Colposcopy Procedure Details
Colposcopy is a method that Gynecologists use to evaluate abnormal cells of the cervix or vagina. Colpos refers to the vagina and scopos means to look. The colposcope is merely a lighted binocular telescope used to evaluate abnormal cells found on a Pap smear of the cervix, or the vaginal apex if you have had a hysterectomy.
Abnormal cells of undetermined significance (ASCUS) in association with high risk human papilloma virus (HPV) subtypes, dysplasia (precancerous cells), carcinoma in situ (full thickness severely abnormal cells that have not broken the basement membrane), or cancer on a Pap smear are reasons that your Gynecologist would recommend colposcopy.
Colposcopy is an outpatient procedure and requires no anesthesia. A 3% acetic acid solution (basically dilute vinegar and water combination) is applied to the cervix once it is visualized with a speculum. The colposcope is then placed in front of the perineum so that the physician can easily visualize the cervix and upper vagina.
Notation of lesions, or abnormal areas, are subsequently documented. White lesions, abnormal blood vessel patterns, and raised lesions are areas that the gynecologist is most concerned about and will subsequently biopsy. The full extent of the lesions must be seen. Abnormal areas that extend into the endocervical canal (area between the uterine cavity and the outside of the cervix) are worrisome and will require an additional biopsy.
The relationship of the abnormal areas to the transformation zone is also documented. The transformation zone is the transitional area between the squamous (or flat cells of the outer cervix) to the glandular cells that occupy the endocervical canal.
The most abnormal areas are biopsied using a special cervical biopsy forcep. This feels like a pinch and is several mm in width and depth. It is very quick and the discomfort goes away within seconds. Occasionally, a solution may need to be applied to the biopsy site to prevent bleeding.
The biopsy tissue is placed into a special liquid medium and sent to the lab where a pathologist who specializes in looking at gynecologic samples will give a final diagnosis. If you require an endocervical biopsy, this specimen is placed in a separate container and also evaluated.
Once the results return, your Gynecologist will decide what, if any, treatment is needed. A two step discrepancy between the biopsy and Pap result requires further evaluation. For example, your Pap smear shows severe dysplasia but the biopsies show no abnormalities.
With an abnormal result from the endocervical biopsy, evidence of cervical intraepithelial neoplasia II-III(CIN), or discrepancy between your pap and biopsy result, it is usually recommended that you undergo a cone shaped biopsy of the cervix.
Cone shaped biopsies are performed as outpatient procedures and may require cervical anesthesia. This can be either by using a scalpel or a wire loop through which electricity is used to enable the biopsy and obtain hemostasis (prevent bleeding). The wire loop biopsies are called either LEEP (loop electrosurgical excision procedure), or LLETZ (large loop excision of the transformation zone).
For CIN I-II lesions, cryotherapy can be performed to freeze and destroy the abnormal cells. In some cases of CIN I, allowing time to heal this mild abnormality can be used with frequent Pap smear follow up. If the abnormality persists, colposcopy with subsequent treatment will be necessary.
Choosing a gynecologist or physician who does frequent colposcopies is recommended. This will insure that the person evaluating your cervix will be more apt to find the truly abnormal areas that need to be biopsied and can present appropriate treatment options to you once the biopsy results return.
If you are diagnosed with cervical dysphasia, it is highly recommended that you stop smoking tobacco products. Smoking is a co-carcinogen with the HPV virus that causes the abnormal cells, and increases the risk of developing cervical cancer over time.