Colposcopy

What is it?

Colposcopy is an examination that allows you to analyze the vaginal wall and the uterine cervix (or cervix); it takes place through the use of an instrument called a colposcope, which allows you to enlarge the images from 6 to 40 times.

When colposcopy concerns the external female genitalia, the term vulvoscopy is used.

What is it for?

To clarify in case of doubtful situations, to exclude or confirm the presence of certain pathologies of the reproductive system.

The doctor prescribes it in particular in the case in which screening tests, such as the pap smear, have shown abnormalities.

In addition, the specialist may choose to resort to this examination even in case of:

• suspected infection with papilloma virus (HPV) or other sexually transmitted diseases
• Detection of abnormalities of the vagina or uterine cervix during the gynecological examination, such as the presence of genital warts or herpes, or lesions, polyps, etc.

Colposcopy can also be used if previous tests provide uncertain results or to pinpoint the cause of certain disorders, such as:

• vaginal bleeding or other discharge, for example after sexual intercourse
• the presence of discomfort such as burning or pain in the vaginal.

How does it work?

Colposcopy, which is usually performed in a hospital setting, lasts about 15 to 30 minutes.

Before the examination you will be asked to remove your clothes from the waist down and you will be made to sit on a seat that allows the assumption of the gynecological position, or with the legs raised and apart, the same that is assumed during a normal visit to the gynecologist.

Your doctor will gently insert an instrument called a speculum into your vagina; To observe the uterine cervix he will use a light-equipped microscope, called a colposcope, which allows you to observe the vagina and uterine cervix as if you were using some sort of binoculars.

The mucous membrane to be examined is gently swabbed with a cotton ball soaked in 5% acetic acid and sometimes an iodized solution (Lugol’s solution); These substances have the ability to highlight the presence of abnormalities or lesions in the tissue of the vaginal mucosa.

If alterations are detected, colposcopy may be accompanied by the collection of small tissue samples by biopsy.

This type of histological examination, the same performed during the pap smear, allows to evaluate the presence of alterations at the cellular level and is important for the diagnosis of pathologies such as:

• a cancer of the uterine cervix
• infections, such as Papilloma virus (HPV).

During examinations, it is possible for the doctor to take photographs used for documentation purposes.

Is it a painful exam?

This is a painless examination, except in some cases a slight discomfort.

Any annoying sensation is related to the execution of the biopsy, which involves the removal of a small portion of tissue.

You may therefore perceive a sensation similar to a puncture or a slight rubbing, which varies depending on the vaginal area where the sample is taken.

In the case of a cervical biopsy, for example, you will experience some discomfort, but no pain.

A slight painful sensation may occur during a vaginal biopsy, which is the taking of a tissue sample from the lower, lower part of the vagina or vulva. In this case, your doctor may decide to give you a local anesthetic.

Can colposcopy cause complications?

In reality, it is a routine procedure, and there are no particular risks either in the short or long term.

Only rarely, during the execution of the biopsy, more or less intense bleeding may occur, due to an involuntary injury of small vessels. In this case, the doctor who is carrying out the test can easily remedy it, thanks to the placement of gauze inside the vagina: a sort of tampon, which can be removed after a few hours.

Alternatively, your doctor may decide to apply antihaemorrhagic substances or hemostatic solutions based on iron (Monsel’s solution) or silver nitrate.

How should I prepare?

To prepare for the execution of this exam there are some tricks that it is good to follow.

For example, in the 48 hours prior to colposcopy, avoid:

• have sex
• apply vaginal creams
• carry out lavenders
• introduce eggs or tampons.

You are not asked to change your diet in any way, either before or after the exam.

On the day you perform the colposcopy, remember to bring with you the results of the latest pap smears or any previous colposcopies.

However, there are some conditions that require you to take some precautions before performing colposcopy, thus avoiding any possible risk.

In particular, if you are a carrier of mitral valve prolapse or other major cardiovascular diseases, you should first consult your cardiologist to assess the need for prophylactic therapy with antibiotics to protect yourself from the risk of bacterial endocarditis.

In addition, it is important to always tell your gynaecologist if:

• you are following a specific drug therapy, for example with antiplatelet or anticoagulant drugs
• you suffer from any allergic reactions, such as allergy to iodine, contrast media or local anesthetics
• You are pregnant.

In the latter case, rest assured: colposcopy itself is a diagnostic test that can be performed even if you are pregnant. However, it is good to specify it, because biopsies will have to be avoided, which are usually postponed until after the birth of the baby.

Dialogue is therefore fundamental, both with the attending physician and with the specialist in charge of carrying out the examination.

Colposcopy and menstruation: is it a problem?

This examination cannot be done during the days of menstrual flow or in case of heavy blood loss.

In these situations, it is best to postpone colposcopy, which should be avoided even if you suffer from strong vulvovaginal inflammation.

After colposcopy

Immediately after performing a colposcopy, you can go home without any particular problems. Since no medication is given during the test, you can also drive.

It is therefore not essential to be accompanied, unless you wish to have someone close to you to feel more comfortable.

In the hours following the colposcopy you may notice small leaks: it is perfectly normal, do not be alarmed.

A useful trick to make this moment as comfortable as possible, is to use an external absorbent or a panty protector after the test.

Wait until the leaks have worn off, before having sex or using tampons.

If, on the other hand, you notice a heavy leakage of blood, high fever with chills or severe abdominal pain, it is advisable to contact your doctor immediately.

The results

In most cases, the doctor who carries out the examination can already give a first opinion immediately after carrying out the test. For example, informing you if you have found visible abnormalities, such as warts or other types of injuries.

The result of a colposcopy can be of two types:

• normal, which happens in 4 out of 10 women, who are suggested to continue to follow regular periodic check-ups
• abnormal, which occurs in 6 out of 10 women, as abnormalities in the cervix or vagina are reported, which must be treated with drug therapy or surgical removal.

If a biopsy is also carried out, to receive the result it will be necessary to wait a certain number of days, which may vary depending on the structure in which the examination is performed, the type of analysis performed on the sample taken and the degree of urgency.

Thanks to the microscopic analysis of the tissue taken with the biopsy, the doctor will be able to collect important information, evaluating in particular if the mucosal sample contains:

• inflammatory cells
• precancerous cells (i.e. cells that could give rise to cancer)
• cancerous cells.

Colposcopy and diagnosis of cancer

Cervical cancer can also be diagnosed during a colposcopy. In particular, this test is able to detect the presence of precancerous lesions: these are benign and superficial alterations of the mucous membrane of the uterine cervix, which in the long term can however give rise to malignant lesions.

About 15% of the most serious cervical precancerous lesions (carcinoma in situ) evolve, degenerating into cancer within 10-15 years.

This type of alteration of the cervix usually does not cause pain and, in general, does not cause any symptoms: the only way to detect them is therefore to perform a colposcopy or a pap-test.

These lesions are caused in most cases by the human papilloma virus (HPV). There are several strains, some harmless (“low risk”), others more dangerous (“high risk”), as they can cause the appearance of cancer cells at the level of the cervix.