Colposcopy

Definition
Purpose
Demographics
Description
Diagnosis/Preparation
Aftercare
Risks
Normal results
Morbidity and mortality rates
Alternatives

Definition

Colposcopy is a procedure that allows a physician to examine a woman’s cervix and vagina using a special microscope called a colposcope. Colposcopy is used to check for precancerous or abnormal areas.

Purpose

Colposcopy is used to identify or rule out the existence of any precancerous conditions in the cervical tissue. If a Papanicolaou (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 a sample of 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.

Demographics

Cervical cancer affects millions of women worldwide. In the United States, the routine use of Pap tests has substantially decreased the rate of this cancer. With the introduction of a vaccine against the family of viruses associated with cervical cancer, the rate in the developed world is expected to continue to fall. Cervical cancer continues to be a major health problem for women in the developing world. Even in the United States, it is estimated that about one-third of women fail to follow up with colposcopy after an abnormal Pap test. Minority women, teenagers, and those of low socioeconomic status are the least likely to follow up.

Description

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 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 takes 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 may destroy the tissue using one of several procedures, including ones that use high heat (diathermy), extreme cold (cryosurgery), or lasers. Another procedure, called 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

KEY TERMS

Biopsy— Removal of a sample of abnormal tissue for more extensive examination under a microscope.

Cervix— Narrow, lower end of the uterus forming the opening to the vagina.

Cryosurgery— Freezing and destroying abnormal cells.

Diathermy— Also called electrocautery, this is a procedure that heats and destroys abnormal cells.

Diethylstilbestrol (DES)— A synthetic form of estrogen that was widely prescribed to women from 1940 to 1970 to prevent complications during pregnancy, and linked to several serious birth defects and disorders of the reproductive system in daughters of women who took DES.

Dysplasia— Abnormal cellular changes that may become cancerous.

Human papillomavirus (HPV)— A family of viruses that cause common warts of the hands and feet, as well as lesions in the genital and vaginal area. More than 50 types of HPV have been identified, some of which are linked to cancerous and precancerous conditions, including cancer of the cervix. A vaccine is now available against some of these viruses.

Loop electrosurgical excision (LEEP)— A procedure that can help diagnose and treat cervical abnormalities using a thin wire loop that emits a low-voltage high-frequency radio wave that can excise tissue.

Monsel’s solution— A solution used to stop bleeding.

Pap test— The common term for the Papanicolaou test, a simple smear method of removing cervical cells to screen for abnormalities that indicate cancer or a precancerous condition.

Speculum— A retractor used to separate the walls of the vagina to make visual examination easier.

(removal of a conical section of the cervix for inspection) will be needed.

Diagnosis/Preparation

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 who are taking blood-thinning

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.

medications such as warfarin (Coumadin) should tell their doctor before the procedure.

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, Advil) 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).

Aftercare

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 several days after the procedure. It is also normal to have some blood spotting after colposcopy. Pain-relieving medication can be taken to lessen any post-procedural 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.

Risks

Colposcopy is a very safe procedure. Patients may have bleeding or infection after biopsy. Bleeding is usually controlled with a topical medication prescribed

QUESTIONS TO ASK THE DOCTOR

• Why is colposcopy recommended in my case?
• Will a biopsy be performed?
• How long will the procedure take?
• When will I find out the results?
• What will happen if the results are positive for cancer or another abnormality?

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:

• heavy vaginal bleeding (more than one sanitary pad an hour);
• fever, chills, or an unpleasant vaginal odor; or
• lower abdominal pain.

Normal results

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 papillomavirus.

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. The American Cancer Society estimated that 11,150 new cases of cervical cancer were diagnosed in 2007 and 3,670 deaths could be attributed to the disease.

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).

Resources

OTHER

“Colposcopy (Position Paper).” American Academy of Family Physicians. 2004 [cited February 12, 2008]. http://www.aafp.org/online/en/home/policy/policies/c/colposcopypositionpaper.html.

“Colposcopy.” MedlinePlus. [cited February 12, 2008]. http://www.nlm.nih.gov/medlineplus/tutorials/colposcopy/htm/index.htm.

Garcia, Agustin A. “Cervical Cancer.” eMedicine.com. December 12, 2007 [cited February 12, 2008]. http://www.emedicine.com/med/topic324.htm.

Pattan, Charles, Alissa Zuellig, Bophal Hong, Shironda Stewart, and Michael P. Grossman. “Colposcopy.” eMedicine.com. July 22, 2005 [cited February 12, 2008]. http://www.emedicine.com/med/topic3298.htm.

ORGANIZATIONS

American College of Obstetricians and Gynecologists, 409 12th St., SW, P.O. Box 96920, Washington, DC, 20090-6920, (202) 638-5577, http://www.acog.org.

American Society for Colposcopy and Cervical Pathology, 152 West Washington Street, Hagerstown, MD, 21740, (301) 733-3640, (800) 787-7227, http://www.asccp.org.

Association of Women’s Health, Obstetric, and Neonatal Nurses, 2000 L St., NW, Suite 740, Washington, DC, 20036, (202) 261-2400, (800) 673-8499, http://www.awhonn.org.

DES Action USA, 158 S. Stanwood Rd., Columbus, OH, 43209, (800) 337-9288, http://www.desaction.org.

Society of Gynecologic Oncologists, 230 West Monroe Street, Suite 710, Chicago, IL, 60606, (312) 235-4060, http://www.sgo.org.

Jennifer E. Sisk, M.A.

Stephanie Dionne Sherk

Tish Davidson, A.M.

Colposcopy

Definition

Colposcopy is a procedure that allows a physician to take a closer look at a woman's cervix and vagina using a special instrument called a colposcope. It is used to check for precancerous or abnormal areas. The colposcope can magnify the area between 10 and 40 times; some devices also can take photographs.

Purpose

The colposcope helps to identify abnormal areas of the cervix or vagina so that small pieces of tissue (biopsies) can be taken for further analysis.

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, further testing, such as colposcopy, often is required. A Pap test is a screening test that involves scraping cells from the outside of the cervix. If abnormal cells are found, the physician will attempt to find the area that produced the abnormal cells and remove it for further study (biopsy). Only then can a diagnosis be made.

Colposcopy may also be performed if the cervix looks abnormal during a routine examination. It may also be suggested for women with genital warts and for diethylstilbestrol (DES) daughters (women whose mothers took DES when pregnant with them).

Precautions

Women who are pregnant, or who suspect that they are pregnant, must tell their doctor before the procedure begins. Pregnant women can, and should, have a colposcopy if they have an abnormal Pap test. However, special precautions must be taken during biopsy of the cervix.

Description

A colposcopy is performed in a physician's office and is similar to a regular gynecologic exam. An instrument called a speculum is used to hold the vagina open, and the gynecologist looks at the cervix and vagina through the colposcope instead simply by eye, as in a routine examination.

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. In 2004, a study showed that a new optical detection system used with colposcopy greatly improved visual detection of precancerous changes in the cervix during the procedure.

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 be done. The biopsy results are usually available within a week.

If the tissue sample indicates abnormal growth (dysplasia) or precancer, 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 (cryotherapy ), 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.

Preparation

Colposcopy is a painless procedure that does not require any anesthetic medication. If a biopsy is done, there may be mild cramps or a sharp pinching when the tissue is removed. To lessen this pain, your doctormay recommend 800 mg of 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 take two tablets of acetaminophen (Tylenol) instead.

Aftercare

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 for a couple of days after the procedure. It is also normal to have some spotting after a colposcopy.

Patients should not use tampons or put anything else in the vagina for at least a week after the procedure, or until the doctor says it is safe. In addition, women should not have sex or douche for at least a week after the procedure because of the risk of infection.

Risks

Occasionally, patients may have bleeding or infection after biopsy. Bleeding is usually controlled with a topical medication.

A patient should call her doctor right away if she notices any of the following symptoms:

• heavy vaginal bleeding (more than one sanitary pad an hour)
• fever, chills, or an unpleasant vaginal odor
• lower abdominal pain

Normal results

If visual inspection shows that the surface of the cervix is smooth and pink, this is considered normal. If abnormal areas are found and biopsied and the results show no indication of cancer, a precancerous condition, or other disease, this also is considered normal.

Abnormal results

Abnormal conditions that can be detected using colposcopy and biopsy include precancerous tissue changes (cervical dysplasia), cancer, and cervical warts (human papilloma virus).

Resources

PERIODICALS

"Optical Detection System With Colposcopy Improves Cervical Cancer Detection." Cancer Weekly March 9, 2004: 51.

ORGANIZATIONS

American Society for Colposcopy and Cervical Pathology. 20 W. Washington St., Ste. #1, Hagerstown, MD 21740. (800) 787-7227. 〈http://www.asccp.org〉.

KEY TERMS

Biopsy— Removal of sample of abnormal tissue for more extensive examination under a microscope.

Cervix— The neck of the uterus.

Cryotherapy— Freezing and destroying abnormal cells.

DES— The abbreviation for diethylstilbestrol, a synthetic form of estrogen that was widely prescribed to women from 1940 to 1970 to prevent complications. It was linked to several serious birth defects and disorders of the reproductive system in daughters of women who took DES. In 1971, the FDA suggested it not be used during pregnancy and banned its use in 1979 as a growth promoter in livestock.

Diathermy— Also called electrocautery, this is a procedure that heats and destroys abnormal cells. It is gradually being replaced by cryosurgery, lasers, or LEEP.

Human papilloma virus— A virus that causes common warts of the hands and feet, as well as lesions in the genital and vaginal area. More than 50 types of HPV have been identified, some of which are linked to cancerous and precancerous conditions, including cancer of the cervix.

Loop electrosurgical excision (LEEP)— A procedure that can help diagnose and treat cervical abnormalities, using a thin wire loop that emits a low-voltage high-frequency radio wave that can excise tissue. It is considered better than either lasers or electrocautery because it can both diagnose and treat precancerous cells or early stage cancer at the same time.

Pap test— The common term for the Papanicolaou test, a simple smear method of examining stained cells to detect cancer of the cervix.

Speculum— A retractor used to separate the walls of the vagina to make visual examination easier.

Colposcopy

Definition

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.

Purpose

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.

Demographics

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.

Description

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.

Diagnosis/Preparation

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).

Aftercare

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.

Risks

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:

• heavy vaginal bleeding (more than one sanitary pad an hour)
• fever, chills, or an unpleasant vaginal odor
• lower abdominal pain

Normal results

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.

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.

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).

Resources

books

Ryan, Kenneth J., Ross S. Berkowitz, and Robert L. Barbieri. Kistner's Gynecology, 7th ed. St. Louis: Mosby, 1999.

periodicals

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.

organizations

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>.

other

"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

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.

QUESTIONS TO ASK THE DOCTOR

• Why is colposcopy recommended in my case?
• Will a biopsy be performed?
• How long will the procedure take?
• When will I find out the results?
• What will happen if the results are positive for cancer or another abnormality?

Colposcopy

Definition

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.

Purpose

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, a 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 also be suggested for women with genital warts and for DES daughters (women whose mothers took DES when pregnant with them). Colposcopy is also used in the emergency department to examine victims of sexual assault and abuse and document any physical evidence of vaginal injury.

Precautions

Women who are pregnant, or who suspect that they are pregnant, must tell their doctor before the procedure begins. Pregnant women can, and should, have a colposcopy if they have an abnormal PAP test. However, special precautions must be taken during biopsy of the cervix.

Description

A colposcopy is usually performed in a physician's office and is similar to a regular gynecologic exam. An instrument called a speculum is used 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, which 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 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.

Preparation

Patients should be instructed not to douche or have sexual intercourse for 24 hours before the 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 800 mg of 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 take two tablets of acetaminophen (Tylenol) instead.

Aftercare

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 a colposcopy. Pain- relieving medication can be taken to lessen any postprocedural cramping.

Patients should not use tampons or put anything else in the vagina for at least a week after the procedure, or until the doctor says it's safe. In addition, women should not douche or have sex for at least a week after the procedure because of the risk of infection .

Complications

Occasionally, patients may have bleeding or infection after biopsy. Bleeding is usually controlled with a topical medication prescribed by the physician or health care provider.

A patient should call her doctor right away if she notices any of the following symptoms:

• heavy vaginal bleeding (more than one sanitary pad an hour)
• fever, chills, or an unpleasant vaginal odor
• lower abdominal pain

Health care team roles

The colposcopy may be performed by a gynecologist or other qualified health care provider. Such examinations will normally be performed in the presence of a female nurse. 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.

Results

If visual inspection shows that the surface of the cervix is smooth and pink, this is considered normal. Areas that look abnormal may 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 (human papilloma virus).

Resources

BOOKS

Carlson, Karen J., Stephanie A. Eisenstat, and Terra Ziporyn. The Harvard Guide to Women's Health. Cambridge: Harvard University Press, 1996.

Ryan, Kenneth J., Ross S. Berkowitz, and Robert L. Barbieri. Kistner's Gynecology, 7th ed. St. Louis: Mosby, 1999.

PERIODICALS

Holmes, Melisa M., and Deborah Kaplan, eds. "Clinical Management of Rape in Adolescent Girls." Patient Care (April 30, 1999). <http://consumer.pdr.net/consumer/psrecord.htm>.

ORGANIZATIONS

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 (AWHONN). 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>.

Jennifer E. Sisk, M.A.

KEY TERMS

Biopsy —Removal of sample of abnormal tissue for more extensive examination under a micro-scope.

Cervix —The neck of the uterus.

Cryosurgery —Freezing and destroying abnormal cells.

DES —The abbreviation for diethylstilbestrol, a synthetic form of estrogen that was widely prescribed to women from 1940 to 1970 to prevent complications during pregnancy. It was linked to several serious birth defects and disorders of the reproductive system in daughters of women who took DES. In 1971 the FDA suggested it not be used during pregnancy and banned its use in 1979 as a growth promoter in livestock.

Diathermy —Also called electrocautery, this is a procedure that heats and destroys abnormal cells. It is gradually being replaced by cryosurgery, lasers, or LEEP.

Dysplasia —Development of abnormal tissue.

Human papilloma virus (HPV) —A virus that causes common warts of the hands and feet, as well as lesions in the genital and vaginal area. More than 50 types of HPV have been identified, some of which are linked to cancerous and precancerous conditions, including cancer of the cervix.

Loop electrosurgical excision (LEEP) —A procedure that can help diagnose and treat cervical abnormalities using a thin wire loop that emits a low-voltage high-frequency radio wave that can excise tissue. It is considered better than either lasers or electrocautery because it can both diagnose and treat precancerous cells or early stage cancer at the same time.

Mousel's solution —An aqueous solution of Monsel's salts with valuable styptic properties.

PAP test —The common term for the Papanicolaou test, a simple smear method of examining stained cells to detect cancer of the cervix.

Speculum —A retractor used to separate the walls of the vagina to make visual examination easier.

Colposcopy

Definition

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.

Purpose

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, a 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 also be suggested for women with genital warts and for DES daughters (women whose mothers took DES when pregnant with them). Colposcopy is also used in the emergency department to examine victims of sexual assault and abuse and document any physical evidence of vaginal injury.

Precautions

Women who are pregnant, or who suspect that they are pregnant, must tell their doctor before the procedure begins. Pregnant women can, and should, have a colposcopy if they have an abnormal PAP test. However, special precautions must be taken during biopsy of the cervix.

Description

A colposcopy is usually performed in a physician's office and is similar to a regular gynecologic exam. An instrument called a speculum is used 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, which 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 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.

Preparation

Patients should be instructed not to douche or have sexual intercourse for 24 hours before the 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 800 mg of 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 take two tablets of acetaminophen (Tylenol) instead.

Aftercare

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 a colposcopy. Pain-relieving medication can be taken to lessen any postprocedural cramping.

Patients should not use tampons or put anything else in the vagina for at least a week after the procedure, or until the doctor says it's safe. In addition, women should not douche or have sex for at least a week after the procedure because of the risk of infection.

Complications

Occasionally, patients may have bleeding or infection after biopsy. Bleeding is usually controlled with a topical medication prescribed by the physician or health care provider.

A patient should call her doctor right away if she notices any of the following symptoms:

• heavy vaginal bleeding (more than one sanitary pad an hour)
• fever, chills, or an unpleasant vaginal odor
• lower abdominal pain

Health care team roles

The colposcopy may be performed by a gynecologist or other qualified health care provider. Such examinations will normally be performed in the presence of a female nurse. 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.

Results

If visual inspection shows that the surface of the cervix is smooth and pink, this is considered normal. Areas that look abnormal may 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 (human papilloma virus).

KEY TERMS

Biopsy— Removal of sample of abnormal tissue for more extensive examination under a microscope.

Cervix— The neck of the uterus.

Cryosurgery— Freezing and destroying abnormal cells.

DES— The abbreviation for diethylstilbestrol, a synthetic form of estrogen that was widely prescribed to women from 1940 to 1970 to prevent complications during pregnancy. It was linked to several serious birth defects and disorders of the reproductive system in daughters of women who took DES. In 1971 the FDA suggested it not be used during pregnancy and banned its use in 1979 as a growth promoter in livestock.

Diathermy— Also called electrocautery, this is a procedure that heats and destroys abnormal cells. It is gradually being replaced by cryosurgery, lasers, or LEEP.

Dysplasia— Development of abnormal tissue.

Human papilloma virus (HPV)— A virus that causes common warts of the hands and feet, as well as lesions in the genital and vaginal area. More than 50 types of HPV have been identified, some of which are linked to cancerous and precancerous conditions, including cancer of the cervix.

Loop electrosurgical excision (LEEP)— A procedure that can help diagnose and treat cervical abnormalities using a thin wire loop that emits a low-voltage high-frequency radio wave that can excise tissue. It is considered better than either lasers or electrocautery because it can both diagnose and treat precancerous cells or early stage cancer at the same time.

Mousel's solution— An aqueous solution of Monsel's salts with valuable styptic properties.

PAP test— The common term for the Papanicolaou test, a simple smear method of examining stained cells to detect cancer of the cervix.

Speculum— A retractor used to separate the walls of the vagina to make visual examination easier.

Resources

BOOKS

Carlson, Karen J., Stephanie A. Eisenstat, and Terra Ziporyn. The Harvard Guide to Women's Health. Cambridge: Harvard University Press, 1996.

Ryan, Kenneth J., Ross S. Berkowitz, and Robert L. Barbieri. Kistner's Gynecology, 7th ed. St. Louis: Mosby, 1999.

PERIODICALS

Holmes, Melisa M., and Deborah Kaplan, eds. "Clinical Management of Rape in Adolescent Girls." Patient Care (April 30, 1999). 〈http://consumer.pdr.net/consumer/psrecord.htm〉.

ORGANIZATIONS

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 (AWHONN). 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〉.