Colposcopy
Most patients
undergo a colposcopic (VAGINA
surgical microscope, Gynecology, Optical colposcope,
Colposcope, Colposcopic, Colposcopy,
Vaginoscope,
Vaginal speculum) examination to further investigate a cytological
abnormality on their pap smears. Other indications for a patient
to have a colposcopy include:assessment of diethylstilbestrol (DES) exposure in utero,immunosuppression such as HIV infection, or an organ transplant
patient
an abnormal appearance of the cervix as noted by a primary care
provider
as a part of a sexual assault forensic examination [4] done by a
Sexual Assault Nurse Examiner
Many physicians base their current evaluation and treatment
decisions on the report "Guidelines for the Management of
Cytological Abnormalities and Cervical Cancer Precursors",
created by the American Society for Colposcopy (Vaginal
speculum,VAGINA
surgical microscope, Gynecology, Optical colposcope,
Colposcope, Colposcopic, Colposcopy,
Vaginoscope)
Cervical Pathology,during a September 2001 conference.[5]
During the initial evaluation,a medical history is obtained,including gravidity(number of prior pregnancies),parity
(number of prior deliveries),last menstrual period,
contraception use, prior abnormal pap smear results,allergies,significant past medical history,other medications,prior
cervical procedures, and smoking history. In some cases, a
pregnancy test may be performed before the procedure(Vaginal
speculum,VAGINA
surgical microscope, Gynecology, Optical colposcope,
Colposcope, Colposcopic, Colposcopy,
Vaginoscope). The
procedure is fully described to the patient, questions are asked
and answered, and the patient then signs a consent form.
A colposcope(Vaginal
speculum,VAGINA
surgical microscope, gynecology,optical colposcope,
Colposcope,colposcopic,colposcopy,vaginoscope)is used to identify visible clues suggestive of abnormal tissue.
It functions as a lighted binocular microscope to magnify the
view of the cervix, vagina, and vulvar surface. Low power (2¡Á to
6¡Á) may be used to obtain a general impression of the surface
architecture. Medium (8¡Á to 15¡Á) and high (15¡Á to 25¡Á) powers
are utilized to evaluate the vagina and cervix. The higher
powers are often necessary to identify certain vascular patterns
that may indicate the presence of more advanced precancerous(Vaginal
speculum,VAGINA
surgical microscope, Gynecology, Optical colposcope,
Colposcope, Colposcopic, Colposcopy,
Vaginoscope) or
cancerous lesions. Various light filters are available to
highlight different aspects of the surface of the cervix. Acetic
acid solution and iodine solution (Lugol's or Schiller's) are
applied to the surface to improve visualization of abnormal
areas.
Colposcopy (Vaginal
speculum,VAGINA
surgical microscope, Gynecology, Optical colposcope,
Colposcope, Colposcopic, Colposcopy,
Vaginoscope) is performed with the patient lying back, legs in
stirrups, and buttocks at the lower edge of the table (a
position known as the dorsal lithotomy position). A speculum is
placed in the vagina after the vulva is examined for any
suspicious lesions.Three percent acetic acid is applied to the cervix using cotton
swabs.Areas of acetowhiteness (vaginal
speculum,VAGINA
surgical microscope, gynecology, optical colposcope,
Colposcope, Colposcopic, Colposcopy,
Vaginoscope) correlate with higher nuclear
density. The transformation zone is a critical area on the
cervix where many precancerous and cancerous lesions most often
arise. The ability to see the transformation zone and the entire
extent of any lesion visualized determines whether an adequate
colposcopic (vaginal
speculum,VAGINA
surgical microscope,gynecology,optical colposcope,
colposcope, colposcopic,colposcopy,vaginoscope) examination is attainable.
Areas of the cervix which turn white after the application of
acetic acid or have an abnormal vascular pattern are often
considered for biopsy. If no lesions are visible, an iodine
solution may be applied to the cervix to help highlight areas of
abnormality.
After a complete examination,colposcopist (vaginal
speculum,VAGINA
surgical microscope , gynecology,optical colposcope,
colposcope, colposcopic,colposcopy,vaginoscope) determines the
areas with the highest degree of visible abnormality and may
obtain biopsies from these areas using a long biopsy instrument,
such as a punch forceps or SpiraBrush CX. Most doctors and
patients consider anesthesia unnecessary; however, some
colposcopists (vaginal
speculum,VAGINA
surgical microscope,gynecology,optical colposcope,
Colposcope, Colposcopic, Colposcopy,
Vaginoscope) now recommend and use a topical anesthetic such as lidocaine or a cervical block to decrease patient discomfort,
particularly if many biopsy samples are taken.
Following any biopsies, an endocervical curettage (ECC) is often
done. The ECC utilizes a long straight curette or a cytobrush
(like a small pipe-cleaner) to scrape the inside of the cervical
canal (vaginal
speculum,VAGINA
surgical microscope,gynecology,optical colposcope,
Colposcope, Colposcopic, Colposcopy,
Vaginoscope).The ECC should never be done on a patient who is
pregnant. Monsel's solution is applied with large cotton swabs
to the surface of the cervix to control bleeding. This solution
looks like mustard and turns black when exposed to blood.After procedure this material will be expelled naturally: (vaginal
speculum,
VAGINA surgical microscope,gynecology,optical
colposcope, Colposcope, Colposcopic, Colposcopy,
Vaginoscope) patients
can expect to have a thin coffee-ground like discharge for up to
several days after the procedure. Alternatively, some physicians
achieve hemostasis with Silver Nitrate.a
Article Source:http://en.wikipedia.org/wiki/Colposcopy |