The observation of the uterine cervix (colposcopy) by means of a magnifying optical device, the colposcope, makes it possible to locate pathological lesions and to perform guided biopsies thereof. A correct colposcopic examination examines the junction area between the outer part of the cervix (the exocervix) and the inner part of the cervical canal (the endocervix). This junction area is clearly visible during the early part of the menstrual cycle, prior to ovulation. In menopausal women, this junction area is mostly located inside the cervical canal and it can be brought out by estrogen treatment.
Colposcopy is recommended:
- In case of abnormal cervical-vaginal smears
- Sometimes immediately, with no prior smear, if at visual examination anomalies are suspected.
- As part of the surveillance of known and treated lesions.
Colposcopic examination includes:
- Cervical examination following cleaning of the secretions with a dry cotton cloth. In some cases, small retractors are necessary in order to view the junction area under optimal conditions.
- Examination by optical magnifying and use of green and blue light filters highlights micro-vessels networks on the cervical surface. Anomalies in these networks make possible the location of suspect areas.
- Examination following application of 2 % acetic acid, which coagulates proteins: the anomalies of the uterine cervix appear in such cases as whitish-colored areas, suggesting a more significant cellular multiplication in these areas.
- Examination following cervical painting with Lugol (a solution rich in Iodine that fixates into glycogen – a complex of sugars -, which is absent from young, rapidly multiplying cells). A healthy cervix will take a brown coloration, with the exception of the suspect areas, which do not take this coloration (Schiller test).
- Cervical biopsies can be carried out at the level of the suspect areas pointed out. In case of a junction area impossible to view, curettage may be necessary, using either a curette, or a Novack canula.
- It's possible to send the smears or biopsies to a specific laboratory to identify the type of papilloma virus and to enter the patient into an adequate follow-up (HPV typing).
Colposcopy is a painless examination. It can be carried out, if necessary, under local anesthesia. The results of the smears or of the biopsies may at times take weeks. Colposcopy, as well as biopsies, may lead to bleeding originating from the outer part of the cervix. Thus, patients who observe the laws of conjugal purity are not, a priori, “niddah”, although, from a medical point of view, it is preferable to wait for the bleeding to stop prior to resuming conjugal relations.
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