A colposcopy is a medical procedure that uses a specialized magnifying instrument, called a colposcope, to closely examine the cervix, vagina, and vulva. It is often recommended when routine screening tests indicate the need for a more detailed assessment of potential cellular changes.
Reasons for a Colposcopy
A colposcopy is recommended when initial screening tests, such as a Pap test, reveal abnormal cellular changes on the cervix. Results like Atypical Squamous Cells of Undetermined Significance (ASCUS), Low-Grade Squamous Intraepithelial Lesion (LSIL), or High-Grade Squamous Intraepithelial Lesion (HSIL) often prompt further investigation to determine their nature and potential progression.
Another common reason for a colposcopy is a persistent infection with high-risk Human Papillomavirus (HPV). Certain HPV strains can cause cervical dysplasia, the abnormal growth of cells on the cervix. A colposcopy helps determine the extent and severity of these HPV-related cellular changes.
A colposcopy may also be performed to investigate unexplained vaginal bleeding, especially after sexual intercourse. It is also indicated if a healthcare provider observes a suspicious area on the cervix during a routine pelvic examination. This examination can identify conditions like cervical inflammation, noncancerous growths such as polyps, or genital warts.
What Happens During the Procedure
A colposcopy is typically performed in a healthcare provider’s office and generally takes about 10 to 20 minutes. During the procedure, you will lie on an examination table with your feet in stirrups, similar to a standard pelvic exam. A speculum is gently inserted into the vagina to hold the vaginal walls open, providing a clear view of the cervix.
The colposcope, resembling binoculars on a stand, is positioned a few inches away from the vulva and does not enter the body. This instrument has a bright light and magnifies the view of the cervix, allowing the healthcare provider to examine the tissue closely. To enhance visibility of any abnormal areas, solutions are applied to the cervix using a cotton swab.
A dilute vinegar solution, known as acetic acid, is commonly used, causing abnormal cells to temporarily turn white, which helps highlight suspicious regions. Sometimes, Lugol’s iodine solution may also be applied; normal cervical tissue containing glycogen will stain brown, while abnormal areas may not. If any unusual areas are identified, a small tissue sample, called a biopsy, may be taken for laboratory analysis. This biopsy can cause a brief pinching or cramping sensation.
Understanding the Results
If a biopsy was taken during the colposcopy, the tissue sample is sent to a laboratory for analysis, with results typically available within a few weeks. The biopsy provides a definitive diagnosis by identifying the type and grade of any cellular changes. A normal result means no abnormal cells were found.
If abnormal cells are identified, they are categorized as Cervical Intraepithelial Neoplasia (CIN). CIN is graded based on the severity of abnormal cell growth within the cervical tissue. CIN 1 indicates mild dysplasia, where abnormal cells are limited to the lower third of the cervical lining. CIN 2 signifies moderate dysplasia, affecting up to two-thirds of the lining, while CIN 3 represents severe dysplasia or carcinoma in situ, involving more than two-thirds or the full thickness of the lining.
CIN, even CIN 3, is not cervical cancer itself, but precancerous changes that could develop into cancer if left untreated. In some cases, Cervical Glandular Intra-epithelial Neoplasia (CGIN) may also be identified, which are considered precancerous. Colposcopy guides where to take biopsies, and laboratory analysis provides the precise diagnosis.
Next Steps After a Colposcopy
The next steps following a colposcopy depend on the biopsy results and the severity of any cellular changes found. If results are normal or show only mild changes like CIN 1, a healthcare provider may recommend watchful waiting, as mild dysplasia often resolves on its own. This involves scheduling repeat Pap tests or colposcopies at specific intervals to monitor the cells.
For more advanced changes, such as CIN 2 or CIN 3, treatment to remove abnormal cells is usually recommended. Common options include Loop Electrosurgical Excision Procedure (LEEP), which uses a heated wire loop to remove affected tissue, or cryotherapy, which freezes abnormal cells. A cone biopsy, which removes a cone-shaped section of the cervix, may be performed for deeper changes or when abnormal cells are higher in the cervical canal. Your healthcare provider will discuss the most appropriate course of action based on your specific diagnosis and individual circumstances.