This is an examination of the cervix through a specially designed microscope (colposcope) that magnifies the cervix 15-30 times. During colposcopy the whole surface of the ectocervix, and usually the lower end of the cervical canal, can be seen. Thus the colposcopist can see the area affected by any abnormality noted in single cells or small clumps of cells wiped ‘ the spatula when the Pap was taken.
The colposcope is mounted on a stand at the end of the examination couch. A speculum is inserted into the vagina so that the cervix can be seen. The colposcope is then brought close to the entrance of the vagina (but not inside it) until the cervix is in focus. After wiping with salty water to remove any mucus, the cervix is carefully examined. At this stage the colposcopist can see the smooth pink covering of the ectocervix, the transformation zone (if present), the S-C junction, the knobbly columnar lining of the canal and any everted columnar epithelium. Any abnormal blood vessels are noted.
The inspection is repeated after painting the cervix with weak vinegar solution, which turns certain abnormal cells white, and again after painting with iodine solution, which stains normal cells brown but is not taken up by most abnormal cells. Any abnormal areas are clearly outlined by these two steps. The colposcopist makes a diagram (and perhaps takes a photograph) for comparison if future colposcopy is needed.
Colposcopy defines changes on the surface of the cervix. If it seems wise to also look at what is going on underneath the surface layer, a biopsy from one or more affected areas is advised. A snippet of tissue is removed with forceps and sent to a laboratory, where it is sliced thinly and examined under the microscope to see if the abnormality extends below the surface. This is called histology. Many women are fearful of cervical biopsy, imagining that it will be as painful as snipping off a fragment of skin would be. But because the nerve supply to the cervix is different to that of other body parts, it is rarely felt.
Colposcopy doesn’t hurt and takes about 15 minutes. If the vaginal walls and vulva need to be examined with the colposcope it takes a bit longer.
High-quality Pap, colposcopy and histology services provide accurate information for deciding whether to recommend treatment.
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