Colposcopy

Chapter 238 Colposcopy



DESCRIPTION


Colposcopy is a diagnostic technique that allows the clinician to identify normal landmarks, find changes suggestive of underlying abnormality, and select sites for biopsy that will yield the greatest information.


Colposcopy is based on a simple stereoscopic operating microscope with magnifications of from 4 to 40 times. Although most often used to examine the uterine cervix, colposcopy may be used to evaluate the vagina, vulva, and other structures.



INDICATIONS


Abnormal cervical cytology (atypia, cancer, dysplasia, koilocytosis), cervical lesions (palpable or visible), condyloma (current or past; relative indication), human immunodeficiency virus (HIV) infection, intrauterine diethylstilbestrol (DES) exposure, surveillance or follow-up.



CONTRAINDICATIONS


Colposcopy is not recommended for adolescents or pregnant patients with Pap test abnormalities of low-grade squamous intraepithelial lesions (LSIL). Endocervical curettage is contraindicated during pregnancy.



REQUIRED EQUIPMENT



• Colposcope with light source

• Endocervical speculum

• Biopsy forceps (e.g., Tischler, Kevorkian)

• Endocervical curette

• Large cotton-tipped swabs, cotton balls, or small gauze sponges

• Examination gloves

• Vaginal speculum

• Tenaculum (optional)

• Acetic acid (3% to 5%) (white vinegar)

• Monsel solution (ferric subsulfate)

• Lugol (5%) solution (supersaturated iodine) (optional)

• Sputum or urine cups (to hold solutions)

• Sterile gloves (optional) (Any instrument that will enter the endocervical canal or will be used for biopsy should be sterilized before use. The use of sterile gloves is not required as long as the portions of instruments that will come in contact with the patient remain sterile.)

• Video, photographic, or digital capture equipment may be attached to the hysteroscope as desired (optional)


TECHNIQUE


The patient is placed in the dorsal lithotomy position. (If a bimanual examination is performed, the amount of lubricant used should be limited because this lubricant, and glove powder, can adversely affect cytologic studies.) By use of the largest warmed but unlubricated speculum the patient can comfortably accommodate, the cervix should be brought into full view. Following gross inspection for lesions, excessive secretions may be gently blotted away, cultures obtained, or a repeat Papanicolaou (Pap) smear taken.

Related posts:

  1. Anemia
  2. Toxic Shock Syndrome
  3. Uterine Anomalies: Bicornuate, Septate, and Unicornuate Uterus
  4. Cervical Cancer

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Jun 6, 2016 | Posted by in GYNECOLOGY | Comments Off on Colposcopy

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