COLPOSCOPY

DR. S. Kalaichandran, MBBS, MD, FRCSC,FSOGC (Canada), FRCOG

Lecturer University of Ottawa
Obstetrics and Gynaecology

    Colposcopy is a special examination of the cervix (and vagina, vulva, perineum and peri-anal areas) under magnification. The special microscope used for this purpose is called the Colposcope.

    Hinselmann invented the Colposcope in 1925. Colposcopy was confined to German speaking nations until 1960. The modern colposcopes have their own illumination and magnification is usually six to forty folds. Often, a still or video camera is attached to the colposcope for documentation and teaching purposes. A video monitor is very helpful to explain the findings to informed patients.

    Abnormal topography, colour, vessels and epithelium with changes on application of saline, vinegar and Schiller’s iodine are studied under magnification.

    The most common reason for colposcopy is abnormal cells on screening Pap test. The other common reasons are post-coital or post-menopausal bleeding, venereal warts, and suspicious or pigmented lesions of cervix, vagina, vulva, perineum or perianal areas. The magnification of the colposcope is also useful in examining of victims of sexual abuse.

The Procedure

    In order to reduce apprehension at the time of colposcopy, counselling should be provided at an earlier visit. The procedure should be explained to the patient with the help of pictures; pamphlets and/or videos and handouts should also be provided. The ideal time for the examination is one week after the end of any vaginal bleeding.
 

    The patient is placed on her back with her buttock at the edge of the examining table with her heels on the foot- rests. A warm speculum is inserted into her vagina to visualize the cervix (same as for a Pap smear). A Pap test is usually carried out first. The colposcope is then used to look at the cervix under magnification. After noting any surface abnormality or colour change (leuckoplakia), saline solution may be used to bathe the cervix.

    The cervix is then visualized using a green filter to check for any abnormal vessels. Vinegar is then applied to the cervix and vagina and a systematic examination is carried out to check for any abnormal epithelium, which may change white in colour or show abnormal, vascular patterns variously described as punctation, mosaics or atypical vessels. When the cervical epithelium, which needs to be studied, is in the endocervical canal, insertion of an endocervical speculum may be necessary to visualize the epithelium.
A biopsy may be taken of any abnormal epithelium with a biopsy punch and the endocervix may be sampled with a brush or curette if colposcopy is unsatisfactory (an anaesthetic is not usually required). The cervix may also be painted with Schiller’s iodine and viewed. Abnormal areas do not stain mahogany colour.

    A complete examination includes examination of the cervix, vagina and vulva and may take about fifteen to thirty minutes.

COLPOSCOPY

Copyright © 1999 [Dr. Kalaichandran]. All rights reserved.
Revised: May 12, 2003 .