Colposcopy is a fundamental exam in gynecology: it is not painful, has a low cost and can give useful results for treating various problems.
What is colposcopy? The term colposcopy comes from the Greek ( scopeo = to observe blow = vagina) and is an endoscopic examination (internal observation) which consists in the visual analysis of the vagina and the cervix with an optical instrument, called colposcope.
The same tool is also used to visualize the external genitalia, the vulva. In this case the examination is called vulvoscopy. Usually the two tests are done simultaneously in the clinic.
The equipment is a sort of microscope – binocular or monocular – equipped with light, which allows a magnified view of the female genitals from 6 to 40 times. During the examination, the instrument is not introduced inside the female body but remains outside allowing only an enlarged view of the completely painless apparatus.
What is colposcopy for?
The colposcopy is not a screening test that either subjecting all women, as is the case for the Pap test , but it is a level II examination, performed for early diagnosis of precancerous lesions of the cervix and thus required by the medical specialist .
But that’s not the only case. The colposcopy is still used as many times as you want to look closely at the female genitalia. The main indications for the execution of vulvo-colposcopy can be summarized as follows:
– The presence of an abnormal pap test , which suggests the presence of an HPV infection, the human papilloma virus, responsible for cancer of the cervix and vagina (the acronyms that appear on the pap test may be the presence of HPV, ASCUS, AGUS, L-SIL, H-SIL)
– the presence of genital warts o warts
– the suspicion of other sexually transmitted diseases, such as syphilis , which manifests itself with ulcerated lesions of the genitals
– the presence of atypical bleeding , for example between cycles or after sexual intercourse
– the finding during gynecological examination of lesions such as polyps, fibroids , cysts of the vulva, vagina or cervix
– the presence ofpersistent vulvar itching and burning (in this case vulvoscopy is done more if the discomfort is only external) or skin lesions, to exclude skin diseases such as lichen or other dermatological diseases.
How is a colposcopy done?
The examination is performed in a gynecological position (legs apart resting on the supports of the doctor’s bed). The vision of the external genitals does not require any maneuver, while to see the vagina and cervix the speculum must first be inserted, the retractor commonly used also for the execution of the pap test .
A preliminary assessment of the tissues is made, then chemical reagents are applied with a cotton swab (acetic acid first and Lugol’s solution then). After a few seconds the evaluation under the microscope is repeated to understand how the tissues have changed after the application of the dye.
The areas affected by HPVthey turn white after application of acetic acid and do not fix Lugol’s brown color, thus remaining lighter. They are thus easily visible in their extension and it is possible to perform a targeted biopsy if the specialist deems it necessary, to have histological confirmation.
How long does the colposcopy last and how do you prepare for the exam?
From 10 to 30 minutes, depending on the clinical picture in front of you. It lasts less if you just have to observe it, it lasts longer if you also perform a biopsy together.
How do you prepare for a colposcopy ? There are no special preparations, as the examination is painless. However, abstention from sexual intercourse and the use of vaginal pessaries or creams within 48 hours prior to the exam is required. This is in order not to interfere with the results and evidence.
Similarly, the examination is not performed on the days of menstruation, since the presence of blood limits the vision of the colposcope and therefore could interfere with a correct diagnosis. The presence of a strong vaginal infection with abundant discharge should also delay the examination.
The pregnancy is not a contraindication instead examination, since you can perform with absolute peace: just tell the gynecologist before the execution of the colposcopy .
Allergies to latex, iodine and various drugs, including local anesthetics, substances that could be used before taking a biopsy, must be absolutely communicated.
The result of the last pap test must always be brought, especially if abnormal.
Are there any risks and complications?
There are no risks or complications, as it is a fast and safe examination. The woman can safely go home alone and even drive after taking the exam. It is possible that at the end of the examination there will be some blood loss , usually scarce, even if a biopsy is to be done, so it is good that the woman brings with her a panty liner.
On the other hand, it is not necessary to administer painkillers, as is usually done after going to the dentist. Antibiotic prophylaxis is reserved for only a few cases on specific medical indication.
How much does colposcopy cost?
The colposcopy has a variable cost depending on whether the service is delivered through the NHS or in the private sphere. In the first case, the cost of the examination and a possible biopsy with histological examination is around 70 euros, while privately the costs are doubled, undergoing considerable variations based on the histological examination to be done.
The examination is usually performed in an outpatient clinic at a hospital, or in some private centers that have a colposcope.
What are the results of a colposcopy?
With colposcopy there are several areas under observation. With this examination we aim to evaluate the lining (epithelium) of the cervix that protrudes into the vagina (exocervix) and of the vaginal walls, the one that covers the inside of the cervix (endocervix) as far as possible and above all the external-internal passage point of the uterine neck (squamous columnar junction), where tumor lesions are most frequently located: the colposcope examination is therefore considered unsatisfactory, which fails to evaluate this area, generally because it is too internal in the canal cervical.
This can happen in several cases, and not necessarily for a pathology. It can occur in menopausal womenor who has not given birth due to the presence of a too narrow and closed neck or in the woman who has undergone operations in the past and therefore presents scars.
The tissues are then searched for any lesions suggestive of viral HPV infection which, as we have seen, react in a typical way to the colors applied.
The identification of these lesions is an indispensable prerequisite for carrying out a targeted biopsy, which is not always necessary, and for subsequently evaluating the appropriate therapies.
To allow for a homogeneous interpretation, the results of the examination are described according to a shared and continuously updated international classification, and reported on a special form which also includes a drawing of the cervix, on which the lesion found can be better represented.
If the colposcopy is negative, ie no lesions were detected and the examination was satisfactory, the acronym NTZ will be seen, which means the presence of the normal transformation zone (ie the squamous columnar junction).
In the presence of alterations, on the other hand, the abbreviation ANTZ will appear on the report, that is, zone of abnormal transformation, with the subsequent classification in degrees from 0 to 2 depending on the characteristics of the lesion found.
The presence of warts is referred to as condyloma tosi.
What to do if the colposcopy is abnormal?
If the examination shows precancerous lesions, confirmed by the biopsy, which allows to directly evaluate the tissue taken, the woman will be subjected in a time following the treatment, which consists in removing the diseased tissue part with different techniques, always in the clinic. under local anesthesia and under colposcope control.
