colposcopy

Colposcopy is a diagnostic procedure used to examine the cervix, vagina, and vulva for signs of disease. It is commonly performed after an abnormal cervical screening result, such as an abnormal cytology (Pap test) or a positive test for high-risk human papillomavirus (HPV). The goal is to identify precancerous changes or other lesions and to guide biopsy or treatment decisions.

During the procedure, a speculum is inserted to expose the cervix. A colposcope, a binocular magnifying instrument with a bright light, is used to inspect the tissues. The clinician typically applies diluted acetic acid to highlight abnormal epithelium, which turns white. Lugol’s iodine or other dyes may be used to help distinguish normal from abnormal tissue. Any suspicious areas are sampled with directed cervical biopsies, and endocervical canal sampling (endocervical curettage) may be performed to assess endocervical involvement.

Colposcopy is indicated after abnormal cytology, after abnormal screening with HPV, or for evaluation of reported lesions within the vagina or vulva. The results are used to grade cervical intraepithelial neoplasia (CIN) or to classify lesions by Bethesda terminology and determine management, such as surveillance, excisional treatment, or follow-up testing.

Risks are minor and include bleeding, infection, or temporary discomfort. The procedure may be less reliable in certain circumstances, and false negatives can occur. In pregnancy, colposcopy is generally considered safe, but sampling of the endocervical canal may be limited.

Aftercare usually includes avoiding sexual intercourse and tampon use for about one week, and monitoring for unusual bleeding or discharge. Pathology results are typically reported within 1–3 weeks, and treatment decisions, such as loop electrosurgical excision procedure (LEEP) or cold knife conization, depend on the severity of biopsied lesions and patient factors.