Follow the examination protocol in sequence (normal saline, acetic acid, Lugol’s iodine) to avoid diagnostic errors (Figs. 9.3, 9.4, 9.5 and 9.6 showing colposcopic images after each).

Examine the squamocolumnar junction (SCJ) in its entirety and the transformation zone (TZ) up to its distal margin. The proximal margin of the TZ is formed by the SCJ, while the distal margin is demarcated by the most distal nabothian follicles or crypt openings. Sometimes the inner margin of TZ recedes into the cervical canal and may require additional manoeuvres to visualise, like using an endocervical speculum or opening the vaginal speculum wider and using a long dissecting forceps to try opening the canal. Based on the extent of TZ visible, it is classified into three types. Type 1 TZ is completely ectocervical, Type 2 TZ is partially endocervical but the upper limit can be visualised by manipulating the cervix or inserting an endocervical speculum, whereas a Type 3 TZ is predominantly endocervical and its upper limit cannot be visualised.

The previously used terms satisfactory and unsatisfactory have been replaced by new terminology by the IFCPC in 2011, and one must be familiar with these terms for adequate colposcopic reporting [3] (Annexure 5).

Document and score any lesions within the TZ or abutting the SCJ: Documentation of findings is as important as the practice of colposcopy itself and serves as a tool for follow-up after treatment. This may be done electronically or in paper form. Usually a structured proforma is used to document results. Two formats (Hammond graph and Odell diagram) are shown to document results in paper form (Fig. 9.7). Most colposcopes have image management systems which store images and patient data electronically using a computer with custom software. This has a capacity for recording video and also selective image enhancement and annotation. In addition, a report can be accessed as a drop-down menu thereby enabling procedure documentation and image retrieval. The obvious advantages of documentation in following up changes in lesion location, size and volume, objective response to treatment and monitoring remote colposcopy practice in clinical trials cannot be over emphasised.

The second part of documenting findings is scoring the lesion to know whether it is high grade or low grade so that appropriate treatment and follow-up can be advised. This is done with the help of one of the many scoring systems in use. These include two-tier system, Coppelson’s grading, Reid’s Colposcopic Index and the two most commonly used ones: Modified Reid’s Combined Colposcopic Index and Swede Score [4, 5]. The latter two are described in detail in Tables 9.1 and 9.2, respectively.