Colposcopy: what is it?

Medically reviewed: 24, January 2024

Read Time:11 Minute

Cervical colposcopy: what it is, preparation for the procedure, how it is done, price

Colposcopy is a non-invasive endoscopic method used to diagnose diseases of the cervix, vulva and vagina. It is one of the most popular ways to examine women with various symptoms of gynecological diseases.

Due to its high specificity and sensitivity, the analysis allows the doctor to accurately determine the disorder in the structure of organs, make a diagnosis and, based on this, choose the right treatment tactics for the patient.

Colposcopy exam: What does cervix diagnostics show?

For several decades now, such a diagnostic technique as colposcopy has been actively used by doctors in all countries. The reason the procedure is so widespread is its high diagnostic value.

The research allows:

  • assess the condition of the mucous membrane of the cervix and vagina;
  • determine the location of the pathological focus and its boundaries;
  • conduct a differential diagnosis between benign and malignant neoplasms (using extended colposcopy, tissue staining);
  • take material for cytological and histological examination;
  • monitor the effectiveness of treatment for certain diseases.

Classification of biopsy of cervix

In practical medicine, there are several methods of colposcopy methods:

  • Simple.

The doctor examines the cervix and vagina without the use of special tools or pharmaceuticals. To carry out the manipulation, you only need a colposcope (8-40 times magnification).
Through color filters. Using this method, the doctor can study in detail the condition of the epithelium and evaluate the characteristics of its blood supply. Through the filter, arteries and veins are distinguished quite clearly. In most cases, green light is preferred.

  • Extended.

The doctor treats suspicious areas with various special means and evaluates their reaction.

  • Chromocolposcopy.

The epithelium is stained with dyes (hematoxylin, methyl violet).

  • Fluorescent.

Also a type of extended. The fabric is stained with acridine orange and uranine.

  • Colpomicroscopy.

Unlike simple colposcopy, in this case the magnification reaches 160-280 times. The examination apparatus is brought directly to the cervix. The study is also carried out using various dyes.

  • Cervicoscopy.

The doctor examines the cervical canal itself, the presence of tumors, the condition of the glands, assesses folding and other characteristics of the structure.

Particular characteristics Conclusion
Normal No pathology detected
Abnormal colposcopic picture grade 1 (L-SIL) Blood vessel changes: delicate mosaic, delicate punctuation. When tissue is stained with acetic acid, small lesions with uneven edges are visualized. CIN I – mild dysplasia (less than 30% of the epithelium is affected).
Abnormal colposcopic picture 1st degree (H-SIL) When exposed to acetic acid, the tissue becomes pale, the lesions are dense. Furrows appear and the glands become keratinized. CIN II – CIN III – moderate and severe degree of dysplasia. These changes are also characteristic of cancer in situ
Nonspecific abnormal colposcopic picture Any changes other than manifestations characteristic of dysplasia Erosion, ectopia, neoplasms, leukoplakia
Suspicion of invasion Signs of a malignant tumor Invasive cancer

The choice of colposcopy technique in each specific case is determined by the doctor individually.
Indications for the study

The simplicity and accessibility of the study determines a large number of indications:

pathologically altered cells were found in a smear from the cervical canal;

  • there is a suspicion of cancer;
  • detection of human papillomavirus (the main cause of cervical cancer) in a smear;
  • discirculatory uterine bleeding;
  • chronic inflammation of the cervix, vagina;
  • pathological discharge from the genital tract;
  • discomfort in the area of the external genitalia, vagina;
  • lower abdominal pain;
  • control of treatment of gynecological diseases;

Colposcopy is performed for cervical erosion (for differential diagnosis with ectopia).

Despite the fairly large number of advantages and indications for colposcopy, the final decision to conduct the study can only be made by the attending physician.

Contraindications for colposcopy

There are no absolute contraindications to the study. However, there are several factors in which it is better to postpone colposcopy:

  • early period after delivery (first 60 days);
  • operations on the pelvic organs (including artificial termination of pregnancy) carried out less than one month ago;
  • the first days of the menstrual cycle;
  • inflammation in the uterine cavity;
  • individual intolerance to tissue dyeing agents (in case of extended colposcopy).

If any of the listed contraindications appear, it is better to postpone colposcopy for some time.

Preparation for cervical colposcopy

Preparation for the procedure begins with studying the patient’s complaints, medical history and life history. Next, the doctor conducts a bimanual examination, takes the necessary smears, and asks you to come back in a few days when the results of the studies are ready. If suspicious lesions are identified, the gynecologist will directly suggest a colposcopy, set a date for the study and tell you how to prepare for it.

The study is recommended to be carried out in the first half of the cycle, but not before the end of menstrual bleeding (from 7 to 14 days). Considering that not all women have a cycle lasting 28 days or their periods come on time, the best time to do colposcopy should be selected only after consultation with a doctor.

It is not recommended to have sex before a colposcopy.

It is prohibited to use local vaginal products (ointments, suppositories, tablets), do not douche, and take a hygienic shower in the morning before the procedure without using intimate hygiene products.

In emergency cases, colposcopy can be done without prior preparation, on any day of the cycle.

Biopsy cervix procedure: How is colposcopy of the cervix done?

An appointment with a gynecologist begins with the woman being repeatedly explained what the procedure is and given to sign consent to perform the manipulation.

Next, the gynecologist invites the patient to sit on the gynecological chair. The doctor inserts a special speculum into the vagina and examines the cervix. Only after this the gynecologist installs a colposcope. Under magnification of 8-40 times, examines pathological foci, their boundaries, and transformation zones. This is where a simple colposcopy ends. If no more is required, the specialist removes the equipment.

However, more often after a simple colposcopy an extended one is performed. The doctor treats areas suspected of atypia with special solutions and evaluates their reaction. To identify pathology, a study is done:

  1. With 3% acetic acid. The gynecologist treats the cervix with acetic acid and looks at the reaction of the blood vessels. Normal: the tissue turns pale for several weeks. Cell atypia: tissue does not change. It is also important to evaluate the time of color change: normally no more than 3 minutes, above this value there is pathology.
  2. Schiller’s test. In this case, Lugol’s solution is used. Normal: the color of the tissue changes to brown, pathology – it stains worse or does not stain at all (the transformation zone looks like an iodine-negative zone).
  3. Adrenaline. The effect of adrenaline is similar to that of using adrenaline.
  4. Trichlorotetrazole and fluorochromes. These reagents are used when tissue malignancy is suspected. In this option, after colposcopy, the doctor takes a biopsy from a suspicious lesion.
  5. Videocolposcopy of the cervix. A separate research option in gynecology is video colposcopy of the cervix. The technique is similar to that described above with the difference that the image is displayed on the monitor screen. The doctor, in real time, can examine organs, evaluate their structure, and record video on digital media.

Biopsy cervix results: Interpretation of the colpo results

Based on the results obtained at the stage of manipulation, the doctor fills out a special form, also known as a colposcopy protocol, which will indicate the entire transcript of the changes found in the organs.

First of all, the following indicators are described in gynecology:

  • Color. Depends on the density of the epithelium, its thickness, and the condition of the stroma. A thin layer will be more pink (this is due to translucent blood vessels). The keratinized zones are lighter. Inflammation and other pathological processes also affect the coloring of tissue.
  • Vascular drawing. Normally, the vessels should be of different calibers and anastomose with each other. In pathology, vascular atypia is determined. The vessels are located chaotically and do not anastomose with each other. The distance between capillaries is also assessed (normally 50-250 µm, with pathology 400-500 µm).
  • Condition of the glands. During tissue regeneration, the glands are covered with flat epithelium, while part of the structure must remain open. If the entire organ closes, the outflow of secretions is disrupted, it stretches, leading to dilation of blood vessels and perifocal inflammation. In addition to the excretory duct, it is important to evaluate the presence of a rim: a narrow, flat, whitish color is normal; a wide one, rising above the tissue, is pathological.

In addition to these indicators, there is other terminology, on the basis of which the doctor can distinguish between a normal picture and a pathological one.

Normal colposcopic signs

Original squamous epithelium

Lines the vaginal part of the cervix. The surface of the tissue is smooth, the color is pink (during gestation and in the last days of the menstrual cycle it may be cyanotic). After exposure to acetic acid, the tissue becomes pale; under the influence of Lugol’s solution, it becomes dark brown.

Columnar epithelium

Tissue directly from the cervical canal, displaced beyond the pharynx area (ectopia). It is a structure with uneven architectonics (there are papillae on the surface, the structure is cluster-papillary). The fabric reacts clearly to the vinegar solution, but does not react to Lugol at all.

Normal transformation zone

Localized between columnar and stratified squamous epithelium.

This area is characterized by metaplastic epithelium, the glands are closed, and the vascular network is pronounced. The zone can be either on the vaginal part of the cervical canal or directly in it. When treated with acetic acid, the ducts of the glands are clearly visualized, the vessels, on the contrary, disappear. They do not stain under the influence of Lugol.

Abnormal colposcopic signs

Acetowhite epithelium

Areas of discoloration of the epithelium after treatment with acetic acid. Depending on the severity of the staining, the epithelium may be whitish, white, thick white, or papillary acetowhite.

Punctuation

Lodine-negative area, which is covered with red foci of equal diameter. When examined histologically, the areas are epithelial papillae with an atypical vascular network. Tender areas are small, equal-sized, equally localized points. Rough – the lesions are large and uneven.

Mosaic

It consists of areas of different shapes and diameters, separated by capillaries. The result is a mosaic drawing. Delicate mosaics do not rise above the fabric, while rough mosaics are shaped like cobblestones (areas of varying diameters and shapes with distinct bright red grooves).

Leukoplakia

Thin leukoplakia is a thin film of whitish color that is easily removed and immediately forms again. Thick leukoplakia – plaques with clear contours, tightly fused to the tissue.

Lodine negative zone

Schiller’s test is diagnosed. The area does not rise above the surrounding tissues, the contours are clear, the shapes are different.

Atypical vessels

Blood vessels are tortuous, may break off or become club-shaped. They do not react to acetic acid and Lugol’s solution.

Atypical transformation zone

Combines several of the listed abnormal colposcopic signs.

Invasive carcinoma

In addition to the atypical transformation zone, “plus tissue” is also diagnosed (additional tissue, uneven surface, erosions, ulcers).

All of the listed signs can be present directly in the transformation zone or outside it.

In addition to the listed subsections of the classification, mixed characteristics are also distinguished separately. They cannot be interpreted according to any of the listed criteria. These include: inflammatory, atrophic changes, ulcerative lesions, condyloma.

The result of the study can be written down in the form of a colpophotography, a diagram, or simply in terms. The conclusion should be based only on clearly detected changes.

Colposcopy of the cervix during pregnancy

Colposcopy can and even should be done during pregnancy. The study allows for timely diagnosis of pathology and its treatment. The procedure does not affect the condition of the expectant mother or child in any way. The only limitation to colposcopy is the threat of miscarriage. In this case, the procedure should be postponed.

Complications after colposcopy

Complications after colposcopy are extremely rare. In most cases, they are caused by tissue infection, bleeding or allergies to solutions.

Complications of the procedure:

  • increased body temperature;
  • intense pain in the lower abdomen;
  • pathological vaginal discharge;
  • chills;
  • severe general weakness, dizziness;
  • heavy bleeding during the day, not heavy for 5 days;
  • allergies to medications used for diagnosis.

In case of any of the listed complications, it is recommended to urgently seek advice from a specialist.

Rehabilitation after colposcopy

The first days after the end of the manipulation, the patient may be bothered by hemorrhagic vaginal discharge, nagging pain in the lower abdomen, or mild discomfort in the genital tract. These symptoms do not require treatment and go away on their own after some time.

However, to reduce their severity or minimize the risk of progression, compliance with several simple rules is required.

  1. Frequent toileting of the external genitalia. Discharge after colposcopy persists, which means that in order to prevent tissue infection, it is necessary to take a hygienic shower frequently.
  2. Sex after colposcopy is prohibited for several days.
  3. Limiting physical activity.
  4. It is recommended to avoid douching, using vaginal tampons, suppositories and other local medications.
  5. Do not visit open bodies of water, baths, or swimming pools.

Compliance with these simple rules will determine a favorable course of the rehabilitation period after colposcopy.

Cost of cervical colposcopy

The cost of a simple colposcopy in USA is approximately 1400$, an extended one – 25000$. How much the procedure costs depends on the chosen clinic, therapy technique, and equipment in the institution.

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