Colposcopy - Procedure and Complications

What Is Colposcopy?

Colposcopy is a diagnostic procedure used by healthcare providers to examine the cervix (the lower part of the uterus) and the vaginal wall for any abnormal tissue. During the procedure, a colposcope, which is a lighted microscope, is used to magnify the tissues. If any abnormalities are detected, the provider may take tissue samples (biopsies) for laboratory testing to check for cancerous or precancerous cells.

What Is Colposcopy Used to Diagnose?

Colposcopy primarily examines cancerous cells or precancerous conditions known as cervical dysplasia. The healthcare provider will assess these cells in the cervix, vagina, and external genitals (vulva). Additionally, colposcopy can detect genital warts and noncancerous growths called polyps. In some cases, the provider may suggest a colposcopy to investigate other symptoms, such as abnormal vaginal bleeding or vulvar itching.

For What Reasons Might a Woman Undergo a Colposcopy?

Individuals designated female at birth (DFAB), including cisgender women, transgender men, and nonbinary people with vaginas, may require a colposcopy to further investigate abnormal test findings. A healthcare provider might suggest a colposcopy if a woman:

• Received abnormal results from a Papanicolaou test or Pap smear.

• Had abnormal findings during a pelvic examination.

• Tested positive for HPV (human papillomavirus).

What Is the Procedure of Colposcopy Biopsy?

A colposcopy is a microscope-like device with a strong light that is used to visualize the cervix. The colposcope does not enter the vagina but remains outside the body. The colposcope has a camera attached, so the cervix images can be on a small screen. Some of the abnormalities of the cervix are highlighted.

Colposcopy is a safe procedure with minimal pain and no complications other than vaginal spotting. The examiner will look at the squamocolumnar junction, which is the area that gives rise to most cases of cervical cancer. The squamocolumnar junction is the border between the two different types of cells (squamous cells lining the cervix's outer surface and columnar cells lining the endocervical canal). During colposcopy, the entire squamocolumnar junction is mostly seen in young women. However, in older women, due to menopause, the squamocolumnar junction may migrate inside the endocervical canal. In such cases of older women, colposcopy is not adequate. So, another procedure may need to be performed to check the entire squamocolumnar junction.

If any abnormal cells are identified, a small piece of tissue may be removed for closer examination. It may feel a small pinch or scratch in terms of sensation while removing the sample for examination. A biopsy aims to confirm whether the screening test correctly identifies a problem. This procedure usually takes about five minutes, but it can take about 10 to 15 minutes if any treatment is carried out.

What Tests Are Performed During Colposcopy Procedure?

Three special tests are performed during colposcopy. They are:

Acetic Acid Wash for Colposcopy - During the examination, the cervix is cleaned with acetic acid, which is three to five percent diluted. The acetic acid will wash out the mucus, allowing clear visibility of abnormal areas with the colposcope, and stain the white areas called acetone white lesions. The normal areas can also stain white, but these areas may have faint or vague borders. However, abnormalities, such as precancers, cancers, and genital warts, produce acetone-white areas with clear and distinct boundaries.

Sometimes, a diluted iodine solution (known as Schiller's solution or Lugol's solution) is used for staining to further examine for abnormalities. Normal cells usually take up the iodine stain and turn brown, whereas severe precancerous and cancerous areas will not.

Use of Color Filters - Using color filters helps doctors examine tiny blood vessels in the area of the squamocolumnar junction. The abnormal capillaries become more obvious when blue or green-filtered light is used. In normal conditions, the capillaries are slender and evenly spaced. But, abnormal capillaries can appear as red spots or a pattern resembling hexagonal floor tiles. The capillaries will be thicker and more widely spaced if the severe cervical disease. When cancer develops eventually, capillaries take on odd shapes and resemble punctuation marks.

Biopsy of the Cervix - The final step of colposcopy is tissue sampling, targeting the abnormal areas. The biopsy of abnormal areas is critical because treatment depends on the severity of the abnormal samples. After taking the sample, a chemical is applied to that area to prevent bleeding. Endocervical curettage is also often performed along with a biopsy.

What Occurs Following the Colposcopy Procedure?

After colposcopy, individuals should be able to resume normal activities right away. If no biopsy was taken, they may experience some spotting for up to two days afterward. However, if a biopsy was performed, they might encounter:

• Vaginal discharge that may appear dark (due to the acetic solution used).

• Light vaginal bleeding that can last a few days.

• Mild vaginal discomfort lasting a few days.

Individuals can manage any discharge or bleed with pads. It is important to avoid inserting anything into the vagina to allow the cervix time to heal. This includes abstaining from sexual intercourse, using tampons, or douching. Consult the healthcare provider for guidance on how long to refrain from these activities to ensure proper recovery.

What Happens if a Colposcopy Shows Abnormalities?

If a colposcopy biopsy reveals early abnormalities such as mild cervical dysplasia, the healthcare provider may recommend periodic repeat Pap tests. Mild dysplasia can sometimes resolve on its own without treatment. For more advanced precancerous cells, treatments may include:

• Cone Biopsy: A cone-shaped tissue sample containing abnormal cells is surgically removed from the cervix.

• Loop Electrosurgical Excision Procedure (LEEP): This involves using an electricity-powered wire loop to remove abnormal cells.

• Laser Surgery: A heated laser beam is used to eliminate abnormal cells.

• Cryotherapy: Cold chemicals, like liquid nitrogen, are used to destroy abnormal cells.

In more severe cases, surgical removal of the entire uterus may be necessary. The healthcare provider will advise on any necessary follow-up tests after treatment.

What Are the Complications of Colposcopy?

Colposcopy is usually a safe procedure. In rare cases, complications during biopsies can occur, which include:

• Pelvic pain.

• Heavy bleeding.

• Infections.

Conclusion

Colposcopy is a simple procedure used to examine the cervix or vagina. During the procedure, a small abnormal sample is collected from the cervix and sent to a laboratory for further examination. It creates little discomfort, but few complications like bleeding and infection can occur in rare cases.