The Colposcopy is a preventive procedure to identify a possible abnormal cells or tissue on the cervix, vagina and vulva. By illuminating and magnifying the area with a coloscope during the examination, areas of concern can be identified earlier by the colposcopist. The procedure was developed by a German physician Hans Hinselmann in 1925 with the help of Dr. Helmut Wirths.
Cause for the Procedure
This examination has multiple candidates. If a patient has been a victim of a sexual assault then evidence can be collected with this procedure performed by a Sexual Assault Nurse Examiner. The SANE nurse will also look for injury or damage from the event.
This procedure is also completed to further investigate cytological abnormalities found on pap smear results as well as abnormal appearance of the cervix to the primary physician.
Part of the evaluation is to gather a thorough medical history and to determine what risk factors apply to the patient. Some of the information that is sought is the number of pregnancies, miscarriages, abortions, last menstrual period, smoking history, contraceptive use, medication history, past medical history and if the patient has ever had an abnormal cervical exam in the past. In cases where pregnancy is possible, a test will be given. This procedure should not be done on a pregnant patient except in rare cases.
The patient will lay on their back with legs in stirrups and their buttocks to the edge of the table. This position is known as the dorsal lithotomy position. The area outer to the cervix, the vulva, is examined before placing a speculum in the vagina. A 3 % acetic acid solution is placed on the cervix with cotton swabs. This solution will cause the areas of higher nuclear density to turn white. This white area is labeled the transformation zone on the cervix and is often where pre-cancerous and cancerous lesions need to be ruled out.
A colposcope is used to examine the vagina and cervix. The coloscopist will identify visible changes suggestive of abnormal tissue. The colpscope is basically a lighted binocular microscope that magnifies the cervix, vagina, and vulvar surface. Used at a low power gives a general impression and outlines the structures. The higher powers on the scope can identify certain vascular patterns that may indicate the presence of more advanced pre-cancerous or cancerous lesions. Other aids combined with the scope to give different views of the surface are light filters and application of iodine. The iodine should not be applied until after biopsies of white areas from the acetic acid, abnormal vascular patterns or visible lesions are gathered.
Once the colposcopist determines where any biopsies should be gathered, an instrument known as either punch forceps or SpiraBrush CX is used to complete the biopsies. In the past most physicians consider anesthesia unnecessary but it is becoming more popular to apply lidocaine or place a cervical block to decrease the pain during the procedure.
After the biopsies, an endocervical curettage (ECC) is often done. The ECC consists of a long utensil, known as a cytobrush or curette, is used to scrape the inside of the cervical canal. Once this is completed the colpscopist will apply Monsel’s solution or iodine to the surface of the cervix to control bleeding. The product will be naturally expelled by the patient with time and the patient should expect a coffee-ground type discharge for several days post procedure.
Possible Problems with the Procedure
Most of the time this procedure is safe for the patient but some complications have occurred such as bleeding, infection, or a missed lesion. There is also pain with the procedure if the colpscopist opts not to use the lidocaine or cervical block.
Image Caption: In this diagram, the canal of the cervix (or endocervix) is circled at the base of the womb. The vaginal portion of the cervix projects free into the vagina. The transformation zone, at the opening of the cervix into the vagina, is the area where most abnormal cell changes occur. Credit: Wikipedia