Colposcopy

November 21, 2009

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Colposcopy

by Marjorie Greenfield, M.D.
reviewed and revised by Marjorie Greenfield, M.D.

Colposcopy is the standard procedure for screening and evaluating women who have had abnormal Pap tests or are suspected of having cervical abnormalities. If the result of your Pap test comes back abnormal, or if an abnormality is found on your cervix, your doctor or advanced practice nurse may recommend colposcopy, the goal being to further evaluate for a condition known as cervical dysplasia.

What is cervical dysplasia?
Cervical dysplasia refers to a condition where the cells of the cervix are abnormal. The extent to which the cells are found to be abnormal determines how the condition is graded, from mild to moderate or severe dysplasia. Once diagnosed, the treatment of significant cervical dysplasia can help to prevent the development of cervical cancer.

What causes dysplasia?
Dysplasia is caused by a viral infection of the cervix. It mostly develops in women who have been exposed to human papilloma virus (HPV). Some people with HPV have warts in the genital area, but most of these viral infections are asymptomatic. Condoms can help prevent transmission of the virus. Diagnosing and treating HPV in the sexual partner does not improve the likelihood that a woman who already has cervical dysplasia or other HPV infection will be cured. Interestingly, cigarette smoking increases the chance that mild changes will progress to a more serious problem, and quitting smoking may help dysplasia to resolve.

What is colposcopy?
Colposcopy is an office procedure in which the cervix is viewed through a special kind of telescope. In addition to most gynecologists, some family doctors, adolescent medicine specialists, and nurse-practitioners are trained in colposcopy. During the actual procedure, a speculum is inserted into the vagina--just as would be done during a routine speculum examination--allowing the practitioner to view the cervix. Then the cervix is carefully rinsed with a vinegar (acetic acid) solution.

This simple process makes abnormalities on the surface of the cervix more visible. Since the goal of colposcopy is to identify the extent and severity of the abnormalities, a thorough visual exam of the cervix is made. Small pinches of tissue (biopsies) often are obtained from any abnormal-looking areas and sent to the lab for further evaluation and to allow the practitioner to determine the severity of the lesion.

A type of biopsy called endocervical curettage (ECC)--obtained by scraping the cervical canal with a tiny spoon (or curette)--is sometimes performed to check for changes inside the cervical canal, since the inner lining of the cervix cannot be seen with the visual inspection. The results of the visual inspection and the biopsies determine whether further treatment will be needed.

What is it like to have colposcopy?
The procedure mostly feels like a lengthy Pap test exam. Biopsies sometimes cause mild to moderate cramping that usually lasts about 10 minutes. Ibuprofen (Nuprin, Advil, Motrin) can be taken before or after the procedure to decrease the intensity of any cramps.

What's the next step if dysplasia is found?
Treatment of cervical dysplasia depends on the extent and severity of the problem. The idea behind all the various treatment options is to remove or destroy the abnormal cells.

Mild dysplasia or HPV changes: Mild dysplasia usually doesn't need to be treated, since it frequently resolves on its own within a few years. Even if the changes appear to be caused by HPV, treatment is not recommended, as resolution over time is common--and treatment doesn't effectively eradicate the virus, anyway.

Moderate to severe dysplasia: For more significant dysplasia, office treatments include cryosurgery, in which the surface of the cervix is touched with a very cold probe to freeze the cells; and LEEP (loop electro-excisional procedure), where a thin slice is taken off the tip of the cervix after it has been injected with local anesthetic.

Hospital treatments for moderate and severe dysplasia include LEEP, as well as laser or scalpel cone biopsy, where a wedge of tissue is removed from the cervix for definitive diagnosis and treatment. Laser ablation of the lesions is another option that involves destruction of the abnormal areas using a laser. Patients treated in the hospital generally go home a few hours after these procedures. Your practitioner will recommend the treatment that is best for you.

Persistent or recurrent dysplasia: While high-grade dysplasia usually is cured by any of the several treatments listed above, it can persist or recur. Anyone who has had moderate or severe dysplasia should have frequent Pap tests. If any are found to be abnormal, colposcopy is usually repeated. A standard recommendation after mild dysplasia is to have a Pap test every six months for two years and until the Paps are normal.

For high-grade lesions, Paps are usually done every three months for a year, every six months for two more years, and then annually after that. Your doctor will tell you the interval appropriate for your individual circumstances. Women who have had dysplasia should never delay Paps beyond one-year intervals.


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Created August 09, 2001
Reviewed and revised August 05, 2004

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