Before application of acetic acid: The cervix is covered with thin normal mucoid secretion. The SCJ is fully visible on the ectocervix.
Cervix before application of acetic acid:
After application of acetic acid: A large thin acetowhite area on the anterior lip arising from the SCJ is seen extending towards the vaginal fornix. Such lesions extend beyond the TZ.
After application of acetic acid: The thin acetowhite area can be seen on the posterior lip also extending towards the vaginal fornix.
Cervix after application of acetic acid:
Squamocolumnar junction visibility:
Squamocolumnar junction location:
If present, description of acetowhite area:
Determined eligibility for ablative treatment:
Remarks: A large oblong (lozenge-shaped) thin acetowhite area with extension to the vaginal fornices is a characteristic feature of the congenital transformation zone (CTZ). It is a normal condition and does not require treatment. However, on naked-eye examination, the CTZ can mimic a low-grade lesion and should be categorized as VIA-positive. Large loop excision of the transformation zone (LLETZ) should not be attempted on such cases, even in a screen-and-treat setting. If there is any doubt, biopsies should be taken.