Colposcopy

Procedure Overview

What is colposcopy?

Colposcopy is a procedure that uses an instrument with a magnifying lens and a light, called a colposcope, to examine the cervix (opening to the uterus) and vagina for abnormalities. The colposcope magnifies the image many times, thus allowing the physician to see the tissues on the cervix and vaginal walls more clearly. In some cases, a cervical biopsy, a small sample of tissue, may be taken for further examination in the lab.

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What are female pelvic organs?

The organs and structures of the female pelvis are:

• endometrium - the lining of the uterus
• uterus - also called the womb, the uterus is a hollow, pear-shaped organ located in a woman's lower abdomen, between the bladder and the rectum. The uterus sheds its lining each month during menstruation, unless a fertilized egg (ovum) becomes implanted and pregnancy follows.
• ovaries - two female reproductive organs located in the pelvis in which egg cells (ova) develop and are stored and where the female sex hormones estrogen and progesterone are produced
• cervix - the lower, narrow part of the uterus located between the bladder and the rectum, forming a canal that opens into the vagina, which leads to the outside of the body
• vagina - the passageway through which fluid passes out of the body during menstrual periods. Also called the "birth canal," the vagina connects the cervix and the vulva (the external genitalia).
• vulva - the external portion of the female genital organs

Other related procedures that may be used to diagnose or treat cervical and vaginal conditions include Pap test, cervical biopsy, and loop electrosurgical excision procedure (LEEP). Please see these procedures for additional information.

Reasons for the Procedure

When cervical or vaginal problems are found during a pelvic examination, or abnormal cells are found during a Pap test, a colposcopy may be performed. Through the colposcope, the physician can see certain changes in cervical and vaginal tissues such as abnormal blood vessels, tissue structure, color, and patterns. Cells that appear to be abnormal, but are not cancerous at the present time, may be identified as precancerous. The appearance of these abnormal cells may be the first evidence of cancer that develops years later.

If abnormal tissue is seen during a colposcopy, a small sample of tissue (called a colposcopic biopsy) may be taken for further study. The physician may also take tissue samples from inside the cervix using an endocervical brush or endocervical curettage (ECC).

A colposcopy procedure may also be used to diagnose and assist in the treatment of the following conditions:

• bleeding
• polyps (benign growths)
• genital warts, which may indicate infection with human papilloma virus (HPV), a risk factor for developing cervical cancer
• diethylstilbestrol (DES) exposure in women whose mothers took DES during pregnancy, as DES exposure increases the risk for cancer of the reproductive system

There may be other reasons for your physician to recommend colposcopy.

Risks of the Procedure

As with any surgical procedure, complications may occur. If a colposcopic biopsy is performed, some possible complications may include, but are not limited to, the following:

• infection
• bleeding

Patients who are allergic to or sensitive to medications, iodine, or latex should notify their physician.

If you are pregnant or suspect that you may be pregnant, you should notify your physician.

If possible, a colposcopy procedure will be scheduled approximately one week after your menstrual period.

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

Certain factors or conditions may interfere with a colposcopy. These factors include, but are not limited to, the following:

• menstruation
• acute pelvic inflammatory disease
• acute inflammation of the cervix

Before the Procedure

• Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
• You may be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
• Generally, no prior preparation, such as fasting or sedation, is required. If a biopsy is performed and requires regional or general anesthesia, you may need to fast for a certain number of hours before the procedure, generally after midnight.
• If you are pregnant or suspect that you are pregnant, you should notify your physician.
• Notify your physician if you are sensitive to or are allergic to any medications, latex, tape, iodine, and anesthetic agents (local and general).
• Notify your physician of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
• Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
• You should not use tampons, vaginal creams or medications, douche, or have sexual relations for 24 hours before the test.
• Your physician may recommend that you take a pain reliever 30 minutes before the procedure, or you may be given a sedative before the anesthesia is started. If sedation is given, you will need someone to drive you home afterwards.
• You may want to bring a sanitary napkin to wear home after the procedure.
• Based upon your medical condition, your physician may request other specific preparation.

During the Procedure

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A colposcopy may be performed in your physician’s office, on an outpatient basis, or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician’s practices.

Generally, a colposcopy follows this process:

1. You will be asked to undress completely or from the waist down and put on a hospital gown.
2. You will be instructed to empty your bladder prior to the procedure.
3. You will lie on an examination table, with your feet and legs supported as for a pelvic examination.
4. Your physician will insert an instrument called a speculum into your vagina to spread the walls of the vagina apart to expose the cervix.
5. The colposcope, which is like a microscope with a light on the end, will be placed at the opening of your vagina. The colposcope does not enter your vagina.
6. Your physician will look through the colposcope to locate any problem areas on the cervix or in the vagina. Photographs with the colposcope or sketches of any areas may be made for your healthcare record.
7. Your cervix may be cleansed and soaked with a vinegar solution, also called an acetic acid solution. This solution helps make the abnormal tissues turn white and become more visible. You may feel a mild burning sensation. An iodine solution may be used to coat the cervix, called the Schiller test.
8. Your physician may take a small tissue sample called a biopsy. When this is done, the physician first numbs the area but you may feel a slight pinch or cramp as the tissue is removed.
9. Cells from the inside of the cervical canal may be sampled with a special instrument called an endocervical curette. This may also cause some cramping.
10. Bleeding from the biopsy site may be treated with a paste-like topical medication or with a pressure dressing.
11. The tissue will be sent to a lab for examination.

After the Procedure

After a colposcopy procedure, you may rest for a few minutes before going home.

If you have a colposcopy with a biopsy, the recovery process will vary, depending on the type of biopsy performed and the type of anesthesia (if any) used.

If you received regional or general anesthesia, you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home. If this procedure was performed on an outpatient basis, you should plan to have another person drive you home.

You may want to wear a sanitary pad for bleeding. If a biopsy was performed, it is normal to have some mild cramping, spotting, and dark or black-colored discharge for several days. The dark discharge is from the medication applied to your cervix to control bleeding.

If a biopsy was performed, you may be instructed not to douche, use tampons, or have intercourse for one week after the procedure, or for a period of time recommended by your physician.

You may also have other restrictions on your activity, including no strenuous activity or heavy lifting.

You may resume your normal diet unless your physician advises you differently.

Take a pain reliever for cramping or soreness as directed by your physician. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

Your physician will advise you on when to return for further treatment or care. Generally, women who have had a cervical biopsy will need more frequent Pap tests.

Notify your physician if you have any of the following:

• bleeding
• foul-smelling drainage from your vagina
• fever and/or chills
• severe pelvic (lower abdominal) pain

Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.