Atlas of Colposcopy: Principles and Practice

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Steps of a colposcopic examination  

  • Make sure that the woman is counselled appropriately and an informed consent has been taken according to local practice.
  • Adjust the eyepieces to achieve binocular stereoscopic vision (this step should be performed on an inanimate object at the start of colposcopy, before the patient is on the table).
    • Look through the left and right eye pieces one at a time. Turn the dioptre ring until you see sharp and clear images through either eyepiece.
    • Place your eyes on both the eye pieces and push them wide apart. You will see two fields of vision.
    • Keeping your eyes trained on the colposcope, bring the two eye pieces closer together until you see a single object (binocular vision) and the examination becomes comfortable.

  • Give the patient a careful explanation of what you are going to do. It is much easier to examine a relaxed, comfortable patient.
  • Help the woman lie down on the table with her legs flexed or supported on leg rests, and cover her with a blanket or a sheet.
  • Position the colposcope head (or the portable colposcope) between you and the foot end of the examination table.
  • Adjust the colposcope head so that the approximate distance between the cervix (after exposing with the speculum) and the front of the colposcope optics will be 30 cm.
  • Switch on the light, and focus the light on the external genitalia.

  • Inspect the external genitalia and the perianal area for any warts, white or red patches, ulcers, or growths.
  • Insert the speculum and adjust it so that the entire cervix is exposed and the woman is comfortable.
  • Move the head of the colposcope towards or away from the cervix until the cervix comes into focus. Then use the fine focusing adjustment to obtain sharp images.

  • Note the characteristics of the vaginal discharge, if any.
  • Use just enough magnification to have a complete panoramic view of the cervix. Usually, 6× to 8× magnification is adequate.
  • Examine the cervix for cervicitis, growths, ulcers, or contact bleeding.
  • Apply normal saline to the cervix with cotton swabs and gently remove the mucus and discharge.
  • Identify the external os and the squamocolumnar junction (SCJ).
  • Ensure that you can visualize the entire cervix.
  • Examine blood vessels with the green filter. Increase the magnification if required.
  • Soak a swab in 3–5% acetic acid and apply to the cervix for 1 minute. Remove the swab from time to time to see if any white patch is appearing. Use copious amounts of acetic acid to soak the entire cervix.
  • Alternatively, acetic acid may be sprayed onto the cervix using a fine-nozzle spray bottle.
  • Locate the SCJ and try to trace the SCJ in its entirely. Determine the type of transformation zone (TZ).
  • Determine the extent of the TZ by locating the most distal crypt opening or nabothian cyst or the outer extent of any lesion present.

  • Look for any acetowhite areas inside and outside the TZ.
  • Use an endocervical speculum to visualize the endocervix if necessary (the steps are discussed later).
  • Apply Lugol’s iodine and inspect for iodine staining.
  • Decide whether to take a biopsy or perform endocervical curettage, and plan the management.
  • Remember to take the biopsy from the colposcopically most abnormal area.
  • Document the findings appropriately after completion of the procedure.

Colposcopy procedure:

Steps of colposcopic examination

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