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Atlas of visual inspection of the cervix with acetic acid for screening, triage, and assessment for treatment

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  • Case: 18

  • Age: 53

  • Before application of acetic acid: Atrophic cervix of a woman with uterovaginal prolapse. Multiple red ulcerated areas are seen on both the anterior and posterior lips.

  • Cervix before application of acetic acid:  
  •  Infective vaginal discharge:   
    Strawberry appearance of cervix
    Cervicitis
    Polyp
    Bleeding on contact
    White patch
    Growth
    Ulcer
    Erosion

    After application of acetic acid: The ulcers have sharp margins. The squamous epithelium is atrophic and appears pale pink. The SCJ is not visible. No acetowhite area.

  • Cervix after application of acetic acid:
    • Squamocolumnar junction visibility:  
    • Squamocolumnar junction location:  
    • Acetowhite area:  

  • VIA category:  

  • Determined eligibility for ablative treatment (if HPV-positive):  

  • Histopathology: Not done

  • Remarks: Ulcerations (decubitus ulcers) are caused by venous congestion and friction in women with long-standing uterovaginal prolapse. Thickened squamous epithelium is due to hyperkeratinization, which occurs because of long-standing irritation of the epithelium. The woman should be referred to an appropriate centre for treatment of genital prolapse.





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