Satisfactory performance of colposcopy is not possible if the cervix cannot be exposed appropriately because of vaginal stenosis or scarring or if the features are obscured because of excessive bleeding or inflammation. In such situations, the colposcopy should be considered inadequate.
Inadequate colposcopy is different from the previously used terminology of “unsatisfactory” colposcopy. “Unsatisfactory” colposcopy essentially indicated a type 3 transformation zone. The term is confusing and should not be used in colposcopy practice.
Management of an inadequate colposcopy depends on the indication for colposcopy, the grade of cytological abnormality (if any), and the reason for inadequacy. If there is any suspicion of invasive cancer, either multiple punch biopsies should be obtained blindly or colposcopy should be repeated under general/regional anaesthesia. If the cervix cannot be exposed because of severe atrophic vaginitis or severe inflammation, then medical treatment is needed with estrogen vaginal cream and antibiotics, respectively, followed by repeat colposcopy. Estrogen cream is applied intravaginally each evening for 4 weeks and stopped 1 week before repeat colposcopy.
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