Womens Health

Cervical Cancer Testing and Prevention: Colposcopy Overview

A colposcopy is a procedure done to follow up on the results of an abnormal Pap smear. If there were any abnormal cells found on your Pap smear, this is a way in which your doctor can examine your cervix more closely to identify the abnormal cells. This is important because abnormal cells found on a Pap smear can indicate the beginnings of cervical cancer, so a colposcopy is a way for your doctor to look more closely at the results to see whether any measures need to be taken about irregular cells, or if there is nothing to worry about.

How to Prepare for a Colposcopy

A colposcopy requires the same preparation as any other pelvic exam. Do not douche, do not use tampons or vaginal medications, and avoid having sexual intercourse for 24 hours before you appointment. Also, menstrual blood can interfere with a colposcopy, so it is important to schedule an appointment for when you won't be menstruating.

You may be more comfortable during the procedure if you empty your bladder and bowels directly before the examination. Sometimes a doctor may recommend you take over-the-counter pain medication before the exam to relieve any discomfort you may feel during the colposcopy. If this is the case, make sure to inform your doctor if you are pregnant or if you have any drug allergies, and make sure you are clear on exactly what to take, how much to take, and when to take it.

Finally, remember to inform your doctor if you are pregnant or if you may be pregnant. This will change the way your doctor performs the exam.

What Happens During a Colposcopy

The experience of a colposcopy is similar to the experience you would have during your Pap smear. It is performed in an examination room where you lie on your back on a table with your knees bent and your feet in stirrups. The doctor will examine your genitals and then gently insert a device called a speculum into your vagina to hold it open so she can see your cervix. The speculum won't hurt, but it can sometimes be uncomfortable. Try taking slow, deep breaths during the whole procedure to ease your discomfort. If you become too uncomfortable at any point, tell your doctor.

The doctor will then position the colposcope. A colposcope is a special lighted microscope that magnifies your cervix and vagina by 10 to 40 times its actual size. This will help her in identifying areas of abnormal cell growth that she wouldn't be able to see with her naked eye. The colposcope is positioned so that the doctor can look into your vagina, but it will never enter your vagina itself.

The doctor may use a saline (saltwater) solution to clean your cervix. She will then apply a vinegar solution (acetic acid) to your cervix. This and the saline solution may feel chilly. Using the magnifying power of the colposcope, your doctor will carefully examine your cervix and vagina for areas of concern.

The acetic acid reacts differently with normal and abnormal tissues by turning only the abnormal tissues white. If the acetic acid fails to detect any abnormality, your doctor will apply a second solution, Lugol's solution. This will (temporarily) stain your cervical tissues but leave any abnormal tissue unstained. Both of these solutions allow your doctor to easily locate any areas of concern.

If your doctor finds abnormal tissue, she will increase the magnification on the colposcope to further examine the area and look at characteristics like the course of blood vessels.

At this point, your doctor may choose to perform a biopsy of the abnormal tissue. A biopsy is the removal of a sample of tissue. This type of biopsy is called an endocervical curettage because it involves taking tissue form the cervical canal. During the biopsy you will feel a pinch and you may experience mild cramping as the tissue is removed. Again, remember to take slow deep breaths to help alleviate any discomfort. A pathologist will examine the tissue sample for abnormal cells.

After the Colposcopy

You may experience some bleeding or other vaginal discharge for up to a week after a colposcopy, especially if your doctor took a biopsy. This is because your body will be expelling the fluids used during the procedure. If you had a biopsy, your doctor may have put a thick brownish, yellowish paste on the area to stop any bleeding. When this mixes with blood, it forms a thick black discharge; this discharge is normal and it may last for a couple of days. You can use sanitary pads for the bleeding and discharge, but do not use tampons.

If you had a biopsy do not put anything in your vagina for a week after the procedure or until your doctor tells you it's safe. Do not douche, do not use tampons or vaginal medications, and avoid having sexual intercourse during that week. You can, however, resume everyday activities like bathing after your exam.

If you experience excessive vaginal bleeding (ex: soaking more than one pad an hour) after the colposcopy call your doctor. Also, there is a very slight risk of infection with a colposcopy, so if you experience foul-smelling or thick yellowish vaginal discharge, or a fever above 100.4 F, call your doctor. Severe pelvic or abdominal pain is not normal and requires emergency medical attention.

You will be contacted by your doctor's office one to two weeks after your colposcopy to come in for a follow-up appointment. There you will be able discuss with your doctor the results of the exam and any additional treatment you may need. If you do not receive the results three weeks after the procedure, call your doctor's office. It is important to follow-up as soon as possible in case you need additional treatment.

Colposcopies and Cervical Cancer

A colposcopy is an important step towards detecting the early signs of cervical cancer. If your Pap test showed abnormal results, this is a way for your doctor to find out more about the nature of the abnormality. Sometimes this may be benign, and other times it may require further attention. Other times, the Pap smear may have even produced false results and nothing may be wrong. However it is very important to follow up an abnormal Pap smear with a colposcopy and follow up on those results because the earlier cancerous cells are detected, the easier they are to treat.

New Developments in Cervical Cancer Detection 

In March 2006 the FDA approved a device called the LUMA Cervical Imaging System. This device helps evaluate cervical tissue by shining a light on the tissue and gathering data on how diff

erent areas of the cervix reflect and absorb this light. The LUMA system is noninvasive.

During a colposcopy, if your doctor determines that there are areas to be biopsied, she may choose to use the LUMA device to see if there are any additional areas that should be biopsied. Studies have shown that the LUMA system can detect precancerous cervical cells that were missed by a colposcopy alone. Currently, the LUMA system is approved to be used in conjunction with colposcopy but not as a substitute.

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