy is used in the emergency department to examine victims of sexual assault and abuse and document any physical evidence of vaginal injury.
It is estimated that 30–44% of women fail to follow-up with colposcopy after an abnormal Pap test. Minority women, teenagers, and those of low socioeconomic status are at a greater risk of this.
Colposcopy is usually performed in a physician's office and is similar to a regular gynecologic exam. An instrument called a speculum is inserted to hold the vagina open, and the gynecologist looks at the cervix and vagina using a colposcope, a low-power microscope designed to magnify the cervix 10–40 times its normal size. Most colposcopes are connected to a video monitor that displays the area of interest. Photographs are taken during the examination to document abnormal areas.
The colposcope is placed outside the patient's body and never touches the skin. The cervix and vagina are swabbed with dilute acetic acid (vinegar). The solution highlights abnormal areas by turning them white (instead of a normal pink color). Abnormal areas can also be identified by looking for a characteristic pattern made by abnormal blood vessels.
If any abnormal areas are seen, the doctor will take a biopsy of the tissue, a common procedure that takes about 15 minutes. Several samples might be taken, depending on the size of the abnormal area. A biopsy may cause temporary discomfort and cramping, which usually go away within a few minutes. If the abnormal area appears to extend inside the cervical canal, a scraping of the canal may also be done. The biopsy results are usually available within a week.
If the tissue sample indicates abnormal growth (dysplasia) or is precancerous, and if the entire abnormal area can be seen, the doctor can destroy the tissue using one of several procedures, including ones that use high heat (diathermy), extreme cold (cryosurgery), or lasers. Another procedure, called a loop electrosurgical excision (LEEP), uses low-voltage, high-frequency radio waves to excise tissue. If any of the abnormal tissue is within the cervical canal, a cone biopsy (removal of a conical section of the cervix for inspection) will be needed.
Women who are pregnant, or who suspect that they are pregnant, must tell their doctor before the procedure begins. Pregnant women may undergo colposcopy if they have an abnormal Pap test; special precautions, however, must be taken during biopsy of the cervix.
Patients should be instructed not to douche, use tampons, or have sexual intercourse for 24 hours before colposcopy. Patients should empty their bladder and bowels before colposcopy for comfort. Colposcopy does not require any anesthetic medication because pain is minimal. If a biopsy is done, there may be mild cramps or a sharp pinching when the tissue is removed. To lessen this pain, the doctor may recommend ibuprofen (Motrin) taken the night before and the morning of the procedure (no later than 30 minutes before the appointment). Patients who are pregnant or allergic to aspirin or ibuprofen can instead take acetaminophen (Tylenol).
If a biopsy was done, there may be a dark vaginal discharge afterwards. After the sample is removed, the doctor applies Monsel's solution to the area to stop the bleeding. When this mixes with blood, it creates a black fluid that looks like coffee grounds. This fluid may be present for a couple of days after the procedure. It is also normal to have some spotting after colposcopy. Pain-relieving medication can be taken to lessen any postprocedural cramping.
Patients should not use tampons, douche, or have sex for at least a week after the procedure (or until the doctor says it is safe) because of the risk of infection.
Patients may have bleeding or infection after biopsy. Bleeding is usually controlled with a topical medication prescribed by the physician or health care provider. If colposcopy is performed on a pregnant patient, there is a risk of premature labor.
A patient should call her doctor right away if she notices any of the following symptoms:
If visual inspection shows that the surface of the cervix is smooth and pink, this is considered normal. Areas that look abnormal may actually be normal variations; a biopsy will indicate whether the tissue is normal or abnormal.
Abnormal conditions that can be detected using colposcopy and biopsy include precancerous tissue changes (cervical dysplasia), cancer, and cervical warts caused by human papilloma virus.
Complications associated with colposcopy are extremely rare. There is a risk that the procedure will miss precancerous or cancerous tissues and thus prolong treatment until the cancer has become advanced. Of the 12,800 women who are diagnosed in the United States each year with cervical cancer, approximately 37.5% will die as a result of the disease.
While the Pap test is an effective screening test for abnormal cell growth of the cervix, it is an inadequate diagnostic alternative to colposcopy because of the potential for false negative results (10–50%). In some instances, a repeat Pap test may be recommended before performing colposcopy (e.g., in the case of inflammation or no previous abnormal Pap test).
Ryan, Kenneth J., Ross S. Berkowitz, and Robert L. Barbieri. Kistner's Gynecology, 7th ed. St. Louis: Mosby, 1999.
McKee, M. Diane, Joseph Lurio, Paul Marantz, William Burton, and Michael Mulvihill. "Barriers to Follow-up of Abnormal Papanicolaou Smears in an Urban Community Health Center." Archives of Family Medicine 8 (March/April 1999): 129–34.
American College of Obstetricians and Gynecologists. 409 12th St., SW, PO Box 96920, Washington, DC 20090-6920. http://www.acog.org .
American Society for Colposcopy and Cervical Pathology. 20 W. Washington St., Ste. #1, Hagerstown, MD 21740. (301) 733-3640. http://www.asccp.org .
Association of Women's Health, Obstetric, and Neonatal Nurses. 2000 L St., NW, Ste. 740, Washington, DC 20036. (800) 673-8499. http://www.awhonn.org .
DES Action USA. 610 16th St., Ste. 301, Oakland, CA 94612. (510) 465-4011. http://www.desaction.org .
Society of Gynecologic Oncologists. 401 North Michigan Ave., Chicago, IL 60611. (312) 644-6610. http://www.sgo.org .
"Colposcopy (Position Paper)." American Academy of Family Physicians, [cited March 11, 2003]. http://www.aafp.org/x6665.xml .
Garcia, Agustin. "Cervical Cancer." eMedicine, April 17, 2002 [cited March 11, 2003]. http://www.emedicine.com/med/topic324.htm .
Mayeaux, E. J. "Colposcopy Atlas." Louisiana State University Health Sciences Center Medical Library, [cited March 11, 2003]. http://lib-sh.lsumc.edu/fammed/atlases/colpo.html .
Pattan, Charles. "Colposcopy." eMedicine, July 15, 2002 [cited March 11, 2003]. http://www.emedicine.com/med/topic 3298.htm .
Jennifer E. Sisk, MA Stephanie Dionne Sherk
Colposcopy may be performed by a gynecologist or other qualified health care provider in an outpatient setting. A gynecologist specializes in the areas of women's general health, pregnancy, labor and childbirth, prenatal testing, and genetics. In cases of sexual assault, a nurse practitioner or registered nurse may perform the procedure. If a biopsy is performed, a pathologist examines the tissue samples under a powerful microscope in the laboratory and sends the results to the health care provider who, in turn, informs the patient of the results.
The large piece they took was very painfull upon removal and i almost swore at the doctor but did manage to thankfully keep it together throughout the procedure. Just glad its over for now, worrying time over the next few weeks for the results.
I know this is some of the symptoms of cervical cancer and it scares me to death,not sure if i should wait till dec or find out sooner,not sure if i really want to know.
I took 800mg of ibuprofen before the procedure, had 4 women in the room with me plus my fiancee.
I would rather have the biopsy than a pap smear with the brush ANY DAY!!!
I went back June 2011 for my yearly check up and my pap smear came back slightly abnormal. I was told to wait 6 months and have another pap smear. Go back December 5, 2011 for my second one. At that time the doctor said I had a slight yeast infection. My results this time come back highly abnormal and the doctor put me on a steroid to clear up the yeast infection. Told to wait several weeks and come back for a third pap smear. Went in January 5, 2012 for my third round and the doctor performed a Colposcopy and notice a white spot on my Viginal Cuff when she was performing the biopsy she tore a hole in Viginal Cuff and my bowel came through. She stated that my cuff was so thin and was not surprised that it had not torn during having sex. She tried to clean it up and stitch it put said I was in too much pain and schedule surgery that afternoon to stitch me up. She said she double stitch me and had another doctor come in and check to make sure that my bowel and intestines had not been punctured. I am back to restrictions no lifting, no squatting, and no bending down for 6 to 8 weeks.
My question is: Is this normal to have such a thin Virginal Cuff after my Hysterectomy and should this be a concern having sex later on? And if she knew my cuff was so thin, should she have done something different as for as doing the biopsy?
My doctor was able to tell me its not cancer (the 'white' bits werent big or dominant), but she wasnt able to tell me if I will need follow up surgery, or just checkups. Need to wait 2 months for that :(
All in all, Im just glad they caught it when they did and will go though any pain to make sure I am around for my 3 kids. Pain is worth it if you know you will not get the dreaded c word!
and also im really worried, i hope that i don't have cancer, I'm not really at ease at the moment since i went to my smear test, I started worryieng then until now.
WOW JUST GOT A PHN CALL MY APPOINTMENT NEXTWEEK AWESSM
Any advice??