Colposcopy
Norm of Colposcopy
Normal appearance of vagina and cervix. Vagina and cervix are free of lesions, and no abnormal cells or tissue are present.
Usage of Colposcopy
Evaluation, by physician or certified nurse, of suspicious lesions or suspected cervical or vaginal cancer, evaluation of abnormal cytologic characteristics of the vagina and cervix, testing for vulvar dystrophy, and screening for cervical abnormalities in women whose mothers were treated with diethylstilbestrol (DES). Collection of cervical specimen for definitive testing after abnormal Pap smear result has been obtained.
Description of Colposcopy
The visual examination of the vagina and cervix using a lighted colposcope that magnifies the mucosal surfaces. Colposcopy helps diagnose benign and preclinical cancerous lesions of the cervix and vagina. Attachments to the colposcope include a green filter (aids in detecting abnormalities of blood vessels in the cervix), teaching arm, or video camera. If an abnormal Pap smear has been previously obtained, the colposcopy may be performed with a loop electrosurgical excision procedure (LEEP), in which a thin wire loop electrode is used to excise cervical tissue in the area of the abnormality for lesion removal and further examination.
Professional Considerations of Colposcopy
Consent form IS required.
Risks
Bleeding, infection, mild discomfort.
Contraindications
Biopsy during colposcopy is contraindicated in the presence of anticoagulant therapy, bleeding disorders, thrombocytopenia, or heavy menses.
Preparation
- The client should disrobe below the waist and the room should be a warm temperature.
- Obtain a speculum, a 3% acetic acid solution, sterile cotton-tipped swabs, a colposcope, biopsy forceps, a cauterizer, a specimen cup with preservative, and sterile cotton.
- Obtain supplies for a Pap smear, if one will be collected during the colposcopy examination.
- Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.
Procedure
- The client is placed in the lithotomy position and draped for comfort and privacy.
- The vagina and cervix are exposed with a speculum.
- Saline may be applied to the cervix, then cervical mucus is removed with acetic acid being applied, and then Lugol's iodine can be applied to outline cervix abnormalities (abnormal epithelium does not contain glycogen and therefore will not stain).
- The colposcope is inserted, and the walls of the vagina and cervix are visually examined for color, keratinization, lesions, blood vessel structure, inflammation, atrophy, and erosion. Suspicious areas may be biopsied, and cautery or pressure is used to control bleeding.
- For clients with low-grade changes on a previous Pap smear, a repeat Pap smear may be taken during colposcopy.
Postprocedure Care
- Vaginal bleeding is not abnormal. Provide a sanitary pad.
Client and Family Teaching
- The procedure lasts about 15 to 20 minutes and may cause slight discomfort from the vaginal speculum.
- A small amount of bleeding may occur because of the sampling of tissue.
- Immediate complications include pain and hemorrhage and secondary hemorrhage can occur up to 14 days after.
- Results may not be available for several days.
- Refrain from sexual intercourse until receiving confirmation on a follow-up visit that the biopsy site has healed.
Factors That Affect Results
- Heavy menstrual flow may interfere with adequate visualization of the cervix.
Other Data
- Colposcopy is helpful in adding information about tumor extension.
- Annual colposcopy provides no additional benefit compared to Papanicolaou smear for detection of cervical cancer in HIV-infected females.
- Colposcopically directed brush cytologic testing is a safe substitute for directed biopsy in pregnant clients.
