Treatments

A colposcopy procedure may also be used to diagnose and assist in the treatment of the following conditions:

• Bleeding
• Polyps (benign growths)
• Genital warts, which may indicate infection with human papilloma virus (HPV), a risk factor for developing cervical cancer
• Diethylstilbestrol (DES) exposure in women whose mothers took DES during pregnancy, as DES exposure increases the risk for cancer of the reproductive system

The organs and structures of the female pelvis are:

• Endometrium: This is the lining of the uterus.
• Uterus (also called the womb): The uterus is a hollow, pear-shaped organ located in a woman’s lower abdomen, between the bladder and the rectum. The uterus sheds its lining each month during menstruation, unless a fertilized egg (ovum) becomes implanted and pregnancy follows.
• Ovaries: Two female reproductive organs located in the pelvis in which egg cells (ova) develop and are stored and where the female sex hormones oestrogen and progesterone are produced.
• Cervix: The lower, narrow part of the uterus located between the bladder and the rectum, forming a canal that opens into the vagina, which leads to the outside of the body.
• Vagina (also called the birth canal): The passageway through which fluid passes out of the body during menstrual periods. The vagina connects the cervix and the vulva (the external genitalia).
• Vulva: The external portion of the female genital organs.
• Fallopian tubes: Two thin tubes that extend from each side of the uterus toward the ovaries as a passageway for eggs and sperm.

Other related procedures that may be used to diagnose or treat cervical and vaginal conditions include Pap test, cervical biopsy, and loop electrosurgical excision procedure (LEEP). When cervical or vaginal problems are found during a pelvic examination, or abnormal cells are found during a Pap test, a colposcopy may be performed. Through the colposcope, the doctor can see certain changes in cervical and vaginal tissues, such as abnormal blood vessels, tissue structure, colour, and patterns. Cells that appear to be abnormal, but are not cancerous at the present time, may be identified as precancerous. The appearance of these abnormal cells may be the first evidence of cancer that develops years later.

If abnormal tissue is seen during a colposcopy, a small sample of tissue (called a colposcopic biopsy) may be taken for further study. The doctor may also take tissue samples from inside the cervix using an endocervical brush or endocervical curettage (ECC).

Before the Surgery

• The doctor will explain the procedure to the patient/family and offer the opportunity to ask any questions about the procedure.
• The patient will be asked to sign a consent form that gives permission to do the surgery. The patient/family must read the form carefully and ask questions if something is not clear.
• In case of suspected pregnancy or confirmed pregnancy, the doctor should be informed about it.
• If possible, a colposcopy procedure will be scheduled approximately one week after your menstrual period.
• Generally, no prior preparation, such as fasting or sedation, is required. If a biopsy is performed and requires regional or general anaesthesia, the patient may need to fast for a certain number of hours before the procedure, generally after midnight.
• The patient / attendant should notify the doctor if she is sensitive to or allergic to any medications, iodine, latex, tape, or anaesthetic agents (local and general).
• The patient / attendant should notify the doctor of all medications (prescription and over-the-counter) and any herbal supplements that she may be taking.
• The doctor should be notified if the patient has a history of bleeding disorders or if she is taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary to stop these medications prior to the procedure.
• The patient should change into hospital gown.  Any excessive hair at the surgical site will be clipped off or shaved.
• An antibiotic may be given the day before the procedure.
• The patient should not use tampons, vaginal creams or medications, douche, or have sexual relations for 24 hours before the test.
• Doctors may recommend that the patient take a pain reliever 30 minutes before the procedure, or they may be given a sedative before the anaesthesia is started.
• Based on the patient’s medical condition, the doctor may request other specific preparation.

During the Surgery

A colposcopy may be performed on an outpatient basis, or as part of stay in a hospital. Procedures may vary depending on the patient’s condition.  Generally, a colposcopy follows this process:

• The patient will be asked to undress completely or from the waist down and put on a hospital gown.
• The patient will be instructed to empty the bladder prior to the procedure.
• Patient will be positioned on an examination table, with her feet and legs supported as for a pelvic examination.
• The doctor will insert an instrument called a speculum into the vagina to spread the walls of the vagina apart to expose the cervix.
• The colposcope, which is like a microscope with a light on the end, will be placed at the opening of the vagina. The colposcope does not enter the vagina.
• The doctor will look through the colposcope to locate any problem areas on the cervix or in the vagina. Photographs with the colposcope or sketches of any areas may be made.
• The cervix may be cleansed and soaked with a vinegar solution, also called an acetic acid solution. This solution helps make the abnormal tissues turn white and become more visible. The patient may feel a mild burning sensation. An iodine solution may be used to coat the cervix, called the Schiller test.
• The doctor may take a small tissue sample called a biopsy. When this is done, the area is numbed, but the patient may feel a slight pinch or cramp as the tissue is removed.
• Cells from the inside of the cervical canal may be sampled with a special instrument called an endocervical curette. This may also cause some cramping.
• Bleeding from the biopsy site may be treated with a paste-like topical medication or with a pressure dressing.
• The tissue will be sent to a lab for examination.

After the Surgery

After a colposcopy procedure, the patient may rest for a few minutes before going home. If the patient undergoes a colposcopy with a biopsy, the recovery process will vary, depending on the type of biopsy performed and the type of anaesthesia (if any) used. If regional or general anaesthesia was used, the patient will be taken to the recovery room for observation. Once blood pressure, pulse, and breathing are stable and the patient is alert, she will be taken to the hospital room or discharged home. If this procedure was performed on an outpatient basis, the patient should plan to have another person drive her home.

Rehabilitation

The patient will be required to wear a sanitary pad for bleeding. If a biopsy was performed, it is normal to have some mild cramping, spotting, and dark or black-coloured discharge for several days. The dark discharge is from the medication applied to the cervix to control bleeding. If a biopsy was performed, the patient is usually instructed not to douche, use tampons, or have intercourse for one week after the procedure, or for a period of time recommended by the doctor.  The patient may also have other restrictions on her activity, including no strenuous activity or heavy lifting. The patient may resume normal diet unless the doctor advises differently. Pain relievers can be taken for cramping or soreness as directed by the doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Hence only recommended medications should be taken.

The doctor will advise the patient on when to return for further treatment or care. Generally, women who have had a cervical biopsy will need more frequent Pap tests.

The doctor should be notified if the patient notices any of the following:

• Bleeding
• Foul-smelling drainage from the vagina
• Fever and/or chills
• Severe pelvic (lower abdominal) pain