Definition & Overview

A colposcopy is a procedure performed to determine whether there are abnormal cells existing in or around the vagina, vulva, or cervix. These abnormalities tend to occur most commonly at the opening of the cervix leading to the birth canal and womb. It is highly important to detect and treat these abnormalities as early as possible as they can significantly increase the risk of cervical cancer. A colposcopy is usually performed when a routine cervical screening procedure raises some suspicions regarding the health of the cervix.

Who should undergo and expected results

The most common reasons why colposcopy is performed include:

  • The presence of abnormal cells as confirmed by a cervical screening sample, regardless if these cells are cancerous or not
  • The patient is diagnosed with human papillomavirus or HPV, a leading cause of abnormal cell changes leading to cervical cancer
  • Inconclusive cervical screening tests
  • Certain symptoms raising suspicions of an unhealthy cervix, including vaginal bleeding and cervical inflammation


The colposcopist will be able to tell right away if there are abnormalities, so there is no need to wait for the results of the test. However, if a biopsy is performed after the colposcopy, the results may take about four weeks. Based on statistics, 40% of patients who were required to undergo colposcopy obtained abnormal results. However, an abnormal result does not necessarily mean that the patient has cervical cancer, but the presence of the abnormal cells point to an increased risk of cancer especially if the abnormality is not treated right away. A colposcopy, however, may be able to diagnose a cervical cancer; in such cases, the patient is quickly referred to a cancer specialist.

Normal results mean that the cervix is healthy and the patient has a low risk of developing cervical cancer. Regardless of the results, women are encouraged to undergo cervical screening test every three to five years as a preventative measure.

How the procedure works

A colposcopy is an outpatient procedure carried out by a specialist known as a colposcopist, who is usually a doctor or a nurse who has received special training in performing this diagnostic procedure. During the procedure, the patient will be asked to lie down on a special chair with padded leg supports, while a speculum is inserted into the vagina. This device gently opens once inside and allows the practitioner to examine the inside of the cervix with the help of a colposcope, a microscope type device with a light attached to it. This device is used from the outside and does not in any way enter the vagina. Some colposcopes also have a camera attached so images are captured on a monitor in real-time. If there are some abnormal areas, certain solutions may be applied to highlight them. In such cases, the colposcopy is followed by tissue biopsy to confirm the diagnosis. There may be cases, however, where the doctor feels certain about the results of the colposcopy that a biopsy is no longer prescribed; in these cases, the patient will move right on to the treatment process.

There are no preparations required prior to a colposcopy. There is no need to fast and there is usually no need for sedation, as long as a biopsy will not be performed. If a biopsy is required, local or general anesthesia may be needed, and the patient will be asked to refrain from eating for a specific number of hours before the procedure is scheduled to be performed.

The colposcopy may cause some discomfort while the speculum is being inserted and is inside the vagina. If it is followed by a biopsy, the patient will also feel a pinch or scratch when the tissue sample is taken. Although uncomfortable, the procedure is not considered too painful. If a patient finds the procedure too painful, it is best to tell the colposcopist who can prescribe another way to deal with the situation or can decide to stop the colposcopy all together. The whole procedure takes about 10 to 15 minutes, but the entire appointment may take up to 30 minutes including the preparation and the discussion.

Possible risks and complications

As a diagnostic procedure, a colposcopy is not considered a surgery and is generally safe. However, there is still a risk of some complications; this risk is greater if the colposcopy is followed by a biopsy. The most common risks involved are:

  • Bleeding
  • Infection
  • Allergic reaction to the substances used during the test
  • Sensitivity to medications or anaesthetics


Some factors may also affect the results of or interfere with a colposcopy. These include:

  • Acute cervical inflammation
  • Acute pelvic inflammatory disease
  • Menstruation


To ensure accurate results and lessen the risk of complications, a colposcopy is best performed approximately one week after a patient's menstrual period.



References:

  • American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 99: Management of abnormal cervical cytology and histology. Obstet Gynecol. 2008;112:1419-1444.

  • Apgar BS, Kittendorf AL, Bettcher CM, Wong J, Kaufman AJ. Update on ASCCP consensus guidelines for abnormal cervical screening: tests and cervical histology. Am Fam Physician. 2009;80:147-155.

  • Beard JM, Osborn J. Common office procedures. In: Rakel RE, ed. Textbook of Family Medicine. 8th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 28.

  • Cervical cancer in adolescents: screening, evaluation, and management. Committee Opinion No. 463. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2010;116:1492-1509.

  • Noller KL. Intraepithelial neoplasia of the lower genital tract (cervix, vulva): Etiology, screening, diagnostic techniques, management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, PA: Mosby Elsevier; 2007:chap 28.

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