Colposcopy
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Indications
Procedure
How to Prepare
Postcolposcopy
Colposcopy is a gynecologic procedure to examine an illuminated, magnified view of the cervix and the tissues of the vagina and vulva. Many premalignant lesions and malignant lesions in these areas have visual characteristics or patterns which can be detected by the application of a vinegar solution that causes dehydration and color change of the tissue. The abnormal cells are thicker and appear more dense and white. The abnormal areas are called acetowhite changes as vewed through the colposcope. By using the colposcope, there is an enlarged view of the cervix and vagina or vulva. Dr. Purdy is able to visually distinguish normal from abnormal appearing tissue and take directed biopsies for further pathological examination. The main goal of colposcopy is to prevent cervical cancer by detecting precancerous lesions early and treating them. The procedure was developed in 1925 by the German physician Hans Hinselmann.
Indications for colposcopy
Most women undergo a colposcopic examination to further investigate a cytological abnormality on their pap smears. Other indications for a woman to have a colposcopy include:
- assessment of diethylstilbestrol (DES) exposure in utero (very rare now - a generational exposure to DES)
- immunosuppression such as HIV infection, or an organ transplant patient candidate
- an abnormal appearance of the cervix as noted by a physician.
The procedure: Colposcopy is an office based minor procedure!
A colposcope is used to identify visible clues suggestive of abnormal tissue. It functions as a lighted binocular microscope to magnify the view of the cervix, vagina, and vulvar surface. Low power (2× to 6×) may be used to obtain a general impression of the surface architecture. Medium (8× to 15×) and high (15× to 25×) powers are utilized to evaluate the vagina and cervix. The higher powers are often necessary to identify certain vascular patterns that may indicate the presence of more advanced precancerous or cancerous lesions. Various light filters are available to highlight different aspects of the surface of the cervix. Acetic acid solution (vinegar) is applied to the surface to improve visualization of abnormal areas.
Colposcopy is performed with the woman lying on her back, legs in stirrups, and buttocks at the lower edge of the table (a position known as the dorsal lithotomy position). A speculum is placed in the vagina after the vulva is examined for any suspicious lesions.
Three percent acetic acid (household white vinegar) is applied to the cervix using cotton swabs. The transformation zone is a critical area on the cervix where many precancerous and cancerous lesions most often arise. The ability to see the transformation zone and the entire extent of any lesion visualized determines whether an adequate colposcopic examination is attainable.
Areas of the cervix which turn white (acetowhite) after the application of acetic acid or have an abnormal vascular pattern are often considered for biopsy. If no lesions are visible, an iodine solution may be applied to the cervix to help highlight areas of abnormality.
After a complete examination, Dr.Purdy determines the areas with the highest degree of visible abnormality and may obtain biopsies from these areas using a long biopsy instrument. D.Purdy uses Hurricane aerosol* as topical anesthetic spray to diminish patient discomfort, particularly if many biopsy samples are taken.
Following any biopsies, an endocervical curettage (ECC) is often done. The ECC utilizes a long straight curette to scrape the inside of the cervical canal. The ECC is never perfomred on a pregnant woman. Monsel's solution (ferrous subsulfate) is applied with large cotton swabs to the surface of the cervix to control bleeding. This solution looks like mustard and becomes black in color when exposed to blood. After the procedure this material will be expelled naturally: women can expect to have a thin coffee-ground like discharge or passage of material that may lool like shinny coal lumps for up to several days after the procedure.
How to prepare for colposcopy:
There is very little preparation required. The patient should avoid sexual intercourse for 24 hours prior to the planned procedure. She should avoid intravaginal application of medications. She should not douche for 24 hours before the procedure. She may want to bring her own fresh sanitary pad for use after the procedure; Dr. Purdy's office has a suppl;y of fresh pads if needed by the patient after the procedure. There is no food or oral fluid restrictions for the procedure. Colposcopy is a simple nearly painless procedure performed in the office.
Complications
Significant complications from a colposcopy are not common -very rare, but may include bleeding, and remote risk of an infection at the biopsy site. Postcolposcopy discomfort is slight and may be crampy.
Post colposcopy and follow up:
Dr. Purdy recommends no sexual intercourse for 5 days or untill the vaginal discharge clears by 24 hours if a biopsy was performed. If no biopsy was performed, then there is no restrictions. Showering is recommended rather than a tub bath untill all discahrge stops by 24 hours!. Strenous physical activity should be avoided for 5 days after the procedure if a biopsy was performed. In general, there should no major life style change required after the colposcopy.
Follow up: Dr.Purdy usually schedules the patient to return in 2 weeks for a review of the biopsy report.
Dr. Purdy does not allow follow up phone conversations on the outcome of the tissue biopsied. The pathology repor t is always discussed in a face to face meeting with Dr.Purdy! This practice reduces errors.
Adequate follow-up is critical to the success of this procedure. Human Papilloma Virus (HPV) is a common infection and the underlying cause for most cervical dysplasia. Dr.Purdy advises on the benefits of safe sex for reducing their risks of contracting and spreading the HPV virus. Recent medical literature suggests that prostaglandin in semen may fuel the growth of cervical and uterine tumours and that affected women may benefit from the use of condoms.
Smoking predisposes women to developing cervical abnormalities. A smoking cessation can reduce the risk of cervical cancer by 50 percent!.
Without proper treatment, minor abnormalities may develop into cancerous lesions. Various treatments exist for significant lesions, most commonly cryotherapy, loop electrical excision procedure (LEEP), and laser ablation.
Hurricane aerosol is a spray anesthetic that dentists use for local numbing on the mouth mucus membranes. The vapor of Huricane smells like wild cherry. It may sting very slightly due to a differecne in the mouth and vaginal Ph of the mucus membranes. The numbing action works immediately.