Colposcopy

  • Medical Author:
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Colposcopy facts

  • Colposcopy is a procedure used by physicians that provides a magnified and illuminated view of the vulva, vaginal walls, and uterine cervix.
  • This procedure is often done to evaluate an abnormal appearing cervix or an abnormal Pap smear result.
  • Special tests are done during colposcopy, including acetic acid wash, use of color filters, and sampling (biopsy) of tissues.
  • Cervical abnormalities include pre-cancer (dysplasia), which can be rated as mild, moderate, or severe, and cancer.
  • The type of treatment procedure chosen by the physician depends on the severity of the cervical abnormality, which is determined by analysis of the colposcopy biopsy sample.
  • The treatments for cervical abnormalities include the destruction (ablation) procedures - cryocautery and carbon dioxide laser -- and the removal (resection) procedures -- loop electrosurgical excision procedure (LEEP), cold knife conization, and hysterectomy.
  • Except for hysterectomy, which is almost always used for invasive cancer and is rarely used for dysplasia, most of the treatments are all safe enough to be performed in the doctor's office.

What is colposcopy?

Colposcopy is a gynecological procedure that illuminates and magnifies the vulva, vaginal walls, and uterine cervix in order to detect and examine abnormalities of these structures. The cervix is the base of the womb (uterus) and leads out to the birth canal (vagina). During colposcopy, special tests [acetic acid wash, use of color filters, and sampling (biopsy) of tissues] can be done. Colposcopy is not to be confused with culdoscopy, which is the insertion of an instrument through the wall of the vagina in order to view the pelvic area behind the vagina.

Why is colposcopy done?

Colposcopy is usually done in one of two circumstances: to examine the cervix either when the result of a Pap smear is abnormal, or when the cervix looks abnormal during the collection of a Pap smear. Even if a Pap smear result is normal, colposcopy is ordered when the cervix appears visibly abnormal to the clinician performing the Pap smear. The purpose of the colposcopy is to determine what is causing the abnormal looking cervix or the abnormal Pap smear so that appropriate treatment can be given.

How is colposcopy done?

A colposcope is a microscope that resembles a pair of binoculars. The instrument has a range of magnification lenses. It also has color filters that allow the physician to detect tiny abnormal blood vessels on the cervix. The colposcope is used to examine the vaginal walls and cervix through the vaginal opening.

  • The first step of the procedure is examining the vulva and vagina for signs of genital warts or other growths. (Genital warts are caused by the human papilloma virus (HPV), which is a sexually transmitted virus that can cause cervical cancer.)
  • A Pap smear is then taken.
  • The cervix is inspected and the special tests are done (see below).

Colposcopy is a safe procedure with no complications other than vaginal spotting of blood.

The examiner wants to get a good look at the squamocolumnar junction, which is the area of the cervix that gives rise to most cases of cervical cancer. The term squamocolumnar junction refers to the border between the two different types of cells (squamous cells and columnar cells) that normally form the lining of the endocervical canal. (This canal connects the cervix with the main part of the uterus.) Most cases of cervical cancer originate from the squamous cells and, therefore, are referred to as squamous cell cervical cancer.

During colposcopy, the entire squamocolumnar junction is more likely to be seen in young women. The reason for this is that after menopause, the squamocolumnar junction tends to migrate inside the endocervical canal. Colposcopy, therefore, is occasionally not adequate in women after menopause. Therefore, if the whole squamocolumnar junction area of the cervix is not visible on colposcopy, another type of procedure may need to be performed that allows the entire squamocolumnar junction to be examined. (See cold knife cone biopsy below.)

Medically Reviewed by a Doctor on 5/13/2015

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