Atlas of Colposcopy: Principles and Practice

The most common indication for colposcopy is an abnormal cervical cancer screening test. Women with a Pap smear report of atypical squamous cells, cannot exclude HSIL (ASC-H) or low-grade squamous intraepithelial lesion (LSIL) or worse should be evaluated by colposcopy. Women with atypical squamous cells of undetermined significance (ASCUS) on cytology may have cytology repeated after 6 months or undergo HPV testing or be directly referred for colposcopy. Visual inspection with acetic acid (VIA)-positive women may have colposcopy or direct treatment, depending on the facilities available. Women positive on an HPV test can have triaging with cytology or VIA or may be directly referred for colposcopy.

Other indications for colposcopy are:

• Symptoms suggestive of cervical cancer, e.g. profuse foul-smelling vaginal discharge, abnormal or contact vaginal bleeding, post menopausal bleeding (along with endometrial assessment)
• Cervical cancer suspected on naked-eye examination of the cervix
• Follow-up after treatment of cervical precancer
• Evaluation of other lower genital tract abnormalities (e.g. genital warts, vulvar lesions)

Colposcopy should be postponed if there is severe cervico-vaginal inflammation, making satisfactory visualization of the cervix difficult. However, if cervicovaginal inflammation is accompanied by a growth or an ulcer on the cervix, a biopsy of the growth or ulcer should be obtained without further delay.