Colposcopy of the cervix: how it is performed, what preparations are required, how are the results interpreted?

Colposcopy of the cervix allows for a thorough examination of abnormalities and ensures an accurate diagnosis.

In gynecological practice, a common method of endoscopic diagnosis is colposcopy of the cervix (or cervix). It involves a detailed examination through a special microscope. Additionally, during the procedure, the specialist can perform a targeted biopsy of the most suspicious areas for subsequent histological analysis of the samples. Typically, this examination is recommended for women who are suspected of having a precancerous condition or cancer.

What's the Deal with Colposcopy of the Cervix?

A colposcope is basically a binocular microscope decked out with a lens system and lighting. It allows for a detailed examination of the tissues of the vagina, vulva, and cervix under magnification – anywhere from 8 to 40 times.

Thanks to the ability to get such detailed images, during a colposcopy, the doc can spot areas of pathology, analyze their outlines, sizes, surface characteristics, locations, colors, and shapes. For a more detailed diagnosis of the microcirculation, a special green filter can be used, helping to diagnose invasive forms of cervical cancer.

Does a colposcopy hurt? Usually not, but some mild pain and discomfort might happen only if a biopsy is performed.

The actual process of examining a patient with a colposcope is done without contact: the device, mounted on a stand, is directed through mirrors with its optical head and prismatic binoculars at the tissues. And the lighting system illuminates the examination area for the doc's convenience. If needed, the examination process is supplemented by taking biopsy samples from suspicious areas, which are then sent for cytological analysis.

Types of Colposcopy

Colposcopic examination can be conducted using two methods:

1. Basic colposcopy – the doctor simply examines the cervical tissues (without the use of any additional reagents or solutions).
2. Extended colposcopy – during the examination, the cervix is treated with certain medicinal substances, facilitating various tissue and vascular tests. When treated with a 3% solution of acetic acid, which allows for a clearer delineation of pathological sites, a temporary swelling of the mucosa occurs due to the constriction of vessels. In some cases, the Schiller test is used: Lugol's solution is applied to the cervix, helping to detect glycogen in the mucosal cells. After staining, tissues undergoing precancerous changes and containing a small amount of glycogen do not stain and appear as whitish spots against the background of the brown cervix. These medicinal tests easily allow for the selection of an area for performing a biopsy material collection for analysis.

When referring a patient for cervical colposcopy, the treating physician initially specifies the type of procedure and the presumed diagnosis of the patient.

Indications for a Colposcopy

Undergoing a colposcopy of the cervix is recommended in the following clinical scenarios:

• presence of abnormal cells in a smear from the cervical canal;
• suspicion of developing genital warts or cancerous processes;
• bleeding outside of menstrual periods;
• discharges of an abnormal nature from the genital tract;
• a positive test for the human papillomavirus;
• feelings of discomfort and itching;
• prolonged painful sensations in the lower abdomen;
• chronically inflamed cervical canal.

The primary goal of prescribing a colposcopy is to conduct a detailed examination and/or take a targeted biopsy from a suspicious area. If necessary, the examination is prescribed to monitor the effectiveness of the treatment administered.

Erosion is one of the most common reasons for performing a colposcopy of the cervix.

Colposcopy provides a multitude of diagnostic signs, based on which a doctor can make a final diagnosis and prescribe effective treatment for the identified pathology. The opportunity to undergo this procedure should not be overlooked.

Colposcopy is one of the few procedures that doesn't really have any no-gos. The only thing that might hold up its use is if someone's a virgin. This diagnostic maneuver is only done on women if there's a suspicion of cancerous growths in the cervix or vagina, when it's a matter of saving a life.

Preparation Guidelines

When scheduling a colposcopy of the cervix, the doctor will definitely explain to the patient the purpose of the procedure and provide recommendations on how to properly prepare for it to ensure its maximum accuracy.

Preparation involves the following:

• Several days before the procedure, you should stop using suppositories, pills, creams, and other vaginal medications.
• Conduct a test to identify any allergic reaction to iodine-containing substances.
• Two days before, stop douching.
• Two days before, refrain from using intimate hygiene products. Use a condom if engaging in sexual activity.
• Abstain from sexual contacts for one day before the procedure.

Following these recommendations is mandatory. If the rules are not adhered to, the results of the colposcopy may be distorted.

If a biopsy is planned during the examination, the doctor will definitely inform the patient about this. Many women are concerned about the pain during a biopsy. Usually, this procedure is not accompanied by pain, but in some cases, painful sensations may occur. More often, a slight discomfort is felt during the material collection, which can also be felt for some time after the procedure. However, it quickly passes and does not cause significant inconvenience.

What Day of Your Cycle is Best for Scheduling the Procedure?

The date for a colposcopy should be chosen with your menstrual cycle in mind, as it's generally better not to conduct it during bleeding. Ultimately, your doctor will tell you the best day of your cycle to have the procedure. It's most often done between the 7th and 10th day because during this time, the mucus in the cervical canal is clear and doesn't obstruct the examination. In emergency situations, a colposcopy can be performed on any day of the cycle.

Is Colposcopy Recommended During Pregnancy?

In certain clinical scenarios, colposcopy may be advised even during pregnancy. The primary reason for undergoing this examination is the suspicion of cancerous conditions, which arises based on the results of a cytological smear. Typically, a simple rather than an extended colposcopy is performed to clarify the diagnosis. It's usually done in the early stages of pregnancy, while in the later stages, it's approached with caution due to the high risk of infection and the potential for bleeding.

How is the Exam Conducted?

A colposcopy can be done on an outpatient basis. It's carried out in the following steps:

• the patient lies down on a gynecological chair;
• first, speculums are inserted, and then the colposcope is positioned;
• the doctor examines the tissues of the vagina and cervix (if necessary, they're dried with a swab);
• if any abnormalities are found, the specialist assesses their parameters;
• then, an examination through a green filter is conducted to evaluate the condition of the vascular pattern;
• if there's a need for a more comprehensive procedure, a corresponding test is performed – with a 3% acetic acid solution or Lugol's solution;
• if indications for a biopsy are present, it's carried out with the sample then sent to the lab;
• if a biopsy was performed, a tampon is inserted into the vagina to prevent bleeding, which the woman will remove herself later.

The results of the exam are given to the patient right away

After the procedure, which takes no more than 15–20 minutes, the woman receives her colposcopy results and can head home. The date for the follow-up doctor's visit depends on when the lab results come back: if a biopsy was done, it's necessary to wait for the analysis results.

After a Colposcopy

If a biopsy was performed during the examination, the patient should follow these recommendations after the procedure:

• Avoid taking baths, visiting pools, saunas, or steam rooms, and swimming in open bodies of water for 10 days.
• Remember to remove the tampon inserted into the vagina after 24 hours. Usually, by this time, any bleeding from the biopsy should have stopped completely.

Typically, a colposcopy doesn't lead to complications and is well tolerated by most patients.

However, some women may experience the following symptoms after undergoing a colposcopy:

• Lower abdominal pain;
• Bloody discharge that lasts more than a day;
• Heavy discharge;
• Pus in the discharge;
• Fever;
• Weakness.

If you experience any of these symptoms, it's crucial to see a doctor immediately.

Decoding the Results: What Colposcopy of the Cervix Reveals

During the examination, the following gynecological conditions may be detected:

• ectropion;
• cervical erosion;
• dysplasia;
• areas of atrophy;
• inflammatory processes;
• papillomas;
• condylomas;
• cervical intraepithelial neoplasia;
• cervical cancer.

Colposcopy can suspect cancerous conditions even in their early stages of development. That's why this method is considered the gold standard for gynecological examination of women suspected of having precancerous and cancerous conditions.

Colposcopy of the cervix is a non-invasive, highly informative, and widely available diagnostic procedure for diseases of the cervix, vagina, and vulva. The device used for its performance allows for the examination of pathological sites at a high magnification. If necessary, the examination is supplemented with the collection of material for smears or biopsies of the most suspicious areas. In some cases, colposcopy is also performed during pregnancy.