Colposcopy

Your Pap Smear was abnormal, now you're having another test done called a Colposcopy. Find out the Facts before have it done.

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ALL ABOUT COLPOSCOPY

	What is a Colposcopy?		What do I need to do to Prepare?
	How is a Colposcopy Done?		What are the Risks and Complications?
	What happens after a Colposcopy?		Additional Resources
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What is a colposcopy?

A COLPOSCOPY is a test in which the doctor uses an instrument called a Colposcope to look at the cervix with magnification (The Colposcope is not inserted into your vagina.) The Colposcope looks like a pair of binoculars mounted on a pedestal with a light attached. This instrument magnifies the cervix, vagina and external genital area when the doctor looks through the lenses into the vagina where a speculum has been placed. Different colored filters, similar to those used for cameras are used to block out colors. Magnification helps to see abnormal areas clearly so that biopsies (pieces of tissue) can be done precisely. The pieces of tissue are looked at in the laboratory under a microscope. After all the biopsies are taken, a scraping is done inside the cervical canal to make sure there are no abnormal cells past where the doctor can see. These scrapings are also sent to the lab to be looked at under the microscope. A Colposcopy is done when abnormal cells are seen on a Pap Smear.

How to Prepare for Your Colposcopy

First - Relax, it will not be as bad as you think it will be.

Take 600-800 mg of Aleve or Advil one hour before leaving for your doctor's office. If you are allergic to ibuprofen, take two Extra-Strength Tylenol.
Make sure you have not started nor will start your period for about two weeks.
Do not use anything in the vagina for 24-48 hours before the procedure. This includes spermicides, vaginal medications, douching products or tampons. These all interfere with the accuracy of the test.
Do not have vaginal sex 24 - 48 hours before the procedure because this can also interfere with teh test's accuracy.

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How is it done?

You will lie on the examining table just as in a regular pelvic exam. The colposcope is placed at the vaginal opening in order to examine the genital area, vagina and cervix. The doctor will use a speculum, the same as used during your regular examination, to separate the walls of the vagina as in a pap smear. The speculum will be moistened with warm water and stays in the vagina throughout the procedure. Upon insertion of the speculum, inspection of the vaginal walls will be done. The speculum will be gently rotated so that the entire vagina can be seen. Next, the speculum is placed so that the cervix is completely visible. While looking through the colposcope, your doctor will do a Pap Smear that will be sent to the lab with any other tissue samples, called biopsies, that may be taken dung your examination. The Pap Smear is done as usual, making sure that cells from the Transformation Zone are included in the smear. The doctor will then look at your cervix under 2 - 3 different magnifications.

Any excess mucus or other secretions will be cleaned from the cervix using a large cotton swab. After this, a cool sensation will be felt. This is the application of acetic acid, a vinegar solution, that will enable abnormal cells to be more visible. This may sting a bit. Acetic acid dissolves mucous and accentuates atypical areas (white epithelium, punctation, mosaic and atypical vessels) by causing cellular dehydration and coagulation of cellular protein.
The effect of the acetic acid peaks in approximately 2 minutes and fades in approximately 5 minutes. Because of this, your doctor may need to re-apply the acetic acid solution several times. Areas of the cervix may turn white after the acetic acid has been applied. These areas are called White (or aceto-white) epithelium. White epithelium is sometimes associated with dysplasia. These areas will be biopsied by your doctor near the end of the procedure.

While the acetic acid is used, she will also look at your cervix using different colored filters to be able to see the blood vessel patterns that can't be seen using regular light. The green filter absorbs the red color so that the pattern of the cervical blood vessels can be seen. There are three abnormal blood vessel patterns that may be found during this part of the examination: mosaic, puntate, and atypical. If any blood vessel patterns are found, these areas will also be biopsied near the end of the procedure.

After looking through the red-free filter, your doctor will paint the cervix and vagina with an iodine solution called Lugol's Solution. This stains the glycogen, a component of cells. Mature, normal cells will stain a dark-brown color. Immature cells, cervicitis, and dyspasia cells will not stain. This is called a Schiller Test. Non-staining areas will biopsied.

Now your doctor will biopsy, cut small pieces of tissue, from all the areas that were noted during the examination. There are several different kinds of instruments made to do this. This will give you an example of them.
The biopsies are then done by your doctor. She will make a notation on your chart of all the areas that have been biopsied. These are noted using the hands of the clock, i.e.. 10:00, 1:00, etc. You may experience a pinch or even cramping when the biopsies are done. Each piece of tissue is placed in a separate jar and labeled using the clock method.

A scraping if the endocervical canal (ECC) will be done by a thin instrument called an endocervical curette. This may cause some cramping.

Finally, your doctor will apply pressure to the cervix using a large cotton swab to stop any bleeding from the biopsy areas. If this doesn't work, a solution called Monsel's Solution or silver nitrate will be applied to the cervix. This will stop any bleeding that is happening.

After the procedure is finished, your doctor will explain what she found. She will also tell you to expect a discharge similar to coffee grounds. This comes from the solution used to stop the bleeding. You will also be told not to put ANYTHING into your vagina for two weeks - this includes having sex and tampons.

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What are the Risks and Complications?

Risks are very slight and are. You may have some minor bleeding from the biopsy sights.

Complications that can occur are:heavy bleeding (more than one pad per hour or more bleeding than your menstrual flow); fever; infection; and pelvic or abdominal pain.

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What happens after a Colposcopy?

You will return to see your doctor 1 - 2 weeks after your procedure to discuss what the laboratory saw on the biopsies and the ECC. She will then discuss the options for treatment if anything has been found.

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ADDITIONAL RESOURCES THAT MAY HELP:

	Colposcopy Atlas Table of Contents		Americam Sociaty for Colposcopy
	How is a Colposcopy Done?		More Colpo FAQ's
	Glossary Of Terms Related To Colposcopy		Things You Should Know
	Colposcopy FAQ's		Glossary Of Terms

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