- What Is It?
- 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 the 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 sometimes necessary 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 that line the outer surface of the cervix and columnar cells that normally form the lining of the endocervical canal). The endocervical 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.)
What special tests are done during colposcopy?
Three special tests are done during colposcopy: acetic acid wash, use of color filters, and sampling (biopsy) of the cervix tissues.
Acetic acid wash for colposcopy
After the cervix is studied with the colposcope, the cervix is washed with a chemical called acetic acid, which is diluted 3% to 5%. The acetic acid (vinegar) washes away mucus and allows abnormal areas to be seen more easily with the colposcope. Moreover, the acetic acid stains the abnormal areas white. The areas that stain white after the acetic acid wash are called "acetowhite lesions." Sometimes, however, normal areas can also stain white, but these areas have vague or faint borders. In contrast, significant abnormalities, such as genital warts, pre-cancers (dysplasia), and cancers, generally produce acetowhite areas with distinct and clear boundaries.
Sometimes staining with a dilute iodine solution (known as Lugol's solution or Schiller's solution) is also performed to further examine for abnormalities. Normal cells will generally take up the iodine stain (and turn brown) in a uniform manner, whereas severe precancers and cancerous areas will not.
Use of color filters for colposcopy
Another aspect of colposcopy involves the use of color filters. The filters help the physician examine tiny blood vessels (capillaries) in the area of the squamocolumnar junction. Blue or green filtered light can cause abnormal capillaries to become more obvious, usually inside an acetowhite area.
Normal capillaries are slender and spaced out evenly. In contrast, abnormal capillaries can appear as red spots (thickened capillaries seen on end) or can produce a pattern resembling hexagonal floor tiles. The worse the cervical disease, the thicker and more widely spaced out are the capillaries. The abnormal capillary pattern ranges from mild, as with pre-cancer (dysplasia), to severe, as with established cancer. Thus, when cancer eventually develops, capillaries take on odd shapes, like punctuation marks.
Biopsy of the cervix
Finally, colposcopy allows tissue sampling (biopsy) that is targeted to the abnormal areas. In fact, the biopsy of abnormal areas is a critical part of colposcopy because treatment will depend on how severe the abnormality is on the biopsy sample. After colposcopy and biopsies, a chemical is applied to the biopsy area to prevent bleeding (spotting). As part of the biopsy procedure, endocervical curettage (sampling of the tissues within the endocervical canal, or the opening of the cervix to the uterine cavity) is often performed.
Based on the colposcopy results, what is the approach to treating cervical abnormalities?
If the biopsy results show pre-cancer (dysplasia) or cancer, treatment might be recommended. The dysplasia may be mild, moderate, or severe. Almost all women with dysplasia can have their treatment procedures performed in the doctor's office. The physician chooses between two general types of treatment. The first type is destruction (ablation) of the abnormal area, and the second type is removal (resection). Both types of treatment cure 90% of patients with dysplasia, meaning that 10% of women will have a recurrence of their abnormality after treatment.
The destruction (ablation) procedures are carbon dioxide laser photoablation and cryocautery. The removal (resection) procedures are loop electrosurgical excision procedure (LEEP), cold knife conization, and hysterectomy. Only certain, carefully chosen cases of cervical cancer are treated with LEEP or cold knife conization. Most cases of cervical cancer and occasional cases of severe dysplasia are treated by hysterectomy. Treatment for dysplasia or cancer is not usually done at the time of the initial colposcopy, since the treatment depends on the analysis of the biopsies done during colposcopy.
Carbon dioxide laser photoablation
This procedure, which is also known as CO2 laser, uses an invisible beam of infrared light. The laser actually vaporizes the abnormal area. Lidocaine, a local anesthetic, is given to numb the area prior to the laser treatment. A chemical is applied afterwards to prevent delayed bleeding. A substantial amount of clear vaginal discharge and spotting of blood can occur for a few weeks after the procedure. To improve healing, sexual intercourse and tampon use should be delayed for several weeks.
The complication rate of this procedure is very low, about 1%. The most common complications are narrowing (stenosis) of the cervical opening and delayed bleeding. Disadvantages of this treatment include that this procedure does not allow sampling of the abnormal area and is not satisfactory for treating cervical cancer. It is useful, however, for milder dysplasia. It is generally not considered safe for use during pregnancy.
Cryocautery is a relatively simple procedure that uses nitrous oxide to freeze the abnormal area. This technique, however, is not optimal for large areas or areas where abnormalities are already advanced or severe. After the procedure, patients can experience a significant watery vaginal discharge for several weeks. To improve healing, sexual intercourse is best avoided for several weeks.
Significant complications of this procedure are rare and occur in about 1% of patients. They include narrowing (stenosis) of the cervix and delayed bleeding. Cryocautery does not allow sampling of the abnormal area and is generally felt to be inappropriate for women with advanced cervical disease. Thus, this procedure is not satisfactory for treating cervical cancer, but is useful for milder dysplasia.
Loop electrosurgical excision procedure
Loop electrosurgical excision procedure, also known as LEEP, uses a radio-frequency current to remove abnormal areas. It is by far the most common treatment for precancerous lesions of the cervix. It has an advantage over the destructive techniques (CO2 laser and cryocautery) in that an intact tissue sample for analysis can be obtained. LEEP also is popular because it is inexpensive and simple. A chemical is applied afterwards to prevent bleeding. Vaginal discharge and spotting commonly occur after this procedure. Sexual intercourse and tampon use should be avoided for several weeks to allow better healing.
Complications occur in about 1% to 2% of women undergoing LEEP, and include cervical narrowing (stenosis) and bleeding. This procedure is used most commonly for treating dysplasia, including severe dysplasia. LEEP also is used, although infrequently, to treat carefully chosen cases of cervical cancer.
Cold knife cone biopsy
Cone biopsy was once the major procedure used to treat cervical dysplasia, but the other methods have now replaced it for this purpose. However, when a physician finds more serious lesions within the endocervix or inner area of the cervix, a cone biopsy continues to be recommended. It is also recommended if special sampling is needed to obtain more information regarding certain types of more advanced abnormalities. This technique allows the size and shape of the sampling to be tailored.
Complications of this procedure include postoperative bleeding in 5% of women and narrowing of the cervix. Cone biopsy has a slightly higher risk of cervical complications than the other treatments. This procedure is occasionally used to treat carefully chosen cases of cervical cancer.
Hysterectomy is the surgical removal of the uterus. This operation is used to treat most cases of invasive cervical cancer. Sometimes, a hysterectomy is done to treat severe dysplasia. It is also used if dysplasia recurs after any of the other treatment procedures.
Subscribe to MedicineNet's General Health Newsletter
"Patient information: Colposcopy (Beyond the Basics)"
Top Colposcopy Related Articles
Byfavo (remimazolam)Byfavo (remimazolam) is a benzodiazepine administered by injection to sedate adults who have to undergo minor surgical procedures lasting 30 minutes or less.
Cervical CancerCervical cancer is cancer of the entrance to the womb (uterus) caused by the human papillomavirus (HPV). Regular pelvic exams, Pap testing, and screening can detect precancerous changes in the cervix. Cervical cancer can be prevented by a vaccine. The most common signs and symptoms are an increase in vaginal discharge, painful sex, and postmenopausal bleeding. The prognosis and survival rate depend upon the stage at which the cancer was diagnosed.
Cervical DysplasiaCervical dysplasia is a condition in which the cells of the inner lining of the cervix have precancerous changes. There are two types of cervical dysplasia: squamous intraepithelial lesion and cervical intraepithelial neoplasia. Cervical dysplasia is caused by infection of the cervix with HPV (human papillomavirus). There are various diagnostic measures for cervical dysplasia. Treatment generally depends upon the progression of the dysplasia: mild, moderate, or severe.
HPV TestThe Cervista HPV test (human papillomavirus infection test in women) is a screening test used with other tests such as Pap smear and colposcopy for screening the two HPV types most likely to cause cancer, and to identify all "high-risk" HPV types. Cervista HPV test is not recommended for routine screening or for women under the age of 30.
Genital Warts (HPV) Infection in WomenGenital warts is a sexually transmitted infection (STI) caused by the human papillomavirus (HPV). Warts look like raised, flesh-colored lumps. Learn about symptoms, transmission, and treatment.
A hysterectomy is a surgical procedure in which the uterus is removed. There are a variety of surgical techniques for performing hysterectomies, which include vaginal hysterectomy, total hysterectomy, laparoscopy-assisted vaginal hysterectomy (LAVH), supracervical hysterectomy, laparoscopic supracervical hysterectomy, radical hysterectomy, and oophorectomy and salpingo-oophorectomy hysterectomies.
Complications include infection, pain, and bleeding. The type of hysterectomy performed is dependent on the woman and the reason for the procedure.
IBD SlideshowWhat is inflammatory bowel disease? IBD can include Crohn's disease and ulcerative colitis. Learn more about testing, treatments, and the home care needed to manage inflammatory bowel disease.
Laparoscopically Assisted Vaginal Hysterectomy (LAVH)Laparoscopically assisted vaginal hysterectomy (LAVH) is a surgical procedure using a laparoscope to guide the removal of the uterus and/or Fallopian tubes and ovaries through the vagina. During LAVH, the uterus is detached from the ligaments that attach it to other structures in the pelvis using laparoscopic tools. If the Fallopian tubes and ovaries are to be removed, they are also detached from their ligaments and blood supply. The organs and tissue are then removed through an incision made in the vagina.
LEEP (Loop Electrosurgical Excision Procedure)Loop electrosurgical excision procedure (LEEP) is a procedure used to remove abnormal tissues of the cervix. LEEP is used often to treat mild to moderate dysplasia. The effectiveness of LEEP is comparable to:
- cold knife conization,
- laser ablation,
- or laser conization.
MenopauseMenopause is the time in a woman's life when menstrual periods permanently stop, also called the "change of life." Menopause symptoms and signs include hot flashes, night sweats, irregular vaginal bleeding, vaginal dryness, painful intercourse, urinary incontinence, weight gain, and emotional symptoms such as mood swings. Treatment of menopausal symptoms varies and should be discussed with your physician.
Pap SmearA Pap smear (Pap test) is a medical procedure to screen for abnormal cells of the cervix. A woman should have her first Pap smear (in general) three years after vaginal intercourse, or no later than 21 years of age. The risks for women at increased risk for having an abnormal Pap smear include: HPV (genital warts), smoking, a weakened immune system, medications (diethylstilbestrol), and others. Some of the conditions that may result in an abnormal Pap smear include: absence of endocervical cells, unreliable Pap smear due to inflammation, atypical squamous cells (ASCUS), low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), cervical intraepithelial neoplasia (CIN), and carcinoma in situ.
Sexual HealthSexual health information including birth control, impotence, herpes, sexually transmitted diseases, staying healthy, women's sexual health concerns, and men's sexual health concerns. Learn about the most common sexual conditions affecting men and women.
Sexually Transmitted Diseases (STDs)Common sexually transmitted diseases (STDs) in women include gonorrhea, chlamydia, genital herpes, and HPV infection (genital warts). Learn about types, symptoms, and treatment.
Vagina PictureThe vagina is an elastic, muscular canal with a soft, flexible lining that provides lubrication and sensation. See a picture of the Vagina and learn more about the health topic.