Colposcopy

What Is Colposcopy? What Exactly Does It Do?

A colposcope is a special binocular microscope with a powerful light source at its tip that can magnify the area it examines 10 to 40 times. It is positioned in front of the vaginal opening of the patient lying on the gynecological examination table (it does not enter the vagina). Looking through the lenses of the colposcope, the doctor examines the surface of the cervix, vagina, and vulva in detail.

The Main Purposes of Colposcopy:

• Evaluating Abnormal Pap Smear/HPV Results: Investigating the cause of cellular changes detected on a Pap smear test (such as ASC-US, LSIL, HSIL, AGC) or the presence of high-risk HPV.
• Identifying Suspicious Areas: Detecting precancerous lesions on the surface of the cervix (CIN – Cervical Intraepithelial Neoplasia) or abnormal areas that may indicate early-stage cancer (color changes, abnormal vascularization, ulceration, etc.).
• Guiding Biopsy: If suspicious areas are seen, colposcopy allows a targeted tissue sample (biopsy) to be taken from these areas, helping to reach the most accurate diagnosis.
• Evaluating Other Conditions: It can also be used to assess the extent of genital warts, evaluate the severity of cervical inflammation (cervicitis), examine growths such as benign polyps, investigate the cause of unexplained postcoital bleeding, or monitor structural changes in women exposed to DES (diethylstilbestrol).
• Post-Treatment Follow-up: To check the healing and recurrence status of patients previously treated for lesions such as CIN (LEEP, conization, etc.).

Why Is Colposcopy Performed? Who Is It Recommended For? (Indications)

The most common situations requiring colposcopy are as follows:

• Abnormal Pap Smear Test Results:
  
  • ASC-US (Atypical Squamous Cells of Undetermined Significance) with High-Risk HPV Positivity
  • LSIL (Low-Grade Squamous Intraepithelial Lesion)
  • HSIL (High-Grade Squamous Intraepithelial Lesion)
  • ASC-H (Atypical Squamous Cells, Cannot Exclude High-Grade Lesion)
  • AGC (Atypical Glandular Cells)
• High-Risk HPV Test Positivity: Especially when there is a persistent high-risk HPV infection even if the Pap smear is normal, or as required by screening protocols for certain age groups.
• Suspicious Cervical Appearance on Examination: The doctor noticing an abnormal appearance of the cervix (erosion, lesion, mass, etc.) with the naked eye during a routine gynecological examination.
• Unexplained Abnormal Vaginal Bleeding: To investigate the cause of bleeding, particularly after intercourse (postcoital) or spotting outside of menstruation (if a cervical pathology is suspected).
• Presence of Genital Warts (Condyloma): To assess the extent of the warts and whether any other accompanying lesions are present.
• Post-CIN Treatment Follow-up: To monitor the effectiveness of treatment and whether the disease has recurred.

Your doctor (Prof. Dr. Nuray Bozkurt) will decide whether colposcopy is necessary based on your Pap smear and HPV test results and your clinical condition.

How Is the Colposcopy Procedure Performed? Step-by-Step Process (Performed in Ankara)

Colposcopy is usually performed in an office setting and includes the following steps:

1. Preparation: No special preparation is usually required. The most suitable time for the procedure is when there is no menstrual bleeding. It is recommended to avoid vaginal douching, vaginal creams or medications, and sexual intercourse for 24-48 hours before the procedure. You may take a mild pain reliever (e.g., ibuprofen) to relax before the procedure. If you have an iodine allergy, you must inform your doctor.
2. Positioning: You will be asked to lie on your back on the gynecological examination table with your legs placed in the supports (lithotomy position).
3. Speculum Placement: Your doctor gently inserts a speculum into the vagina to spread the vaginal walls apart and make the cervix visible (as in a Pap smear test).
4. Examination with the Colposcope: The colposcope device is positioned in front of the vaginal opening (it is not inserted into the vagina). Looking through the lenses of the colposcope, the doctor examines the surface of the cervix under magnification.
5. Cleaning with Saline Solution: The cervix may be gently wiped with saline solution to clean away mucus or discharge.
6. Application of Acetic Acid: A 3% or 5% acetic acid solution (diluted vinegar solution) is applied to the cervix with a cotton swab. This solution causes areas containing abnormal cells to temporarily turn white (acetowhite reaction) by precipitating their proteins. A mild burning or stinging sensation may occur during this step. The doctor carefully examines the borders, density, and vascular pattern of these white areas.
7. Application of Lugol’s (Iodine) Solution (Schiller Test): After the acetic acid application, an iodine-containing Lugol’s solution is applied to the cervix. Because healthy cervical cells contain glycogen, they absorb the iodine and turn dark brown or black. Abnormal cells (CIN or cancer cells), which do not contain glycogen, do not absorb the iodine and remain light yellow (iodine-negative areas). This test helps determine the borders of abnormal areas. This step is skipped in patients with an iodine allergy.
8. Biopsy (If Necessary): If suspicious (abnormal) areas highlighted by acetic acid or Lugol’s solution are detected on colposcopic examination, a small tissue sample is taken from these areas for a definitive diagnosis. This procedure is called a cervical biopsy. A very small, specialized biopsy forceps is used. A brief, mild pinching sensation or menstrual-cramp-like feeling may be felt during the procedure. Anesthesia is generally not required. Sometimes biopsies may need to be taken from more than one area.
9. Endocervical Curettage (ECC – If Necessary): To evaluate the interior of the cervical canal (endocervix), especially when the source of abnormal cells is thought to be this canal, or when the transformation zone (the area where the outer and inner surfaces of the cervix meet, where changes most commonly occur) cannot be fully visualized on colposcopy, cell samples are scraped from this canal using a small curette or brush. This procedure may also cause a mild cramping sensation.
10. Bleeding Control: Silver nitrate sticks or a special chemical solution called Monsel’s solution are typically used to stop the very light bleeding that occurs after a biopsy. This solution may sometimes cause dark-colored discharge. Rarely, cauterization (burning) may be needed to stop bleeding.
11. End of the Procedure: The speculum is removed and the procedure is complete.

Procedure Duration: A purely diagnostic colposcopy generally takes 5-15 minutes. The duration may be slightly longer if a biopsy or ECC is added.

Recovery After Colposcopy and Biopsy: What to Watch For

Recovery after colposcopy is generally quick and uneventful:

• Immediately Afterward: You can return to your daily activities right after the procedure. You may drive.
• Pain/Discomfort: There is usually no pain. If a biopsy was taken, mild cramp-like pain lasting a few hours may occur; simple pain relievers are generally sufficient.
• Bleeding/Discharge: It is normal to have mild vaginal spotting or bloody or brown (due to Monsel’s solution) discharge for a few days after the procedure. It is recommended to use a pad during this period. If heavy bleeding occurs (heavier than a menstrual period), you should definitely contact your doctor.
• Restrictions: To reduce the risk of infection and support healing, your doctor generally recommends avoiding the following for about 1 week after the procedure:
  
  • Sexual intercourse
  • Tampon use (use pads instead)
  • Vaginal douching
  • Entering a pool or bathtub (standing showers are fine)
• Biopsy Results: If a biopsy was taken, results from the pathology laboratory generally take 7 to 10 days. Once the results are ready, your doctor will inform you and discuss the next steps (follow-up or treatment) with you based on the outcome.

What Are the Risks of Colposcopy? Is It a Safe Procedure?

Colposcopy is a very safe diagnostic procedure when performed by an experienced gynecologist. The risk of complications is very low. Possible rare risks include:

• Bleeding: More bleeding than expected from the biopsy site (very rare).
• Infection: Development of cervical or pelvic infection (very rare). A doctor should be consulted if symptoms such as fever, severe abdominal pain, or foul-smelling discharge occur.
• Pain: Mild cramp-like pain during or after the procedure.
• Allergic Reaction: Rarely, an allergy may develop to the iodine solution used (those with an iodine allergy should mention this beforehand).
• Uterine Perforation: A very, very rare risk, particularly during ECC.

Colposcopy does not prevent pregnancy and does not affect fertility. If necessary, it can also be safely performed during pregnancy, although the decision on whether to take a biopsy is made more carefully depending on the week of pregnancy and the situation.

Colposcopy in Ankara: Accurate and Reliable Evaluation with Prof. Dr. Nuray Bozkurt

Prof. Dr. Nuray Bozkurt offers her patients in Ankara an expert approach to managing abnormal Pap smear results, HPV positivity, and other cervical problems:

• Expertise and Experience: She has the necessary training and experience in performing colposcopy and evaluating cervical pathologies.
• Modern Equipment: She performs accurate and detailed examinations using high-resolution, modern colposcopy devices at her clinic in Ankara or at affiliated institutions.
• Careful and Meticulous Application: She performs the procedure gently and carefully, keeping patient comfort at the highest level. She avoids unnecessary biopsies while aiming to sample the correct area in suspicious cases.
• Patient Information and Reassurance: Before the procedure, she explains the procedure, why it is being performed, and what to expect in language the patient can understand. She works to ease the patient’s concerns and provides information throughout the procedure.
• Interpretation of Results and Management: She accurately interprets biopsy results and works with the patient to create the necessary follow-up or treatment plan (including referral for or performance of further procedures such as LEEP or conization) based on the outcome.
• Accessibility: She provides an easily accessible point of contact for questions after the procedure or about your results (0538 983 18 78)(0312 284 00 12).

If an abnormality has been detected on your Pap smear test, your HPV test has come back positive, or your doctor has mentioned a suspicious finding on your cervix, having a colposcopy to clarify the situation before worrying is the most appropriate next step. Early diagnosis allows precancerous cervical lesions to be treated before they progress to cancer. You can safely have your colposcopic evaluation by making an appointment with Prof. Dr. Nuray Bozkurt in Ankara. For appointments and information, please contact our clinic at 0538 983 18 78.