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What is a Colposcopy?
Coloposcopy is a diagnostic instrument used to determine the cause of abnormalities found in Pap smears. It is essentially a microscope which magnifies the cervix, so that the doctor can take a closer look at the cervix. It is a simple and painless procedure and can be performed at a clinic setting. The procedure does not require an anaesthetic and takes approximately ten to fifteen minutes.
FMGC has a digital colposcopy which takes magnified images of the cervix and displays them onto a monitor. The cervix can be visualized in exquisite details.
When is a Colposcopy done?
A colposcopy is done when the pap smear shows an abnormality. Some of the abnormalities include dysplasia or cancer, human papilloma virus (HPV) infection, typical squamous cells of undetermined significance (ASCUS) or repeated (ASCUS). However, you should remember that most abnormal Pap smears are not cancer, and your abnormal results are likely caused by an inflammation or infection.
How can I prepare for a colposcopy?
Preparation for a colposcopy is similar to preparing for any gynecological exam. You should schedule an exam when you are not menstruating. Avoid douching, sexual intercourse, vaginal medications, and tampons for 24 hours before the examination. You may be given an analgesia (such as panadol) to take before the procedure. There are no fluid or food restrictions.
How is a Colposcopy done?
A colposcopy is much like having a Pap smear. You are positioned on the examination couch, and a plastic disposable speculum passed gently into the vagina to visualize the cervix. The speculum will remain in place for the duration of the examination.
The colposcope is positioned approximately 30 cm from the vagina. A bright light on the end of the colposcope makes it possible for your doctor to visualize the cervix. The doctor will inspect your vagina and cervix. A small amount of saline solution (salt water) may be applied into the vagina to moisten the surface.
An acetic acid preparation (vinegar solution) will then be applied to your cervix. The solution may feel cool but will not burn. The acetic acid application will enable abnormal cells to be more visible. The doctor then will re-inspect the vagina and cervix and will perform a biopsy (take a tissue sample) if it is necessary. Different filters (green , red) may be used to accentuate the blood vessels that are abnormal. Special stains may be required to see certain areas in the cervix. The most common stain is an iodine (Lugol's) solution, which stains glycogen in cells. Normal cells will stain dark-brown while the abnormal cells will not stain. These areas are then biopsied.
The doctor uses forceps to remove a small piece of tissue (biopsy) from an area of the cervix where abnormal cells have been detected. The doctor may use local anesthetic to numb the cervix first. You may briefly experience pain, mild cramping in the lower abdomen or light bleeding.
The doctor may also perform an endo-cervical sampling-a gentle scraping of the cervical canal (endo-cervix). After using local anesthetic to numb the cervix, the doctor inserts a narrow instrument called a curette into the passage between the outer part of the cervix and the inner part of the uterus. That may cause a cramping sensation. Any specimens obtained from these procedures then will be sent to a lab for examination under a microscope.
Cone biopsy:
This procedure consists of removing a cone-shaped piece of cervical tissue from the border between the ectocervix and the endocervix. This area is called the transformation zone and this is the area where cancerous or precancerous conditions most often originate.
What are the Risks and Complications?
Colposcopy is a relatively safe procedure. You may experience slight bleeding from the biopsy sites. However, if you experience heavy bleeding (more than 1 pad every 2-3 hours) or if the bleeding lasts more than 5 days, you should consult your doctor. Similarly, you should contact your doctor should you develop a fever, worrisome vaginal discharge, or increasing or continued pelvic or abdominal discomfort for longer than 24 hours after the examination.
What happens after the colposcopy?
Following the colposcopy, you should wear a sanitary pad. Small amounts of bleeding may occur for up to 5 days. Do not be alarmed if you see dark fluid-like material, sometimes green, resembling coffee grounds on the pad. The fluid is normal because you are expelling the solutions used during the examination. You should avoid douching, sexual intercourse, vaginal medications, or tampons until the bleeding stops.
Biopsies and samples of tissue undergo microscopic inspection at a pathology lab, often with special chemicals. A pathologist will determine normal cells from abnormal cells and send a report to your doctor. The report normally takes several days. The doctor will telephone you the results as soon as it is available. You may be given a follow-up appointment to discuss the report and further treatment. If you do not have the results within 2-3 weeks, call your doctor, unless other arrangements have been made.