Colposcopy

What is Colposcopy?

Colposcopy is a special examination using a magnifying instrument (colposcope) to look closely at the cervix (opening of the uterus), vagina and vulva. The colposcope is not inserted into the vagina. It won’t cause any radiation, and it will not go inside the vagina.

It typically requires 10 to 20 minutes and is conducted in an outpatient clinic so you can be discharged home the same day.

Why might I need a Colposcopy?

A colposcopy might be recommended if you:

• You have abnormal cells on your Pap test.
• You have a positive HPV test result for a high-risk HPV type.
• You experience unexpected bleeding following sex.
• You have prolonged heavy bleeding.
• On pelvic examination, the cervix is abnormal.
• Previous treatment for cervical abnormalities needs follow-up.

A colposcopy does not always mean you have cervical cancer. It can be used in many situations to just confirm if the abnormality is harmless or if it requires treatment.

What are the conditions detected by Colposcopy?

A colposcopy can be used to diagnose:

• Abnormal cervicovaginal cells (Cervical dysplasia / CIN) – Abnormal cells on the cervix, which may require monitoring or treatment.
• Changes caused by infection with the human papillomavirus (HPV) – Changes that are seen in the body because of infection with a high-risk type of HPV.
• Cervical cancer – Identifies suspicious areas that need to be biopsied to confirm the diagnosis.
• Vaginal intraepithelial neoplasia (VAIN) – Pre-cancerous cells in the vagina.
• Vulvar Intraepithelial Neoplasia (VIN) – abnormal cells that look like cancer in the vulva.
• Vaginal cancer – abnormal areas in the vagina that can be biopsied.
• Vulva cancer – Lesions that look suspicious on the vulva.
• Cervicitis – An infection or irritation of the cervix.
• Polyps in the cervix – non-cancerous growths which can lead to bleeding or discharge.
• Warts that develop on the genitals are due to specific types of HPV.

How should I prepare for Colposcopy?

Make an appointment at the appropriate time.

• If possible, have the test done during the time between periods.
• Light bleeding is okay, but heavy bleeding can make it hard to examine the cervix.

Do not use anything in the vagina for 24-48 hours before the test.

Your healthcare provider might recommend that you stop doing the following:

• Sexual intercourse.
• Tampons
• Any vaginal creams or medicines (unless instructed to take).
• Do not use cranberry juice, coconut milk or other fluids to douche (this is not recommended at any time).

Let your doctor know if you:

• Are you pregnant or think you might be pregnant?
• Are sensitive to medications, iodine or latex.
• Take blood-thinning medications or have a bleeding disorder.
• Have had previous cervical procedures or surgery.

Feed and drink as usual

• In most cases, There is no requirement to fast. If not directed otherwise by a doctor, a person consumes a light meal and drinks plenty of liquid.

Wear comfortable clothing

• Wear loose, comfortable clothes that can be easily removed.
• You will be required to change from waist up to waist down and will have to wear a medical gown.

Take a sanitary towel

If a biopsy is taken:

• A few days of light spotting or brown/black discharge may occur.
• The sanitary pad is generally more comfortable after the procedure than a tampon.

What is procedure of Colposcopy?

Preparation

• Before the exam, you will be asked to empty your bladder.
• You will be positioned on a table for an examination with your feet supported, like a standard pelvic exam.
• The insertion of the speculum
• A speculum is a small instrument that is inserted gently into the vagina to open it up and allow the doctor to clearly view the cervix.
• You might feel a bit of pressure, though it is typically not painful.

Examination using the colposcope

• The colposcope is placed about 2 inches from the opening of the vagina.
• Using a bright light and a magnifying lens, the doctor can look at the cervix closely.
• The colposcope is not inserted into the body.

The special solutions are applied.

• The cervix is treated with a 3-5% acetic acid (vinegar) solution. This can result in slight temporary stinging.
• An iodine solution (Lugol’s iodine) is also applied to diagnose abnormal regions.

The doctor checks for any changes like:

• Acetowhite areas (white patches)
• Abnormal blood vessels
• Patterns of mosaics or punctuation
• Those areas where iodine is not absorbed are Iodine negative areas.

Biopsy (if needed)

• A small tissue sample (biopsy) is taken if an abnormal area is detected.
• It is possible that you will experience a small pinch or cramp.
• An endocervical curettage (ECC) may be done to retrieve cells from within the cervical canal.

Control of bleeding

If a biopsy is performed, a special solution or paste may be applied to prevent any minor bleeding.

What happens after the Procedure?

• Most people get recovered faster and return to their normal activities.
• If a biopsy is not carried out, there are no restrictions.

If a biopsy is taken,

• Discharge of dark coloured, mild spotting for a few days, which is very common.
• Avoid vaginal intercourse, using tampons and douching for about 3-7 days.
• If you have heavy bleeding, fever, foul-smelling vaginal discharge, or abdominal pain, then seek medical care.

What are the risks of Colposcopy?

The procedure of colposcopy is generally quite safe and rarely has serious complications.

The side effects of a temporary nature are:

• Mild abdominal pain.
• Light vaginal bleeding or spotting.
• Black or brown discharge (from the solution used during the procedure).
• Mild pain or cramps for 1-2 days.

Rare complications include:

• Heavy bleeding
• Infection of the vagina
• Pelvic pain

Can colposcopy help to prevent Cervical cancer?

Colposcopy is not a way to prevent cancer.

It only looks for abnormal cells and allows them to be treated before they develop into cancer. That is why regular cervical screening and early colposcopy have helped to significantly lower the prevalence of cervical cancer in many countries.

What are modern innovations used in Colposcopy?

Digital Colposcopy

High-definition cameras are used for digital colposcopy so that images of the cervix are magnified and displayed on a screen, rather than just on a microscope.

Benefits:

• Offers more detailed and sharper images.
• Supports saving and comparing images at a later time.
• Improves documentation and patient counselling.
• Assists others in consulting with specialists.

Artificial Intelligence (AI)-assisted Colposcopy

Incorporating AI (Artificial Intelligence) into colposcopy systems is a growing trend to examine the images of the cervix and detect any suspicious lesions.

Benefits:

• Enhances the ability of detecting high-grade cervical lesions.
• Reduces variability between different examiners.
• Supports less experienced health care practitioners.
• Aids in deciding the most appropriate biopsy site
• Dynamic Spectral Imaging (DSI)

Dynamic Spectral Imaging analyses the changes that occur in cervical tissue after acetic acid is applied. It creates a colour-coded map, which indicates areas where there are likely to be abnormal cells.

Benefits:

• Increases the ability to detect unusual regions.
• Increases biopsy accuracy.
• Minimises the risk of missing important lesions.
• Enhances diagnostic consistency.

Cutting-edge Optical Imaging Technologies

This is because new optical technologies are available that enhance the visualisation of cervical tissue beyond what is offered by traditional colposcopy.

Examples include:

• Narrow-band imaging (NBI)
• Fluorescence imaging
• Optical spectroscopy

Benefits:

• Improved detection of abnormal blood vessels.
• Improved detection of abnormal, precancerous cells.
• The possibility of avoiding unnecessary biopsies.

Portable and Smartphone-Based Colposcopy.

The introduction of portable colposcopy (P-Co) and Smartphone-based systems has increased the availability of cervical screening, particularly in rural and less-resourced areas.

Benefits:

• Easy to carry and lightweight.
• More affordable than traditional colposcopes.
• Increases access to screening for cervical cancer.
• Enables community-based screening programs.

Tele colposcopy

During the tele colposcopy, digital images of the vaginal exam can be safely transmitted to a specialist gynaecologist for further interpretation from a distance.

Benefits:

Provides access to specialist opinions.

• Reduces delays in diagnosis.
• Enhances health care provision in suspicious
• Helps with medical education and quality assurance.

Integrating Electronic Medical Record (EMR) systems.

New colposcopy systems can be integrated into computer medical records.

Benefits:

• Simplifies documentation.
• Enables easy follow-up and comparison of previous findings.
• Enhances collaboration between health care practitioners.
• Helps with research and clinical audits.

This is a simple, safe and highly effective procedure which is essential for women health, called colposcopy. This news of the need for a colposcopy may be anxiety-provoking, but remember that an abnormal Pap test and/or HPV test is not a sign of cervical cancer. The procedure is usually carried out to look for changes at an early stage when they are easiest to monitor or treat.

Usually 10-20 minutes, not much preparation is required, and most women can follow up with their normal activities on the day of the exam. When a biopsy is necessary, it can be very useful in helping the doctor to decide on treatment.

Cervical screening is becoming more accurate, accessible and patient-centred through modern innovations like digital colposcopy, high-definition imaging, Artificial Intelligence (AI) with assisted analysis, smartphone-based colposcopy, tele-colposcopy and HPV DNA testing.

These developments enable health care providers to identify abnormal cervical changes at an earlier stage, avoid unnecessary biopsies, and provide better follow-up care, particularly in rural and low-resource settings.