Colposcopy / Biopsy
Colposcopy is the examination of the cervix and/or vagina performed with a magnifying scope (the colposcope) for the purpose of identifying the cause of an abnormal PAP and/or HPV test. More specifically, colposcopy is done to find pre-cancerous or cancerous changes on the face of the cervix that aren’t visible to the naked eye. Less commonly, it is performed to identify or evaluate a suspected infection of the cervix and/or vagina. Colposcopy is a diagnostic procedure, not a treatment. It is conducted in the office without need for anesthesia, and it takes about 15-20 minutes (depending on the patient’s anatomy and the ease with which the cervix and abnormal area(s) are identified).
For the colposcopic procedure, the patient rests on the exam table in a reclining position with her feet in stirrups. The gynecologist inserts a speculum into the vagina and finds the cervix. Then, acetic acid (vinegar) is applied to the cervix and vagina. It causes a mild burning sensation in the vagina.
The acetic acid transforms the areas of the cervix or vagina that have abnormal cells from the usual pink-tan color to white. It also causes atypical blood vessels on the cervix (that may be suspect for malignancy) to become visually prominent. By using the magnification capability of the colposcope, the gynecologist can identify the abnormal white areas on the cervix or vagina so that targeted biopsies can be performed. The colposcope also enables the identification of atypical blood vessels. If no white areas are seen, then a scraping biopsy of the canal of the cervix is performed, seeking abnormal cells there.
A single or multiple biopsies of the cervix and/or vagina may be taken in the same setting. Once obtained, the biopsy specimens are sent to a laboratory so they can be evaluated microscopically for pathology. In this way, abnormal pathology in the cervix and/or vagina is diagnosed, and the need for any treatment can be determined.
If a suspected infection is the reason for the colposcopic evaluation, then a culture is taken instead of a biopsy for identification of the specific pathogen.
The colposcopic procedure is terminated once there is cessation of any bloody oozing that may be coming from a biopsy site. Physical recovery in the minutes that follow colposcopy is enough to allow the patient to leave the office without issue. If any biopsies were performed, the patient will be advised to lay down and rest for the remainder of the day. If no biopsies were done, then normal activity could be resumed for the rest of the day. Prior to leaving the office, the patient is informed of the colposcopic findings and of what was done during colposcopy. She is given post-colposcopy care instructions and an appointment to return to examine biopsy site healing and discuss pathology results.
During colposcopy, brief, mild pelvic discomfort may be experienced because of either or all the following: the placement of the speculum in the vagina, the application of acetic acid on the cervix and vagina, or the taking of the biopsy of the cervix and/or vagina.
Vaginal spotting (not menstrual-like bleeding) or brown-black vaginal discharge may follow colposcopy for several days. A vaginal infection may occur after colposcopy. However, colposcopy is a safe procedure that allows the gynecologist to diagnose abnormalities on the cervix or vagina that may be on a path to malignancy.
We at Adaptive Gynecology, have extensive experience in colposcopy and the management of abnormal PAP and HPV tests.
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