Colposcopy and cervical biopsy

Normal:	The vinegar or iodine does not show any areas of abnormal tissue. The vagina and cervix look normal.
	A biopsy sample does not show any abnormal cells.
Abnormal:	The vinegar or iodine shows areas of abnormal tissue. Sores or other problems, such as genital warts or an infection, are found in or around the vagina or cervix.
	A biopsy sample shows abnormal cells. This may mean cervical cancer is present or likely to develop.

What To Think About?

Colposcopy is not usually used as a screening test for women at high risk for cervical cancer. A Pap test is done for that purpose. But a colposcopy gives you and your doctor more information if you have an abnormal result from a Pap test.
Sometimes only abnormal cervical biopsy results are reported back to the woman. Tell your doctor if you want to be informed of normal biopsy results.
If a colposcopy and cervical biopsy are normal, it is not likely that you have cell changes that can lead to cervical cancer.
Another biopsy may be needed if a Pap test, colposcopy, and cervical biopsy show different results. In some cases, a larger biopsy area, called a cone biopsy, is removed. Special tools, such as laser or a heated loop, can be used to remove a cone-shaped wedge of normal and abnormal tissue from the cervix. A cone biopsy may treat the problem because all of the abnormal tissue is removed. Your doctor will give you more instructions if a cone biopsy is needed.
Women with human immunodeficiency virus (HIV) have a higher chance of developing cervical cancer. A colposcopy is recommended for all women with HIV and an abnormal Pap test.
Article Source: 

 http://health.yahoo.com/women-gyn/colposcopy-and-cervical-biopsy/healthwise--hw4205.html

Recovery

If you have a colposcopy without a biopsy, you should feel fine right away. You can do the things you normally do. You may have a little spotting for a couple of days.
If you have a colposcopy with a biopsy, your vagina may feel sore for 1 or 2 days. You may have some vaginal bleeding. You also may have a dark discharge for a few days. This may occur from medication used to help stop bleeding at the biopsy site. You may need to wear a sanitary pad until the discharge stops.
Your doctor may suggest you limit your activity for a brief time. While the cervix heals, you will be told not to put anything into your vagina for a short time:

  ·Do not have sex.
  ·Do not use tampons.
  ·Do not douche.
  Call your doctor right away if you have any of these problems:
  ·Heavy vaginal bleeding (using more than one sanitary pad per hour)
  ·Severe lower abdominal pain
  ·Fever
  ·Chills

Following treatment to get rid of abnormal cells in the cervix, you may have pain similar to period pain as the anaesthetic wears off. Taking mild painkillers should help this.
If abnormal cells have been removed by loop excision, you will have a bloodstained vaginal discharge for about 2 weeks, although it can last for 4-6 weeks. The discharge should not be heavier than your normal period and should get progressively lighter. If you are worried this is not the case, ask your GP for advice.
Following a cone biopsy, gauze may be packed into your vagina to prevent bleeding, but it is normal to bleed for up to 4 weeks following the operation. You should rest for the first week after the operation (although you don't have to stay in bed), and avoid having sex or doing hard exercise for 4 to 6 weeks.
Article Source: 

 http://www.acog.org/publications/patient_education/bp135.cfm

Finally...

A Pap test is a good way to find cervical changes that could become cancer. Colposcopy gives more information if a Pap test result is abnormal. Talk with your doctor about the results of your colposcopy and biopsy. Article Source:  
 http://www.acog.org/publications/patient_education/bp135.cfm

Glossary

Biopsy: A minor surgical procedure to remove a small piece of tissue that is then examined under a microscope in a laboratory.
Cervix: The opening of the uterus at the top of the vagina.
Pap Test: A test in which cells are taken from the cervix and vagina and examined under a microscope.
Polyps: Benign (noncancerous) growths that develop from membrane tissue, such as that lining the inside of the uterus.
Speculum: An instrument used to hold apart the walls of the vagina so that the cervix can be seen.
Vagina: A passageway surrounded by muscles leading from the uterus to the outside of the body; also known as the birth canal.
Article Source:

 http://www.acog.org/publications/patient_education/bp135.cfm

What It's Used For

Doctors use colposcopy to check for cervical cancer or precancerous changes after an abnormal Pap test or as a follow-up procedure to view an abnormal area seen during an earlier gynecological examination. During the exam, your doctor can remove a sample of tissue from the cervix for testing (biopsy). Article Source: 
 http://www.intelihealth.com/IH/ihtIH/E/9339/31384.html

Preparation

Your doctor may ask you not to take aspirin for a week before the procedure. Don't douche or use vaginal creams or medications the day before the procedure. Because you will need to remove your clothing from the waist down, consider wearing a two-piece outfit with slacks or a skirt. Also, because you may have some mild vaginal bleeding in case the doctor performs a biopsy, bring a sanitary napkin to wear after the procedure.
Be sure to tell your doctor about all of the medications you take. It is also very important to let your doctor know if you may be pregnant. Do not stop using birth control prior to the procedure.
Because heavy menstrual bleeding may make it difficult for your doctor to see inside the vagina, plan your procedure for a time other than your monthly period.

Tell your doctor if you:
Are or might be pregnant. A blood or urine test may be done before the colposcopy to see whether you are pregnant. Colposcopy is safe during pregnancy. If a cervical biopsy is needed during a colposcopy, the chance of any harm to the pregnancy (such as miscarriage) is very small. But you may have more bleeding from the biopsy. A colposcopy may be repeated about 6 weeks after delivery.
Are taking any medicines.
Are allergic to any medicines.
Have had bleeding problems or take blood thinners, such as aspirin or warfarin (Coumadin).
Have been treated for a vaginal, cervical, or pelvic infection.
Do not have sexual intercourse or put anything into your vagina for 24 hours before a colposcopy. This includes douches, tampons, and vaginal medicines. You will empty your bladder just before your colposcopy.
You may want to take a pain reliever, such as ibuprofen (Advil or Motrin), 30 to 60 minutes before having a colposcopy, especially if a biopsy may be done. This can help decrease any cramping pain that can be caused by the colposcopy.
Schedule your colposcopy for when you are not having your period. Heavy bleeding makes it harder for your doctor to see your cervix. The best time to schedule a colposcopy is during the early part of your menstrual cycle, 8 to 12 days after the start of your last menstrual period.
You will need to sign a consent form that says you understand the risks of colposcopy and agree to have the colposcopy done. Talk to your doctor about any concerns you have regarding the need for the colposcopy, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form(What is a PDF document?).Preparing for a colposcopy is simple.
Schedule your colposcopy procedure for when you will not have your period.
You may want to take an over-the-counter pain reliever about an hour before the exam to reduce the chance of discomfort. Ask your health care provider in advance to recommend a pain reliever.
Do not douche, use tampons, put medications in your vagina, or have vaginal intercourse for at least 24 hours before the procedure.

There is not much you will have to do in order to prepare for a colposcopy. Some health professionals will not want to carry out a colposcopy if you are menstruating (having your period) because it may make it more difficult to accurately assess the cells in your cervix.

If your period starts when you are due to have your colposcopy, call the clinic where you are due to have the procedure in order to see whether it will need to be rescheduled.

If you feel nervous, or concerned, about your colposcopy you can bring a friend, or relative, with you, to help you feel more at ease. Some clinics will allow your friend, or relative, to stay with you during the procedure if you want.

Some women experience some mild discharge following a colposcopy, so you might want to bring a sanitary towel with you.

In the 24 hours prior to your colposcopy you should avoid:

• using a tampon,

• using vaginal creams, or pessaries (medication inserted into the vagina), and

• having sex.

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).
Article Source: 

 http://www.intelihealth.com/IH/ihtIH/E/9339/31384.html

During the colposcopy

A nurse will help you into position on a special type of couch. The couch has padded supports for your legs. During the procedure, you will lie on your back with your knees drawn up and your legs apart.
An instrument known as a speculum will be gently inserted into your vagina, which widens the opening of the vagina, allowing your doctor, or specialist nurse, to access your cervix. A speculum is the same instrument that is used during a cervical screening test.
Your doctor, or specialist nurse, will use a colposcope(colposcopic,a colposcopy,colposcopes) to look at your cervix. A colposcope is a magnifying instrument that has a light source attached to it, and is similar in appearance to a pair of binoculars. The colposcope(colposcopic,a colposcopy,colposcopes) will not touch you, or go inside you. It simply allows your doctor, or specialist nurse, to get a closer look at the cells inside your cervix.
Several different substances will be applied to your cervix. These substances will help to identify abnormal cells because any abnormal cells will show up as a different colour.
If abnormal cells are found, a small tissue sample (biopsy) may be taken from your cervix. This should not cause you any pain, although you may feel a slight stinging sensation. If necessary, you may be given a local anaesthetic in order to numb the area from which the biopsy will be taken.
It will usually take up to 20 minutes for the investigation of your cervix to be carried out.
Article Source: 

 http://www.nhs.uk/Conditions/Colposcopy/Pages/How-is-it-performed.aspx

Treating abnormal cells in the cervix

If the results of your colposcopy show that you have abnormal cells in your cervix, you may require treatment. The aim of treatment is to remove the abnormal cells, while minimising any damage to healthy tissue.
When will my treatment be carried out?
It may be possible for you to have treatment at the same time as your colposcopy. This may be more convenient for you rather than having to make another appointment.
Some women find that waiting for treatment causes anxiety, and they prefer to have the treatment as soon as possible. Others prefer to have some time to think about their treatment. If this is the case, you may wish to schedule your treatment for another time.
Some types of treatment that are more intensive cannot be carried out on the same day as a colposcopy. Your doctor will advise you about when your treatment should be carried out, and they will always discuss any treatment with you before it is given.
What treatments are available?
The treatment that you receive will depend on how many abnormal cells you have in your cervix, and how advanced the abnormalities are. Some of the treatments available are outlined below.
Large loop excision of the transformation zone (LLETZ)
In the UK, large loop excision of the transformation zone (LLETZ) is the most common form of treatment for abnormal cervical cells. It involves cutting out the area of the cervix where the abnormal cells have developed. This is done using a thin wire loop that is heated with an electric current. The loop is then used to cut away tissue and to seal the wound at the same time.
LLETZ is carried out under local anaesthetic, and the procedure normally only takes between 5-10 minutes. Sometimes it can be carried out at the same time as a colposcopy. If a larger area of the cervix needs to be treated, you may require a general anaesthetic, and the procedure will take longer.
LLETZ is not usually painful, but you may experience pain similar to period pain. You may also have light bleeding, or discharge, for several weeks after the procedure.
Cone biopsy
A cone biopsy will not be able to be performed at the same time as your colposcopy. It is a minor operation which, in most cases, requires an overnight stay in hospital.
A cone of tissue is cut away from your cervix. The section of tissue that is taken should include the whole area of cervix where the abnormal cells are. The tissue can then be sent to a laboratory for further testing.
Following a cone biopsy, you may need to have gauze packed into your vagina in order to help to stop any bleeding. If you do require a gauze pack, you may also need to have a catheter (a thin tube which drains urine from your bladder) because the pack usually presses on your bladder and urethra.
It is normal to have bleeding for up to four weeks after a cone biopsy. You may also experience some period-like pain.
You should try to rest during the first week after a cone biopsy. Although you will not need to stay in bed, you should avoid tasks such as heavy lifting. You will also need to avoid vigorous exercise, and should not have sex during the first 4-6 weeks following your biopsy. After this time, the tissue in your cervix should have healed.
Other treatments
There are several other ways of removing abnormal cells from your cervix. Your doctor will be able to advise you about which type of treatment is the most suitable for you. Some of the other treatments are listed below.
Cryotherapy - this is when the abnormal cells in the cervix are frozen and destroyed.
Laser treatments - lasers are used to pinpoint and destroy abnormal cells in the cervix. If necessary, a laser can also be used to remove a small piece of the cervix itself.
Cold coagulation - this procedure involves applying a heat source to the cervix which burns away and removes the abnormal cells.
You will always be given a local anaesthetic before having any of the treatments described above.
Article Source:  

 http://www.nhs.uk/Conditions/Colposcopy/Pages/Treatment.aspx

Treatment

If the colposcopy shows up abnormal cells, it is common for the doctor or nurse to carry out further treatment at the same time if you are happy for them to do so. In other cases, it is necessary to wait for the biopsy results before deciding on treatment.
Types of treatment vary, but all aim to destroy or to remove the abnormal cells. Although the treatments may sound unpleasant, you shouldn't experience anything worse than a period-type pain while it is carried out. You will be able to go home straight afterwards.
Cold coagulation: A source of heat is applied to the cervix to burn away the abnormal cells.
Cryocauter: Cells are frozen to remove them.
Loop excision: Abnormal cells are cut out using a heated wire with an electrical current running through it. The cells can be examined later under a microscope.
Laser: A laser beam is applied to the cervix and can either simply destroy some cells or be used to remove a small piece of the cervix.
Along with loop excision, cone biopsy and hysterectomy are two further ways of completely removing whole sections of the cervix, although these types of treatment are less common.
Treatments that remove the cells alone allow normal cells to grow back in their place. These treatments can be performed at an outpatients clinic and do not usually require an anaesthetic.
Article Source: 
 http://www.cks.nhs.uk/patient_information_leaflet/colposcopy

Morbidity and mortality rates

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. Article Source: 
 http://www.surgeryencyclopedia.com/Ce-Fi/Colposcopy.html

Alternatives

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) Article Source: 
 http://en.wikipedia.org/wiki/Cervical_cancer

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

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. Article Source: 
 http://www.surgeryencyclopedia.com/St-Wr/Vagotomy.html

Should I have colposcopy if my Pap test shows minor cell changes?

·Get the facts
·Compare your options
·What matters most to you?
·Where are you leaning now?
·What else do you need to make your decision?
1. Get the facts
Your options
Have colposcopy.
Don't have colposcopy. Instead, have a follow-up Pap test in about 6 months or get an HPV (human papillomavirus) test to see if you have a type of HPV that can increase your risk of getting cervical cancer.
Key points to remember
Most minor cell changes go away on their own and don't cause problems. And they are not usually cancer.
You may decide to wait and have another Pap test in about 6 months to see if the changes have gone away. More severe changes aren't likely to occur during a short period of watchful waiting.
If you're not comfortable waiting, you may decide to have colposcopy. This test allows your doctor to take a closer look at the abnormal cells and find out if treatment is needed.
Minor cell changes may be caused by HPV infection. You can get an HPV test—if you haven't already had one—to find out if you have a type of HPV that can increase your risk of getting cervical cancer. If you have one of these types, colposcopy is recommended.
2. Compare your options
　

	Have colposcopy	Don't have colposcopy
What is     usually involved?	You lie on your back with your feet raised and supported by footrests while your doctor uses a magnifying device called a colposcope to look at your vulva, vagina, and cervix. Photos or videos of your vagina and cervix may be taken. If your doctor sees a problem, he or she will take a small piece of tissue (biopsy) from your cervix to check for problems. You may feel some discomfort and mild cramping, but colposcopy usually isn't painful. During a biopsy, you may feel a brief, sharp pain or have some cramping. Colposcopy and a cervical biopsy can be done in your doctor's office.	You have a follow-up Pap test in about 6 months or as often as your doctor suggests to see if the abnormal cells have returned to normal. You may have an HPV test to see if minor cell changes are caused by a type of HPV that can cause more severe cell changes and cervical cancer.
What are the benefits?	Colposcopy and a cervical biopsy can: Let you know right away if there is a more serious problem and whether you may need treatment. Show abnormal cells that can't be seen by the naked eye. Detect cervical cancer. Help rule out cervical cancer.	You avoid the cost of colposcopy. You avoid the risks of having colposcopy and a cervical biopsy. The abnormal cells may return to normal on their own. If you start to worry and don't want to wait any longer, you can decide later to have colposcopy.
What are the risks and side effects?	Possible side effects after a cervical biopsy include: Vaginal bleeding and discharge. Soreness. Infection. But this is very rare.	Minor cell changes may become more severe. If you don't have colposcopy, you won't know right away if the cell changes may be the kind that are more likely to turn into cancer and that need to be treated.

Article Source: 

 http://www.questdiagnostics.com/kbase/dp/topic/aa66808/dp.htm

What are your choices after a Pap test shows minor cell changes?

All abnormal Pap tests require some kind of follow-up to be sure that the cell changes haven't gotten worse or have returned to normal.
If you have atypical squamous cells of undetermined significance (ASC-US) cell changes, there are several follow-up options you can choose from. Most of the time, ASC-US cell changes stay the same or return to normal on their own. Women with ASC-US changes are not likely to get cervical cancer.
Your choices of what to do next include:
Watchful waiting with a follow-up Pap test in about 6 months or as often as your doctor suggests. More severe cell changes aren't likely to occur during this time. More than half of all minor cell changes return to normal on their own.
An HPV test —if you haven't already had one—to find out if you have a type of HPV that can increase your risk of getting cervical cancer. If you already had this test during your initial Pap test, your doctor can tell you the results. If you don't have a high-risk type of HPV, no further testing is recommended. But if you have a high-risk type of HPV:
Colposcopy is recommended to see how severe the cell changes are.
It doesn't mean that minor cell changes will progress to cancer, because HPV infections can go away on their own.
Colposcopy if you:
Are not comfortable waiting and want to know right away if you may need treatment.
Have certain risk factors, such as a high-risk type of HPV infection or a weakened immune system.
Are not able to return for a follow-up Pap test.
If you're pregnant and have ASC-US cell changes, your choices are the same as those for women who aren't pregnant.
Article Source:

 http://www.questdiagnostics.com/kbase/dp/topic/aa66808/dp.htm

Who may not need colposcopy?

Most of the time, colposcopy is not advised for:
Women who have gone through menopause, because a natural decrease in estrogen levels is likely to cause minor cell changes.
Teenage girls, because minor cell changes and HPV infection are more likely to go away on their own. And it's very rare that girls this age get cervical cancer.
Instead, a period of watchful waiting and repeat Pap tests are tried first. Articel Source: 
 http://www.questdiagnostics.com/kbase/dp/topic/aa66808/dp.htm

What are the side effects or risks of colposcopy?

Colposcopy is usually not painful, but it may cause some mild cramping. The tool (speculum) used to spread open your vagina is in place longer than during a routine pelvic exam. This may cause some discomfort.
A biopsy may be done at the time of colposcopy. You may feel a brief, sharp pain or have some cramping while this is done.
After the test you may:
Have vaginal bleeding and discharge.
Be sore.
Get an infection. But this is very rare.
Article Source:

 http://www.questdiagnostics.com/kbase/dp/topic/aa66808/dp.htm

Why might your doctor recommend colposcopy?

Your doctor may recommend colposcopy if:
You have had two abnormal Pap tests in a row that show atypical squamous cells of undetermined significance (ASC-US) cell changes.1
You have ASC-US cell changes and certain risk factors, such as a high-risk type of HPV infection or a weakened immune system.1
You're not comfortable waiting and want to know right away if you may need treatment.
Article Source: 
 http://www.questdiagnostics.com/kbase/dp/topic/aa66808/dp.htm

How do I take care of myself after the procedure?

Your medical provider may have applied a medication to the biopsy site(s) to stop any bleeding. Do not be alarmed by a brownish-black vaginal discharge. This is due to the medication and is to be expected. It may last up to 1 week.
It is common to have some spotting similar to the spotting that occurs during the last 2 days of your menstrual period. This discharge is from the biopsy site(s) and will stop when healing is complete (usually within 4 to 7 days).
Call your medical provider if the following occurs:
Bleeding greater than one sanitary napkin/hour
Spotting longer than 7 days
Bright red bleeding
Temperature greater than 100 degrees F
To allow the cervix to heal:
No sexual activity or douching while spotting or as directed by the gyn specialist.
When healing is complete, sexual activity may be resumed with preferred method of STI prevention and/or birth control. If you take birth control pills, continue your daily schedule without interruption during this healing process.
Use sanitary pads rather than tampons for any spotting or if your menstrual period should begin during the healing process (4 to 7 days).
Article Source:

http://brown.edu/Student_Services/Health_Services/Health_Education/womens_health/colposcopy.php

Can I get a colposcopy at Health Services?

Your medical provider may have applied a medication to the biopsy site(s) to stop any bleeding. Do not be alarmed by a brownish-black vaginal discharge. This is due to the medication and is to be expected. It may last up to 1 week.
It is common to have some spotting similar to the spotting that occurs during the last 2 days of your menstrual period. This discharge is from the biopsy site(s) and will stop when healing is complete (usually within 4 to 7 days).
Call your medical provider if the following occurs:
Bleeding greater than one sanitary napkin/hour
Spotting longer than 7 days
Bright red bleeding
Temperature greater than 100 degrees F
To allow the cervix to heal:
No sexual activity or douching while spotting or as directed by the gyn specialist.
When healing is complete, sexual activity may be resumed with preferred method of STI prevention and/or birth control. If you take birth control pills, continue your daily schedule without interruption during this healing process.
Use sanitary pads rather than tampons for any spotting or if your menstrual period should begin during the healing process (4 to 7 days).
Article Source:

http://brown.edu/Student_Services/Health_Services/Health_Education/womens_health/colposcopy.php

Can I get a colposcopy at Health Services?

Health Services does not offer colposcopy services. If you need a colposcopy, your Health Services medical provider will refer you to a local GYN office for the procedure. Article Source: 
http://brown.edu/Student_Services/Health_Services/
Health_Education/womens_health/colposcopy.php

When is it recommended?

Colposcopy is generally recommended for women who have had an abnormal pap smear. Most commonly, a diagnosis of atypical cells on the cervix has been made, requiring a closer look at the cervix. Persistent high risk types of HPV on the cervix may also require colposcopy. It is also suggested for DES-exposed daughters as a screening test or to follow those women who show DES-related changes.
Occasionally, during a pelvic examination an irregularity in the cervix or vaginal wall is noted that requires colposcopic examination. Any condition that required colposcopic examination in the past may call for a follow-up examination at future intervals suggested by your provider. It is also possible that your Pap smears will be done more frequently over the next year or more to ensure that your problem remains under control.                                                                                  Article Source:

http://brown.edu/Student_Services/Health_Services/Health_Education/womens_health/colposcopy.php

The Colposcopic Examination Step-by-Step

It is important to explain the examination procedure and reassure the woman
before colposcopy. This will ensure that the woman relaxes during the
procedure.
Written informed consent should be obtained from the woman before the
colposcopic examination.
Relevant medical and reproductive history should be obtained before the
procedure.
A strict adherence to the essential steps involved in colposcopic
examination ensures that common errors are avoided.
It is important to visualize the squamocolumnar junction in its entire
circumference, otherwise, the colposcopic procedure is termed
‘unsatisfactory’.
One should identify the transformation zone (TZ) during the colposcopic
procedure. The proximal limit of the TZ is defined by the squamocolumnar
junction, while the distal limit of the transformation zone is identified by
finding the most distal crypt openings or nabothian follicles in the lips of
the cervix and by drawing an imaginary line connecting these landmarks.
It is essential to obtain directed biopsies, under colposcopic control, from
abnormal/-suspicious areas identified. Colposcopy during pregnancy requires
considerable experience. As pregnancy progresses, cervical biopsy is
associated with increased probability and severity of bleeding, which is
often difficult to control. The risk of biopsy should always be weighed
against the risk of missing an early invasive cancer. Non-invasive lesions
may be evaluated post-partum.
The steps involved in colposcopic examination to identify cervical neoplasia
are described in detail in this chapter. A strict adherence to this
examination protocol ensures that common errors in colposcopic practice are
avoided to a large extent. It is advised that students should have
thoroughly reviewed the anatomical and pathophysiological basis of
colposcopic practice described in the previous chapters before going any
further.

Practise first on inanimate objects
The colposcope(colposcopic,a colposcopy,colposcopes) can be thought of as an extension of the clinician’s visual
sense; as such, with practice, it should become a familiar tool rather than
an impediment - a part of the colposcopist’s body, so to speak. When one is
learning colposcopy, it is helpful to become familiar with the equipment
that one will be using. It is a good idea to practise focusing on inanimate
objects (such as apples, oranges, flowers, small bottles with labels, etc.)
in the examining room, using different light intensities and magnifications,
with and without the green and/or blue filter.
Two adjustments may be required to personalize the instrument for use. The
instrument should be adjusted to suit the interpupillary distance of the
colposcopist to achieve stereoscopic vision by altering the separation
between the two ocular lenses (eyepieces). The eyepieces should be kept wide
open initially. If when looking through the colposcope(colposcopic,a colposcopy,colposcopes), one can see two
separate fields of vision, the eyepieces should be brought closer until the
two fields merge to give a stereoscopic binocular vision. The eyepieces can
also be adjusted to compensate for variation in an individual colposcopist’
s vision by changing the focus of each ocular lens, which can be matched to
the correction required (+ or - dioptres), if any, by using the dioptre
scale on the side of the eyepieces. This is achieved by looking through the
right eyepiece with the left eye closed and moving the colposcope(colposcopic,a colposcopy,colposcopes) and by
tuning the fine focus using the fine focus handle so that the image comes
into focus. Without moving the colposcope(colposcopic,a colposcopy,colposcopes), and closing the right eye, the
left eyepiece should then be turned slowly until the image comes into focus.
Now the instrument has been adjusted to suit the individual’s vision. Those
with normal eyesight or eyesight corrected by glass need not do any
correction of dioptre setting.
One method of practising colposcopic biopsy technique on an inanimate object
involves using a piece of pipe that matches the diameter and length of the
vagina (about 5 cm wide and 15 cm long) and a foam rubber ball that can be
cut into sections and wedged into the distal end of the pipe. Typewriter
correction fluid or similar paint can be used to simulate lesions on the
surface of the foam rubber. These painted lesions form the targets with
which to practise colposcopy. This avoids the problem of procuring animal
tissues on which to practise and the attendant problems of storing and
cleaning them up. Biopsies should be done under colposcopic visualization
whenever possible, so the biopsy technique should be learned using the
colposcope(colposcopic,a colposcopy,colposcopes). Whenever possible the student should be under the supervision of
an instructor who is experienced in colposcopy and, if possible, has taken a
training course. Interactive learning, based on actual patients, will
accelerate the learning curve. In practice sessions, it is worthwhile
learning to use colposcopy assessment forms (see Appendix 1) to document the
findings and the location where a biopsy has been taken.

Steps in the colposcopic examination
Many authors have provided good advice about the proper way to conduct a
colposcopic examination ( Campion et al., 1991; Cartier & Cartier, 1993;
Coppleson et al., 19.3; Soutter 1993; Wright et al., 19.5; Anderson et al.,
1996; Burghart et al., 1998; Singer & Monaghan 2000). Though there are
different schools of thought and practice of colposcopy, the approach
discussed in this manual is based on the classical or extended colposcopy
technique.
Colposcopists often form their own judgements regarding what they believe is
essential to the colposcopic examination, and discard much of what they deem
not to be useful. It seems that colposcopic practice is somewhat flexible in
content and the order of performance of different steps may vary in
different settings, since circumstances change according to cultural and
other contextual settings in which colposcopy is conducted worldwide.
However, we recommend that the following steps be carefully followed during
the learning phase, as well as during routine colposcopic practice. Wherever
possible, we have given the reason for each step. Often the evidence for the
value of each step will come with experience. The evaluation of normal and
abnormal colposcopic findings is given in Chapters 6 to 9.

Explain the procedure to the woman
Women referred to a colposcopy clinic may not have had the procedure
explained to them in detail before their arrival. For literate women,
pamphlets on what an abnormal cervical cytology or other screening test
means and an explanation of the colposcopic examination may be helpful. It
is important for all women to have a prior explanation of the procedure and
reassurance by the clinic nurse or the colposcopist. Colposcopic examination
may prove difficult and yield suboptimal results if the woman does not relax
during the procedure. Privacy during the consultation and examination is of
utmost importance.

Obtain informed consent
After the procedure has been explained to the woman, written informed
consent should be obtained, before colposcopy. The written consent form
should include information about the colposcopic examination and the usual
procedures that may accompany it, such as biopsy, endocervical curettage and
photography, and summarize the usual complications (less serious and more
frequent ones, as well as more serious but less frequent ones) that may
occur. An example of a written informed consent form is given in Appendix 2.
It may be preferable to obtain informed consent each time, if a woman
requires subsequent colposcopic examinations.
Treatment for a colposcopically confirmed cervical intraepithelial neoplasia
(CIN) may be planned during the same visit as colposcopy, to minimize the
number of visits and to ensure compliance with treatment, as women may not
be willing (for a variety of reasons) to make a subsequent visit to complete
treatment. An ablative treatment like cryotherapy (see Chapter 12) may be
planned after directing a biopsy during colposcopy (so that histopathology
results for the treated lesion will be available at a later date). On the
other hand, an excisional treatment such as loop electrosurgical excision
procedure (LEEP) (see Chapter 13) will produce a tissue specimen that will
help to establish the pathological nature of the lesion treated. If such an
appproach to treatment immediately after colposcopy in the same visit is
planned, the informed consent process should deal with treatment issues as
well. The possible consequences of this approach in terms of overtreatment
or unnecessary treatment, as well as the potential side-effects and
complications of the treatment procedure, should be explained before
obtaining the informed consent.

Obtain a relevant medical history
The woman’s medical history is usually taken after her written informed
consent has been obtained. Most women are referred after a screening
examination and it is ideal to have the result of the screening test
available at the time of colposcopic examination. If the woman has been
referred because of abnormal cytology results, it is ideal to have a written
copy of the previous smear(s) on hand at the time of the colposcopy
appointment. Relevant obstetric and gynaecological history and history of
any relevant exposures (e.g., number of pregnancies, last menstrual period,
history of oral contraceptive use, hormonal supplements, sexually
transmitted infections, etc.) should be obtained and recorded with the aid
of a form designed for this purpose. It is important to enquire about the
last menstrual period in order to assess the possibility of pregnancy or
menopause.

Insert the vaginal speculum and inspect the cervix
The woman should be in a modified lithotomy position on an examining table
with heel rests, or stirrups or knee crutches. It is preferable to place the
buttocks slightly over the end of the table. It is important to ask the
woman to relax. Positioning the buttocks in this way makes it much easier to
insert the speculum and to manipulate it in different axes, if needs be. An
instrument tray with essential instruments for colposcopy is placed beside
the couch (Figure 4.3). A medium-size bivalve speculum (Cusco, Grave, Collin
’s or Pedersen’s) is usually adequate. Warm, clean water on the speculum is
the preferred lubricant, as it warms the metal, but does not interfere with
the interpretation of cervical specimens, such as a cytology smear. If the
woman has extremely lax vaginal walls, a lateral vaginal side-wall retractor
(Figure 4.5) or a latex condom on the speculum (with the tip of the condom
cut 1 cm from the nipple) is helpful (Figure 4.9). Particular care should be
taken to align the blades of the vaginal side-wall retractor perpendicular
to the vaginal speculum to prevent vaginal pinching. The skills for this
manoeuvre come with practice. In very obese women, it may be preferable to
use two Sim’s specula to retract the anterior and posterior vaginal walls.
Once the speculum is inserted and the blades are widely separated, a good
view of the cervix and the vaginal fornices is obtained. This may also
result in some eversion of the lips of the multiparous cervix, allowing the
lower portion of the endocervical canal to come into view. After exposing
the cervix, one should assess the nature of the cervico-vaginal secretions
and note any obvious findings such as ectropion, polyp, nabothian follicles,
congenital transformation zone, atrophy, inflammation and infection,
leukoplakia (hyperkeratosis), condylomata, ulcer, growth and any obvious
lesions in the vaginal fornices. Following this, excess mucus should be
removed gently from the cervix with saline-soaked cotton swabs. Swabbing
with dry cotton balls is discouraged, as these may induce traumatic bleeding
and subepithelial petechiae. Loss of epithelium and bleeding due to rough
and traumatic manipulation of the speculum and swabs should be avoided.

Obtain a cervical cytology smear, if necessary
It is likely that the woman has been referred because of an abnormal
cytology result; it is, therefore, debatable whether a repeat smear is
necessary in such instances. On the other hand, if the colposcopist is
interested in the results of a repeat cytology test, the cervix should be
sampled for the smear before the application of any solution, such as acetic
acid. Sometimes the process of taking a smear will cause bleeding, but this
usually subsides gradually after acetic acid is applied.
Obtain specimens for laboratory examination, if necessary
Any necessary swab for screening or diagnostic work-up because of suspicious
signs or symptoms should be done at this stage. For example, a swab for
Neisseria gonorrhoeae culture can be obtained from the endocervical canal or
pus in the vaginal fornix, and a Chlamydia trachomatis specimen can be
obtained from the endocervical canal after excessive mucus has been removed.
If an ulcerative lesion is found on the vagina or cervix or on the external
anogenital area, the colposcopist should consider the possibility of one or
more sexually transmitted infections as the cause and the appropriate work
up should be performed. If a sample is required to test for example for
human papillomavirus (HPV), the cervical cells should be obtained before
application of acetic acid.
Following this, the cervix should be inspected at low-power magnification
(5x to 10x), looking for any obvious areas of abnormality (e.g.,
leukoplakia).

Apply normal saline solution
Normal saline is applied to the cervix with a sprayer or cotton balls and
excess liquid is removed afterwards. This is not only the ideal way to
conduct a preliminary inspection for surface abnormalities (e.g.,
leukoplakia, condylomata), but also the best way to examine the detail of
cervical capillaries and surface blood vessels. The examination of the blood
vessels is further aided by using the green (or blue) filter on the
colposcope(colposcopic,a colposcopy,colposcopes) to enhance the contrast of the vessels, and by using higher
levels of magnification (about 15x). Although some experienced colposcopists
do not routinely perform an examination after saline has been applied
(instead going directly to the application of acetic acid), it has been
argued that an examination should be done in all cases, since the
information obtained on the location of abnormal vessels can be noted and
integrated with the findings from later steps, which will determine the
appropriate biopsy site(s), if any. The application of acetic acid, and even
Lugol’s iodine solution, to the cervix can result in tissue swelling and
consequent opacity. This swelling and opacity tend to obscure some of the
details of the vessels in the subepithelial tissue, so it is always is best
to assess the capillaries and vessels with saline before the application of
any other solution. The other important task at this step is to identify the
distal and proximal borders of the transformation zone. The inner border is
defined by the entire 360-degree circumference of the squamocolumnar
junction. If the junction is proximal to the external os, in the canal, it
requires additional effort to visualize the entire junction. Opening the
blades of the vaginal speculum and using a cotton-tipped applicator to pry
the anterior lip up or the posterior lip down will often allow visualization
if the junction is close enough to the os. The endocervical speculum (Figure
4.6) or the lips of a long dissection forceps can also be used, and often
will allow a greater length of canal to be inspected. The skill for these
manoeuvres comes with practice. If the squamocolumnar junction is not
visualized in its entire circumference, the colposcopic procedure is termed
inadequate or unsatisfactory (see Chapter 6). The distal limit of the
transformation zone, namely the location of the original squamocolumnar
junction, may be identified by finding the most distal crypt openings or
nabothian follicles in the lips of the cervix and by drawing an imaginary
line connecting these landmarks (Figure 5.1).
figure 4.6: Endocervical speculum
FIGURE 5.1: A method of identifying outer and inner borders of the
transformation zone (SCJ: Squamocolumnar junction)

Apply acetic acid
This step may be carried out using 3-5% dilute glacial acetic acid. We
prefer to use 5% dilute acetic acid as the acetowhite changes may occur
faster and be more obvious than with a 3-4% solution. If white table vinegar
is used, it is usually 5% acetic acid, but it is preferable to confirm the
strength of the solution. The two main purposes of applying acetic acid are,
first, to conduct another inspection of the entire new squamocolumnar
junction and second, to detect and evaluate any areas of abnormal or
atypical transformation zone (ATZ). Acetic acid should be liberally applied
to the cervix with a cotton-tipped swab or cotton balls or using a 2 x 2
inches gauze or with a sprayer so that it covers the entire cervical
surface, including the external os.
Wiping the cervix a few times with a cotton ball or other large applicator
assists in the coagulation and removal of mucus, which in turn helps the
acetic acid to penetrate to the epithelium in full strength. The mucus in
the canal may be difficult to extract, but it can be easily and temporarily
pushed into the os with an acetic acid–soaked cotton swab, particularly if
it is obscuring the assessment of an important feature, such as the
squamocolumnar junction. In the latter case, the swab also helps to apply
the acid to the area of the squamocolumnar junction, which may be just
inside the os, and can also be used to manipulate the cervix to view
otherwise hidden areas of interest. Patience is required during this step
because the acetowhitening effect of acetic acid develops gradually over the
course of 60 seconds and the effect may fade afterwards. Hence, acetic acid
may be reapplied every 2 to 3 minutes during the examination. A swab may be
used to reapply, using the acetic acid pooled in the posterior aspect of the
vagina.

Apply Lugol’s iodine solution
Normal squamous (both original and mature metaplastic) epithelial cells
contain stores of glycogen that give a mahogany brown or nearly black stain
when an iodine-containing solution, such as Lugol’s, is applied. In
contrast, normal columnar epithelium does not contain glycogen and does not
take up the iodine stain. Similarly, immature squamous metaplasia,
inflammatory and regenerating epithelium and congenital transformation zone
contain very little or no glycogen and either do not or only partially stain
with iodine. Condylomata also either do not or only partially stain with
iodine. Abnormal transformation zones, such as those with CIN or invasive
cancer, contain very little or no glycogen. The degree of differentiation of
the cells in a preneoplastic squamous lesion determines the amount of
intracellular glycogen and thus the degree of staining observed. Therefore,
one would expect to see a range of staining from partially brown to mustard
yellow across the spectrum from low- to high-grade CIN. Usually high-grade
CIN takes up less of the stain, appearing as mustard or saffron yellow
areas. In the case of high-grade CIN, vigorous or repeated application of
iodine may occasionally peel off the abnormal epithelium and the underlying
tissue stroma may appear pale, as it lacks glycogen.
It is important always to integrate the findings of the saline, acetic acid,
and iodine tests to make a colposcopic assessment. The iodine test is also
very helpful for determining whether vaginal lesions are present.
Application of iodine will clearly delineate the borders of a lesion before
a biopsy, or treatment of the lesion, is attempted.

Perform cervical biopsies, if necessary
Once an abnormal transformation zone is detected, the area is evaluated and
compared with other areas of the cervix. If any other abnormal zones are
present, the colposcopist should then decide from where a biopsy or biopsies
should be taken. It is essential to obtain one or more directed punch
biopsies from areas colposcopically identified as abnormal and/or doubtful.
Biopsy should be obtained from the area of the lesion with worst features
and closest to the squamocolumnar junction. Biopsy always should be done
under colposcopic control by firmly applying the biopsy instrument (Figure
4.8), with the jaws wide open (Figure 5.2), to the cervical surface to be
sampled. The cervix may move back somewhat with this manoeuvre, but that is
normal.
To obtain a tissue sample, the biopsy forceps is guided under colposcopic
visualization to the area from which the tissue specimen is to be obtained.
The cervix may tend to slip away on pressure, but it is usually easy to
grasp and remove tissue if the forceps used for biopsy has wide and sharp
cutting edges, with one or two teeth to anchor the forceps while taking the
biopsy (Figure 5.2). A tenaculum may be also used to fix the cervix before
taking the biopsy. The jaws are then closed completely, and the specimen is
removed and immediately placed in formalin. The biopsy performed should be
deep enough to obtain adequate stroma, in order to exclude invasion. Cutting
the specimen should be carried out by quick and firm closure of the jaws.
Repeated cutting and rotation of the forceps should be avoided, as they can
crush the tissue sample. The procedure is usually painless if carried out
efficiently using a sharp and toothed biopsy forceps. A skin hook is
sometimes useful to anchor a potential biopsy site if it is difficult to
grasp with the biopsy instrument. After the biopsy has been obtained, it is
advisable to indicate the site of the target area which has been biopsied,
on the diagram of cervix in the reporting form. It is important to place the
freshly obtained biopsy specimen in a labelled bottle containing 10%
formalin. The biopsy site(s) may be cauterized with Monsel’s paste or with
a silver nitrate stick immediately after the procedure to control any
bleeding.
figure 4.8: Cervical punch biopsy forceps with sharp, cutting edges
figure 5.2: Biopsy technique: A toothed and sharp cutting biopsy forceps
should be used for biopsy. Firmly apply the biopsy punch onto the cervix
with the jaws wide open; fix the lower lip of the biopsy punch and close the
jaws completely. Cutting the specimen should be carried out by quick and
firm closure of the jaws. Repeated cutting and rotation of the forceps
should be avoided, as this can crush the tissue sample. The removed specimen
should be immediately placed in formalin. The biopsy site may be cauterized
with Monsel’s paste.

Apply Monsel’s paste after biopsy
It is usual practice to ensure haemostasis by applying Monsel’s (ferric
subsulfate) paste to the biopsy site. This is done by gently applying
pressure with a cotton-tipped applicator, the tip of which has been coated
with Monsel’s paste (see Appendix 3). Monsel’s solution is the most common
haemostatic agent used after cervical biopsy or excision, and it performs
well when it has a thick, toothpaste-like consistency. The paste-like
consistency may be produced by exposing the stock solution to the air in a
small container, which results in evaporation and thickening of the agent,
or using a microwave oven. The paste-like consistency may be preserved by
keeping the paste in a closed container and by adding small amount of Monsel
’s solution whenever it becomes dry and excessively thick.
A silver nitrate stick can also be used to cauterize a biopsy site. The
haemostatic action of these chemicals is much better if the chemical is
applied promptly, before bleeding begins, allowing direct contact of the
chemical with the tissue rather than with blood.

Perform endocervical curettage, if necessary
There are three commonly encountered circumstances, in which an endocervical
curettage (ECC) should be performed using an endocervical curette (Figure
4.7). First, if the colposcopic examination of the ectocervix has not
revealed any abnormality, yet the woman has been referred because of a
cytological abnormality, an ECC should be performed to properly evaluate the
endocervical canal, which may contain a hidden invasive cancer or other
lesion. Second, if the referral cytology indicated that a glandular lesion
may be present, an ECC should be performed (regardless of the findings of
the colposcopic examination). Third, an ECC should be performed if the
colposcopic examination has been unsatisfactory (whether or not a cervical
lesion has been detected). However, it should be mentioned that the yield of
an ECC is very low in inexperienced hands, as it is frequently associated
with inadequate tissue sampling. Thus, in such situations, a negative ECC
should not be taken as unequivocal evidence of the absence of neoplasia in
the endocervical canal.
In the above three situations, and particularly in the case of an acetowhite
lesion extending into the canal, it may be prudent to excise the cervix with
a cone (by LEEP or cold knife conization, as appropriate; see Chapter 11 and
Chapter 13). However, this approach places a large work load on
histopathology services and, as such, may not be feasible in several sub-
Saharan African countries and other developing regions with extremely
limited or even no histopathology services. In the assessment of women in
such settings, it is left to the discretion of the colposcopist to decide
whether an ECC and/or cone biopsy should be performed. Due to the risk of an
adverse effect on pregnancy outcome, ECC is absolutely contraindicated in
pregnant women.
Before ECC is performed, the posterior fornix must be dry to avoid the loss
of curetted tissue in the acetic acid solution which accumulated during its
application on the cervix. When performing ECC, the colposcopist holds the
curette like a pen and scrapes the endocervical canal in firm, short, linear
strokes until it has been completely sampled. During the procedure the
curette should remain in the canal. When extracting the curette, care should
be taken to twirl it in order to encourage the contents of the curette
basket to remain trapped therein. The curettings should be put onto a piece
of either gauze or brown paper, and then promptly placed into formalin. Any
residual tissue can be removed from the canal with forceps. In order to
avoid the potential confusion of inadvertently sampling a visible lesion on
the ectocervix or including residual tissue from an ectocervical biopsy in
the neighbourhood of the external os in the endocervical curette specimen,
some colposcopists perform ECC under colposcopic control, before obtaining a
cervical biopsy.
figure 4.7: Endocervical curette
Inspect vaginal walls, vulva, perineum, and perianal areas
As the speculum is withdrawn, the vaginal walls and, subsequently, the
vulvar, perineal, and perianal epithelium should be inspected. The surfaces
are bathed with acetic acid and after one or two minutes the acetowhite
areas are noted and evaluated. There is no general agreement on whether
these areas should be routinely examined in this fashion, but it seems
sensible, given that the examination adds very little time and effort, and
that HPV has a propensity to infect these areas and cause intraepithelial
lesions, most of which are treatable.

Bimanual and rectal examination
Some practitioners believe that bimanual and rectal examination should be
performed before colposcopy, some believe that it should be done after, and
some do not include it as a part of the normal colposcopy clinic protocol.
If it is performed before colposcopy, only water should be used as a
lubricant. Despite this lack of agreement, bimanual and rectal examination
can provide information about the orientation of the axis of the vaginal
canal before insertion of the vaginal speculum, and it allows palpation of
the cervix to detect signs of nodularity or hardness and masses in other
pelvic structures, such as the ovaries and uterus. It has been argued that
knowledge of other abnormalities, such as sizeable uterine fibroids, can
play a role in planning the best therapy for a woman.

Explain the findings to the woman
After the woman has dressed, carefully explain the examination findings and
offer her the opportunity to ask questions. Review the management plan,
emphasize the importance of adequate follow-up, and discuss any barriers to
compliance.

Document the findings
The findings of the colposcopic examination should be recorded with the aid
of appropriate forms that are filed in such a way as to be easily
retrievable.

If the woman is pregnant
The effects of pregnancy on the cervix are oedema, an increase in the area
of the epithelium, enlargement and opening of the os, and eversion. As
pregnancy progresses, these changes are exaggerated, so that an inadequate
examination at the beginning of pregnancy may become adequate by a later
stage due to eversion. Certain difficulties in examination, however, become
more pronounced as pregnancy progresses: the vaginal walls tend to be
redundant and collapse, obscuring the view; cervical mucus is increased;
increased vascularity leads to easily induced bleeding; the blood vessel
pattern in cervical pseudo-decidual tissue tends to mimic invasive cancer;
and CIN tends to appear as a more severe grade than it actually is (due to
increased size, increased oedema and vasculature pattern). Thus considerable
experience is required for colposcopy in pregnancy.
The steps in the colposcopic procedure for a pregnant woman are similar to
those for a non-pregnant woman, but extra care must be taken not to injure
any tissues when a digital examination or speculum insertion is performed.
If a repeat cytology smear is needed, this may be performed using a spatula,
by applying gentle pressure to avoid bleeding. Some may prefer to obtain a
cytology sample at the end of the colposcopic procedure, in order to avoid
inducing bleeding that may obscure the colposcopic field, but this may
result in a poor hypocellular sample, as cells might have been washed away
during the different steps of the colposcopic procedure.
As pregnancy progresses, cervical biopsy is associated with an increased
probability and degree of bleeding, which may often be difficult to control.
The risk of biopsy should always be weighed against the risk of missing an
early invasive cancer. All lesions suspicious of invasive cancer must be
biopsied or wedge excised. Sharp biopsy forceps should be used, as they will
produce less tearing of tissue. Biopsy should always be carried out under
colposcopic vision to control depth. The prompt application of Monsel’s
paste or silver nitrate to the biopsy site, immediate bed rest for 15 to 30
minutes, and the use of a tampon or other haemostatic packing to put
pressure on the biopsy site are helpful to minimize bleeding. Some women may
need an injection of pitressin into the cervix or suturing for haemostasis.
To avoid a large amount of tissue slough, due to the effect of Monsel’s
paste, haemostatic packs should not be left in place for more than a few
hours after the paste has been applied. Alternatively, cervical biopsy in a
pregnant woman may be performed with diathermy loop. If colposcopy is
inadequate, and cytology suggests invasive cancer, a conization must be
performed, ideally in the second trimester. Non-invasive lesions may be
evaluated post-partum.
Article Source:

http://screening.iarc.fr/colpochap.php?chap=5&lang=1

What is a Colposcopy and When Do You Need One?

A colposcopy is done after an abnormal pap smear to help determine if there are an early signs of cancer. This procedure is done in your gynecologist's office and normally takes from 20 minutes to 30 minutes to complete.
A colposcopy allows your doctor to look at the vagina, vulva and cervix. A colposcope(colposcopic,a colposcopy,colposcopes) is a medical instrument with light and magnification to allow the doctor to closely see inside the vagina. A speculum is used to open the vagina. A vinegar solution is then applied to the cervix and vagina. This causes any abnormal tissue to turn white so the doctor can identify and examine these areas.
When abnormal tissues are apparent, a doctor may perform a biopsy at the time of the colposcopy. This involves removing small amounts of tissue for further testing to be done by a pathologist. Results from the biopsy are usually available one to two weeks after the biopsy.
If you are scheduled to have a colposcopy, you need to avoid using douching products, tampons or having sexual intercourse for the 24 hours preceding the procedure.
After the colposcopy, you may experience some dark colored vaginal discharge or some spotting. If you had a biopsy as well, there may be a thick, black discharge. This is caused by a paste placed over the area where tissue was removed during the biopsy. The discharge may last for several days.
In addition, for one week after the procedure you should not use a tampon or have sexual intercourse.
This procedure is considered safe. Sometimes, however, complications will arise. You should contact your doctor if you have any of the following after the colposcopy:
Heavy bleeding
Lower abdominal pain (you may experience some cramping, especially if you have had a biopsy, this is normal)
Fever or chills
Article Source: 

 http://www.healthcentral.com/sexual-health/c/55184/42014/colposcopy

What is a colposcope(colposcopic,a colposcopy,colposcopes)?

A colposcope(colposcopic,a colposcopy,colposcopes) is like a set of binoculars with a bright light mounted on a stand, used to look at the cervix and vagina under magnification.
Article Source: 

 http://www.nyu.edu/shc/medservices/colposcopy.html

Why are some women advised to have colposcopy？

If a Pap smear indicates the presence of abnormal cells or if the cervix looks abnormal, colposcopy may help in diagnosis and in planning of treatment.
It is impossible to diagnose diseases or other problems simply by looking at the cervix with the naked eye. A magnified view is necessary to find any abnormalities, or to show that the cervical areas in question are not cause for concern. When abnormal areas are found, colposcopy helps to determine the areas where biopsies should be taken.
Article Source: 

 http://www.nyu.edu/shc/medservices/colposcopy.html

The suitability of digital colposcopy for telematic applications

Since carcinoma of the cervix is one of the most common cancers in women, screening of the cervix has acquired considerable importance. Colposcopy is a simple diagnostic method of detecting suspicious changes at an early stage. Shortcomings of this method are its low specificity and high inter- and intra-observer variability. A clinical pilot study was therefore carried out to investigate the advantages of a digital colposcopic system comprising a binocular colposcope(colposcopic,a colposcopy,colposcopes) coupled to a CCD camera and a computer. The aim of the study was to evaluate the reliability of diagnostic findings of the cervix obtained with digital colposcopy in comparison with standard binocular colposcopy, and to assess its suitability for telematic applications (teleconsultation, telediagnostics, treaching). A total of 315 patients were examined and statistically analysed. The patients were first submitted to a conventional colposcopic examination and a diagnosis was established. During the colposcopic examination camera images were stored on a computer, on the basis of which a second physician experienced in colposcopy reviewed the initial diagnosis. The primary and secondary findings of each patient were classified into 4 categories and compared following the Rome classification system. Agreement between the primary and secondary diagnosis was established in 69% of the cases (kappa = 0.60 +/- 0.03). No bias was observed in terms of under- or overrating. The percentage of non-assessable colposcopic examinations was 9.2%. Digital colposcopy is therefore suitable for reproducing diagnostic findings on the computer, given adequate digital image quality and a suitable classification model. The method has clear advantages with regard to follow-up, internal quality control of the diagnosis, and the training and further education of physicians and students. In the future, telecolposcopy may open up new opportunities in gynaecology.
Article Source:

http://www.ncbi.nlm.nih.gov/pubmed/1527946