Colposcopy

What is colposcopy?

Colposcopy is the live examination of the cervix during the procedure with a magnifying instrument called a colposcope. The main target of the examination is the transformation zone of the cervix — the area where cell change begins and where, for that reason, precancerous changes are most often seen.

What colposcopy looks for falls under two headings: precancerous cell changes (referred to in guidelines as CIN or SIL) and early-stage cervical cancer.

When is colposcopy requested?

Colposcopy is most often requested after a screening result. The main situations are:

• Cell changes found on a smear test (reports such as ASC-US, LSIL, HSIL)
• HPV 16 or 18 being found — even if the cell examination is normal
• No clear result from two screenings in a row
• Unexplained bleeding, for example bleeding after intercourse

For when a positive HPV result calls for colposcopy and when it calls for a repeat test, see HPV (Human Papillomavirus). Colposcopy and colposcopic biopsy are carried out at the practice in Muratpaşa, Antalya.

How do you prepare for colposcopy?

• In the 24 hours before the procedure, do not have vaginal intercourse; do not use tampons, vaginal creams or vaginal medicines.
• It can also be done during your period; if you prefer, you can change your appointment.
• If you are pregnant or think you may be, say so beforehand; colposcopy can also be done safely in pregnancy.
• If you use an intrauterine device (coil), avoid intercourse or use a condom in the 7 days before the procedure; rarely the coil may need to be removed.
• Because there may be light bleeding after the procedure, have a sanitary pad with you.
• You can ask for someone to be with you during the procedure.

What happens during the procedure?

Colposcopy is carried out in the position used for a gynaecological examination. The examination rests on magnification and illumination; these are the basic elements of colposcopy.

1. The cervix is brought into view and assessed under magnification.
2. Acetic acid at a concentration of 3–5% (a dilute vinegar solution) is applied to the cervix. Suspicious tissues turn white temporarily; this is called an aceto-white area.
3. Where necessary, Lugol's iodine solution is applied to see whether the tissue takes up the stain.
4. The doctor assesses together the response to the acetic acid, the border characteristics of the lesion (tissue change), the appearance of the surface, its size, the vascular pattern and the uptake of iodine.
5. If there is a suspicious area, a targeted biopsy (a small tissue sample) is taken from it.

The procedure usually takes 15–20 minutes and you go home afterwards. The colposcope does not go into the vagina; it looks from outside, with magnification. What you may feel:

• Mild discomfort while the speculum (the examination instrument that opens the vagina) is put in — if you feel pain, say so.
• Mild tingling or stinging while the liquid is applied.
• If a biopsy is taken, a slight pinching feeling; the sample taken is about the size of a pinhead.

You can ask for the procedure to be stopped at any moment.

Why is a biopsy taken, and from how many places?

Because the colposcopic impression rests on visual assessment, it is known not to be sufficiently certain on its own. For this reason guidelines recommend that a biopsy be taken from every suspicious area seen.

When there is a lesion, targeted biopsies are generally taken from 2 to 4 separate points so that the most advanced disease can be caught. In low-risk people whose colposcopic appearance is normal, avoiding a biopsy is an acceptable approach.

In selected high-risk situations where there is strong evidence in favour of high-grade disease, removal of the whole transformation zone (excision with a loop) may come up immediately after the colposcopy; in that case diagnosis and treatment take place in the same session.

After colposcopy and biopsy

• For a few days there may be mild pain similar to period pain; a painkiller can be used.
• Light bleeding and discharge pass within a few days if only colposcopy was done; if a biopsy was taken they may last longer. After LEEP, bleeding may last up to 4 weeks.
• For as long as the bleeding and discharge continue, do not have intercourse and do not use tampons or a menstrual cup; use pads. Avoid heavy exercise, which can increase bleeding.

What do the results mean?

If no changes are seen at colposcopy, you are usually told straight away; even so, routine screening needs to continue. If a biopsy was taken, the result comes after the pathology (tissue) examination. Abnormal cells are not cancer; they are named according to their grade:

CIN is a precancerous cell change in the surface layer of the cervix; the higher the grade, the greater the chance of progression. The changed tissue is most often removed with a thin wire loop — see LEEP. Colposcopy and biopsy find cancer in very few cases.

Colposcopy in pregnancy

Colposcopy can also be done safely in pregnancy. Be sure to mention before the procedure that you are pregnant or think you may be; the assessment is planned accordingly.

What does colposcopy achieve?

Before colposcopy came into use in the 1970s, almost all women in whom a marked abnormality was found on examination of the cervical cells underwent cone biopsy or removal of the womb for both diagnosis and treatment.

Colposcopy together with targeted biopsy achieved two things at once: correct detection of disease where it is present, and the ability to show safely that it is absent where it is not. The result was a marked reduction in the number of tissue-removal procedures; these are now limited to people in whom a precancerous change has actually been confirmed or who are at high risk of hidden cancer.

What this means in practice is this: changes unlikely to progress can be followed up rather than operated on unnecessarily, while advanced disease is treated in time.

Weighing benefit and risk together

As with every medical procedure, in colposcopy too the benefit and the possible harm must be weighed together within the person's own situation. The main benefit of colposcopy is that precancerous changes and early-stage cancer can be detected correctly.