home Drugs Colposcopy is better. How do women undergo cervical colposcopy? What the study will show

Colposcopy is better. How do women undergo cervical colposcopy? What the study will show

Colposcopy is a gynecological examination of the vagina, cervix and vulva. This procedure is carried out using a special device - a colposcope. The main indications for colposcopy are deviations from the norm in the results of a Pap test (cytology smear, Pap test - the same thing). If unusual, suspicious formations are found during a colposcopy, the doctor can immediately perform a biopsy, taking a few abnormal cells for further detailed laboratory tests.

Many women experience anxiety before colposcopy and are afraid to undergo it. This is often explained by a lack of awareness about the essence of the procedure, what colposcopy of the cervix is, what it is needed for, and how it is done. In addition, there are myths that colposcopy is painful, but in reality even a cervical biopsy is considered painless, although sometimes it causes a feeling of pressure and mild spasmodic pain. However, in some cases both one and the other procedure are irreplaceable.

Why is colposcopy done?

This study is used in the diagnosis of many women's diseases, including the following:

– Genital warts;
- Cervical erosion;
– Cervicitis – inflammation of the uterine cervix;
– Anomalies of precancerous tissue of the uterine cervix;
- Cervical cancer;
– Precancerous changes in the vulva;
– Vulvar cancer;
– Anomalies of precancerous vaginal tissue;
– Vaginal cancer;
- etc.

Indications for colposcopy

The colposcopy procedure is a study, a gynecological examination of the condition of part of the cervix, as well as the mucous membrane of the entire vagina, carried out using a colposcope, which allows for a detailed examination of the tissue. Indications for colposcopy are the need to analyze and evaluate the condition of the mucous membrane of the vagina and cervix, diagnose diseases, and confirm the diagnosis. Actually, the main purpose of the procedure is to detect abnormal, suspicious tissues, and most importantly, it allows you to distinguish a benign tumor from a malignant one (cancer). In addition, indications for colposcopy are monitoring the effectiveness of treatment.

Contraindications for colposcopy

In fact, there are no contraindications for colposcopy, given the simplicity and absolute safety of the study. There is only one temporary limitation, according to which, by the time of examination with a colposcope, menstrual bleeding must end - the procedure is not carried out during menstruation. And even pregnancy is not a contraindication.

Colposcopy during pregnancy

Colposcopy for pregnant women is an absolutely safe procedure; however, in any case, the doctor must be notified of pregnancy before performing the procedure. But if treatment is necessary, appropriate measures are postponed until the birth of the child (except in cases where neoplasms seriously threaten women’s health and require immediate medical intervention). Colposcopy during pregnancy does not threaten the health of the child; it does not affect childbirth or the ability to conceive a child in the future. There are no reasons that could classify the procedure as dangerous during pregnancy. In fact, even a biopsy is safe for a pregnant woman, which is often resorted to during or after colposcopy if there are suspected abnormalities in the tissues and mucous membranes (although a biopsy in such cases can cause quite severe vaginal bleeding).

Treatment after colposcopy is usually delayed until after delivery due to the risk of bleeding, especially if the pregnancy is more than ten weeks. Colposcopy during pregnancy is done to eliminate the risk of developing cervical oncology (cancer). Pregnancy can modify the cervical mucosa (cervical dysplasia is more pronounced; an increase in the amount of mucus in the cervical canal can complicate the examination), therefore the colposcopy procedure should be performed exclusively by a qualified gynecologist. In most cases, a biopsy, which usually follows a colposcopy, is not recommended during pregnancy.

The reason for this is increased vascularization of the uterine cervix and an increased risk of heavy bleeding during pregnancy. But if colposcopy reveals the presence of potentially dangerous neoplasms or third-degree cervical dysplasia, then a biopsy should be performed, regardless of the risks to pregnancy. Taking tissue samples for analysis from the cervical canal is contraindicated due to the possibility of fetal damage.

What is a colposcope and how does it work?

A colposcope is a special device consisting of a microscope with optical and lighting systems, adapted for non-contact research. The colposcope contains a binocular optical head, the base of the device and its tripod, which allows you to install and use the device in any position convenient for the doctor. The optical head includes prismatic binoculars, which are equipped with interchangeable magnification eyepieces, allowing you to see tissue in great detail at a distance of 195 mm. The head has a built-in illuminator that creates uniform, intense illumination of the surface examined by the doctor.

The procedure itself for cervical colposcopy can be simple and extensive. The procedure is simple and only involves examining the mucous membrane of the cervix, after first cleaning its surface from everything that separates. As for extended colposcopy, it consists of examining the vaginal part of the cervix after it has been treated with a special reagent, namely a 3% solution of acetic acid. This treatment allows you to see pathological changes in the tissue more clearly, since the layers of its mucous membrane swell for a short time, and contraction occurs in the treated area blood vessels, decreased blood supply to tissues.

To detect glycogen in cells, the tissue surface under study is pre-treated with another reagent - Lugol's aqueous solution (in medicine this is called Schiller's test). Epithelial cells in the case of precancerous diseases turn out to be poor in glycogen, which means they are not stained with Lugol's solution; the abnormal tissue in this case looks like whitish spots on a dark brown background healthy tissue vagina or cervix, which is normal reaction to the solution. As mentioned earlier, during colposcopy the doctor can take (pinch off) a piece of tissue for further detailed examination. laboratory research– biopsy.

Colposcopy is painful, is it dangerous?

As you probably already understood, the procedure is safe and painless - it is not painful or dangerous. When performing an extended colposcopy, you may experience a slight burning sensation from contact with the acidic reagent. However, even if extremely in rare cases, but still, complications may arise as a result of colposcopy, such as:

1. Severe bleeding;
2. Pain in the lower abdomen;
3. Infection.

If in the next few days after the procedure you experience symptoms such as heavy menstrual bleeding, heavier than usual (if the bleeding is small or spotting and persists for 2-3 days after the procedure, this is normal), chills, fever and severe pain in the lower abdomen, urgent medical attention is needed. Therefore, you need to see a doctor as soon as possible!

Preparation for the procedure

In anticipation of a colposcopy, your doctor should recommend that you comply with the following conditions:

1. For one to two days before the procedure, abstain from sex.
2. For a couple of days before the examination, do not use tampons, do not use suppositories, do not do vaginal baths, etc. – the internal flora should remain natural.
3. If a woman is highly sensitive, it is allowed to take some over-the-counter pain reliever, for example, a paracetamol or ibuprofen tablet immediately before the procedure.

The date of the study must be chosen taking into account the woman’s menstrual cycle, so that it does not coincide with her period.

How is a colposcopy done?

As a rule, the entire procedure takes 10-20 minutes. At the same time, the woman lies in a gynecological chair, in fact, as in the most ordinary gynecological examination. How is colposcopy done? The gynecologist inserts a vaginal speculum into the vagina. Metal frame mirrors can cause several unpleasant sensations, simply because it can be cold, but in normal conditions It shouldn’t be painful or particularly uncomfortable. Then the doctor places the colposcope in close proximity to the gynecological chair, at a distance of several centimeters. The device will allow the doctor to examine the cervix, vagina, and vulva in an enlarged form, down to the cellular level.

To identify pathological changes in tissues, the doctor can apply Lugol's (an aqueous solution of iodine), as well as a vinegar solution, to the cervix. A slight but quickly passing burning sensation is caused by contact with vinegar. Lugol's solution does not cause any sensations at all. But healthy, normal tissue cells upon contact with it change color, becoming dark brown, but pathologically altered cells remain unchanged. Thus, they are easier to detect, and the research result is more reliable. If abnormal areas are detected, the doctor can immediately perform a biopsy, taking a small sample of tissue for analysis - one way or another, but if there is pathology, it will have to be done anyway, so it’s better right away.

Biopsy of the cervix is a painless procedure due to the absence of nerve endings, but mildly spasmodic or pressing pain in the lower abdomen it can sometimes provoke. As for biopsy of the lower part of the vagina and vulva, it can be painful, so before starting local anesthesia, applying the product to the area of tissue being examined. In some cases, a special hemostatic agent is used to reduce bleeding after the tissue sample is collected. By the way, the method of such sampling can be scraping, separation with a scalpel, or maybe excision of tissue with a wire radio wave loop. You can expect to receive the results of a cervical biopsy after 10-14 days. As for the reliability of the analysis, it is very high, namely 98.6%. 4-6 weeks after the biopsy, you should go to an appointment with the antenatal clinic.

What is visible during colposcopy?

Examination using a colposcope allows you to detect even very small, initial changes and accurately determine the location and nature of the disease. During the examination they evaluate appearance and the structure of the mucous membrane: violations of the integrity of the epithelium, tissue color, vascular pattern, shape and presence of glands, boundaries of identified formations. The mucous membrane in its normal state has a shiny, pale pink color; in the second part of the menstrual cycle it has a slightly bluish tint. Upon contact with Lugol's solution, its surface is uniformly painted dark Brown color, and against such a background, any tissue anomalies are clearly visible.

IN EROSION(cervical erosion is an area devoid of epithelium near the vagina) the surface of the erosion is smooth or fine-grained, red in color, blood vessels on the erosive surface are visible in the form of loops.

WITH PSEUDOEROSION (ECTOPIA) epithelium of the cervix (in in good condition stratified squamous) is replaced by cylindrical epithelium, which has smooth, clear contours. On colposcopy it looks like a cluster of bright red small papillae.

Glandular POLYPS can be of various sizes, single or multiple. When examined, they have a shiny surface and have a shade from light pink to bluish-purple. In addition, the surface of glandular polyps often looks like columnar epithelium, and during colposcopy it looks like ectopia (pseudo-erosion).

PAPILLOMA– growths of pink color, with dilated vessels in individual papillae. When a 3% vinegar solution is applied to it, the vessels contract, and the mucous membrane in the area of pathology turns pale.

CERVICAL ENDOMETRIOSIS(when tissue similar to the tissue of the mucous membrane of the uterine body is formed on the cervix of the uterus, and these formations undergo corresponding “uterine” changes throughout the menstrual cycle) are distinguished by the irregular ovoid shape of formations having a pink or bluish-purple color. They protrude above the general surface of the mucosa and bleed if you touch them. The size of the formations often changes, depending on the specific phase monthly cycle women. During extended colposcopy, the color of endometriosis lesions remains almost unchanged, which is important for diagnosis.

LEUKOPLAKIA OF THE CERVIX is a thickening of the mucous membrane; if left untreated, leukoplakia can develop into a tumor. On colposcopy it appears as whitish, rough spots or thin films that are easily separated from the mucosa.

CERVICAL CANCER On colposcopy it is distinguished by edematous glassy areas with tuberous protrusions, vessels are visible on them. Moreover, they do not react or narrow under the influence of vasoconstrictor reagents (for example, acetic acid) during an extended study. In such cases, a biopsy is mandatory.

After colposcopy

When a biopsy is not performed during colposcopy, the woman’s activity after the procedure is in no way limited. A day or two after the examination, slight spotting bleeding may be observed, but this is quite rare. However, if the situation is different and you encounter any complications, immediately go to the antenatal clinic! As for the biopsy, the pain after it usually goes away after one or two days; light bleeding may well persist for up to several days. In this case, the presence of heavy bleeding is a reason for immediate appeal see a doctor, especially if accompanied by pain, fever and other abnormalities in health. In case of unusual dark discharge There is no need to worry after a biopsy - this happens to some women. For a week after the procedure, it is recommended not to have sexual intercourse, not to use tampons, and to avoid douching.

And a little more about colposcopy and biopsy, video:

Colposcopic examination is considered one of the most common methods for diagnosing diseases of the female reproductive system. Indications for its implementation are any suspicion of deviations from the norm. This procedure completely painless and safe. Our article will tell you about when it is better to do a colposcopy, since only a properly conducted examination will help diagnose many diseases.

What is colposcopy

Colposcopy is carried out using a special device, essentially reminiscent of a microscope, which is equipped with lighting and optics that provide an increase in the area under study by almost half. Thus, helping to identify minor pathologies that are not noticeable to the naked eye. In addition, today there is a more advanced device - a video colposcope, which has a digital camera.

Using this device, all images are displayed on the monitor. The results can be saved and later compared with each other. Colposcopy has wide range indications for the study. First of all, diagnostics are prescribed when the doctor is dissatisfied with the results of cytology or when diagnosing condylomas.

In addition, this examination is prescribed:

if there is prolonged discomfort in the lower abdomen;
intermenstrual bleeding;
for pain, bloody discharge during sex.

This study is also widely used as an additional study to evaluate therapy.

Features of colposcopy

During the examination, the woman should sit more comfortably on the gynecological chair. Then, after dilating the vagina, the doctor turns on the colposcope and conducts a visual examination. To obtain a better image, the gynecologist changes the eyepieces, thereby improving the image quality.

Using a colposcope you can detect many pathological processes located on the cervix

Important! If a woman has irregularities in her menstrual cycle, she should definitely notify her doctor about this; only he will be able to really assess the condition of the mucous membrane and choose a day for diagnosis. When any changes in the epithelium are detected during colposcopy, an additional study is carried out using an iodine solution. The doctor lubricates the areas that are suspicious with iodine. If the tissues change their color, then this is considered the absence of pathologies. When the examined area turns white, this indicates the presence of cancer.

When to diagnose

Colposcopic diagnosis is prescribed both if there are any indications and as a preventive method, which allows you to verify the absence pathological processes. To obtain the most accurate results, the recommended period of examination is important. Since the greatest effectiveness can be obtained only in a certain period of the menstrual cycle.

Diagnosis of the cervix is best done exclusively in the first phase female cycle. The most optimal time for colposcopy is considered to be the period from 3 to 7 days after the end of menstrual flow. Since only at this time it is possible to conduct the most accurate examination and obtain the most accurate results. During menopause, colposcopy is allowed at any time.

Of course, not everyone is able to complete the study on the most standard day. If it was not possible to undergo colposcopy on the third day, then it can be performed after ovulation. Since the cervix becomes full during ovulation big amount mucus that interferes with qualitative research.

With the help of modern devices, it is possible to view the area being examined on a computer monitor

Diagnostics in the second period of the cycle is not recommended. Since it will be impossible to obtain accurate results. In addition, research in given time can cause the development of some complications. This diagnostic often causes pain and bleeding. Examination in the second phase of the menstrual cycle leads to prolonged healing of minor injuries.

Is it possible to conduct research during menstruation?

Colposcopy cannot be performed during menstrual flow, since it is quite difficult to visualize the pathology during this period and, in addition, the risk of infection in the female body increases.

Of course, if this is an emergency and an examination must be carried out urgently, then waiting for the most convenient period will not work. You have to perform a colposcopy at any time.

If it is planned to carry out a planned examination, the doctor will find out the date of the last menstruation and set a day for the examination. The examination cannot be carried out during menstruation, since during this period there are heavy bleeding and the rejected mucus is released.

Typically, gynecologists do not recommend diagnostics during menstruation. Because, if there is no critical condition, then it is recommended to plan the study in such a way that its date falls between 3-7 days after the end of menstruation.

If there is an urgent need, it is possible to do a colposcopic examination 2-3 days before the start of menstruation. This is especially true for diagnostics carried out with such therapeutic measures, How laser coagulation. The therapy may trigger the onset of menstruation. In addition, menstruation after colposcopy leads to natural process rejection of post-manipulation scab and acceleration of tissue healing.

Preparation

To obtain the most accurate results, not only the experience of the doctor is important, but also proper preparation to research. To obtain the most informative diagnosis, you should visit a doctor a few days before it and find out recommendations regarding preparation for colposcopy.

To obtain the most reliable information, you should carefully follow your doctor's recommendations.

When a woman is prescribed this examination, she needs:

2-3 days before the proposed study, completely abstain from sex;
do not do any douching for a week before colposcopy;
do not use local contraceptives;
All hygiene measures should be done only with water, excluding any detergents.

Consequences of the procedure

After a colposcopic examination, for some time a woman may be bothered by slight nagging pains and minor bleeding. This is especially true for. In order to prevent the development of complications, the following recommendations should be followed for 10 days:

do not go to the sauna and bathhouse, do not wash in the bathroom, you are only allowed to take a shower;
do not use tampons, only sanitary pads are allowed;
Avoid taking any medications that can cause bleeding.

When a colposcopic examination should be performed depends on each individual case, as it is an individual case with a specific diagnostic purpose.

Cervical colposcopy is a procedure performed by a gynecologist to examine the vagina, cervix, and vulva. This is done using a colposcope. This device in gynecology is intended for stereoscopic examination of the female genital organs. Thanks to the presence of a pin in it, inspection can be carried out non-contactly.

Why is cervical colposcopy necessary?

Colposcopy of the cervix in gynecology is used in the following situations:

ulcerative pathology of the vaginal mucosa of the cervix;
proliferation of endometrial cells outside the inner layer of the uterine wall;
the presence of atypical cells on the cervix;
atrophy of the epithelium that covers the cervix;
development of papilloma virus;
polyps;
cancerous conditions.

To avoid the appearance serious illnesses All women are recommended to undergo colposcopy once a year by a specialist. If pathologies are detected, he will promptly prescribe measures to eliminate them, which will protect the patient from complications.

You should contact a gynecologist if you have symptoms such as:

causeless painful sensations lower abdomen;
pain during intimacy;
bleeding;
copious vaginal discharge of unknown origin.

How to prepare for the procedure

Preparation for cervical colposcopy consists of following several simple recommendations. Firstly, a few days before the procedure, it is advisable to exclude sexual contact. Secondly, you should not use vaginal tampons intimate gels and other hygiene supplies. Thirdly, douching should not be done. You need to wash with boiled water at room temperature.

The procedure should be carried out a couple of days after the end of menstruation and no later than a few days before the start of menstruation.

Extended colposcopy of the cervix is considered an inexpensive and highly informative method for diagnosing gynecological diseases.

The following factors influence the result of the procedure:

lack of estrogen or progesterone in the patient’s body;
phase of the menstrual cycle;
the stage at which the disease is located;
woman's age.

Description of cervical colposcopy

Colposcopy of the cervix for erosion and other diseases is a procedure that many women want to know everything about. After all, they must understand why they prescribed the procedure and how it is carried out.

How is colposcopy of the cervix done? First, the patient must completely undress from waist to toe and lie down in a gynecological chair. The gynecologist inserts a speculum into the woman's vagina. She should remain relaxed for 20 minutes while the doctor conducts the examination. On initial stage research he uses the green filters of the device. With their help, you can determine the presence of atypically located vessels on the cervix.

Before the second stage of the examination, the gynecologist checks whether the patient is allergic to medications. If not, then he treats the mucous membranes with a weak vinegar solution, then repeats the manipulation with an iodine solution. The doctor makes a diagnosis based on the coloration of the mucous membranes.

The procedure for colposcopy of the cervix ends with the removal of the speculum from the vagina. The result of colposcopy can be announced immediately.

Pathologies that can be detected during the procedure

One of the most common pathologies is Nabothian cysts - benign neoplasms on the cervix, which are located in the vaginal area. Often their size is no more than 3 cm. The main factor provoking their appearance is the ability of the epithelium to change. The causes of nabothian cysts are hormonal changes, abortions, venereal diseases, inflammation of the genital organs, injuries after surgery.

Treatment of the pathology consists of removing the cyst using an electrocoagulation procedure.

Quite often, during colposcopy of the cervix, a specialist notices exophytic condylomas. They are formed on the surface of the mucosa, have a multilayer epithelial coating, and keratinization is often present. The disease is asymptomatic, so a woman learns about it only after examination by a gynecologist. If the pathology is neglected form, then a woman may experience such unpleasant signs as: white discharge with specific smell, itching and burning, pain syndrome during sexual contact.

The disease is practically untreatable. Eliminating the virus from the body is very difficult. The most common treatment methods are:

destructive effect of surgical laser on tumors;
removal of condylomas using a beam of high-frequency radio waves;
burning of tumors special device using high temperature;
chemical burning of condylomas using nitric acid-based products;
destruction of condylomas with liquid nitrogen.

Another serious problem is cervical erosion. It occurs in approximately 66% of women of childbearing age during colposcopy. The disease is characterized by the formation of ulcers on the mucous membrane of the cervix. It is important to start treatment in a timely manner, otherwise over time the pathology may develop into cervical cancer.

A decoction of St. John's wort helps with vaginitis. You should pour 2 liters of water 3 tbsp. l. dry raw materials, then put on low heat and boil for 20 minutes. After the specified time, strain and use for douching.

Can be cooked remedy from yarrow combined with sage, oak bark and rosemary. It is necessary to take all the components in equal proportions and pour 3 liters of boiling water, then put on low heat and boil for at least 5 minutes, closing the container with a lid. After this, the broth must be filtered and douched.

An effective remedy for treating vaginitis is walnut. Take 50 g of leaves and add 1 liter of water. Place on the fire for half an hour, strain after the time has elapsed. Use the resulting decoction for douching 2 times a day. Instead of walnut you can use calendula or nettle.

It should be noted that such factors as: blood during menstruation, uterine discharge after childbirth, sperm and intimate hygiene products. Doctors recommend not using soap when washing. After each intimate relationship, you should wash your genitals under running water.

Colposcopy– method of gynecological examination of the cervix using optical device – colposcope. This device resembles a binocular microscope equipped with a light source. If necessary, the doctor can choose the required magnification from 2 to 40 times. The use of color filters during colposcopy allows you to assess the condition of surface capillaries and vessels.

The colposcopy procedure lasts no more than 30 minutes. It may be accompanied by some discomfort, but is completely painless.

Purposes of colposcopy

identifying areas of pathological epithelium that may indicate cervical dysplasia or cancer;
determination of the size and location of affected areas of the mucous membrane of the cervix and vagina;
determining whether a biopsy is appropriate;
choosing a method of treating identified diseases - cauterization with drugs, electric current, laser, surgical instrument;
monitoring detected lesions every 3-6 months;
assessment of treatment effectiveness.

Possibilities of colposcopy. A colposcope allows you to examine in detail the slightest changes in the mucous membrane of the vaginal part of the cervix. During the procedure, the gynecologist evaluates:

color of the mucous membrane without staining and after treatment with solutions of acetic acid and iodine;
surface and relief of the mucous membrane (plaques, elevations, depressions, erosions);
vascular pattern (presence of altered vessels, vascular loops);
the presence and size of areas of altered epithelium;
the boundaries of the identified lesions (can be blurred or clear);
presence and condition of glands (open, closed).

Timing of colposcopy. The procedure can be performed on any day of the cycle, but not during menstrual bleeding. The first 5 days after the cessation of menstruation are considered optimal. Next, the cervix produces a large number of mucus, which makes diagnosis difficult.

Types of colposcopy:

simple or overview– examination of the cervix using a colposcope without the use of chemicals;
extended– during the examination, various tests with chemicals (acetic acid and iodine solution) are used. Allows you to detect small foci of atypical epithelium invisible during simple colposcopy;
colpomicroscopy– examination of the mucous membrane at high magnification over 300 times. Allows you to evaluate the ratio of nucleus to cytoplasm and other structural features of cells.

Colposcopy results are issued immediately upon completion of the inspection. They can be in the form:

a schematic drawing similar to a watch dial - the doctor schematically indicates the location and size of the identified pathological areas;
verbal description of the identified changes;
colpophotography or video filming.

Cervix

Cervix – lower section uterus, which is the transitional part between the body of the uterus and the vagina. It is a tube consisting of smooth muscle and connective tissue with a large number of collagen fibers and fewer elastic fibers. Passes inside the cervix cervical canal, aka cervical canal, which looks like a spindle. It has two narrowings:

internal os– a hole at the site where the canal opens into the uterine cavity;
external os- opening into the vagina.

There are two in the cervix parts:

Vaginal part– lower part of the cervix:
Supravaginal part– the area located above the vaginal part.

Cervical mucosa covers the surface of the organ. It consists of:

Epithelium– tissue lining the surface of the mucous membrane. On different areas cervix is normally found:

Stratified squamous epithelium - covers the vaginal part;
Columnar epithelium - covers the walls of the cervical canal.

Connective tissue lamina (basal membrane)– fibrous connective tissue underlying the epithelium, which does not contain cells, but consists of collagen and elastic fibers.

Vaginal mucosa cervix - lined stratified squamous epithelium, the same as the walls of the vagina. This epithelium tends to slough off and renew itself. The rate of renewal depends on the phase of the menstrual cycle; it is maximum during the period of ovulation. In multilayered squamous epithelium, there are 4 layers of cells that differ in size, ratio of nucleus to cytoplasm and functions:

Basal– immature cells that are located in one row on the basement membrane;
Parabasal– cells in which signs of differentiation appear. Located in 2-3 rows on the basal cells;
Intermediate– moderately differentiated cells located above the parabasal ones in 6-12 rows;
Superficial- cells that are located in the upper layer of the mucosa. They do not keratinize and are constantly renewed. Arranged in 3-18 rows.

Mucous membrane cervical canal lined cylindrical or goblet epithelium. The cells are tall cylinders arranged in one row. The columnar epithelium produces a mucous secretion, the density of which varies depending on the phase of the cycle. This mucus forms the mucous plug of the cervical canal, ensures the filtration and advancement of sperm, and protects the uterus from the penetration of bacteria. The mucous membrane of the cervical canal is collected in folds - crypts. The depths of the folds contain a large number of simple tubular glands, also lined with columnar epithelium. Sometimes they become clogged and form cysts. At the same time, a large amount of mucous secretion accumulates inside the gland.

Mucosa in the transition zone is of particular interest. Transition zone- this is the area of the mucosa where the transformation of columnar epithelium into multilayered squamous epithelium occurs. Usually it is located on the border of the external pharynx. In girls and young women, it can shift, covering the vaginal area. In women over 45 years of age, the transition zone may be located deep in the cervical canal. In the transition zone, most often there is a failure in the formation, maturation and death of epithelial cells. 90% of diseases and pathological conditions of the cervix develop here. In this regard, the transition zone is especially carefully examined during colposcopy.

Indications for colposcopy of the cervix

The reasons for prescribing colposcopy may be:

Cytological analysis results indicating cervical dysplasia.

ASC-US – atypical cells squamous epithelium of undetermined significance;
LSIL – lesion of squamous epithelium low severity;
HSIL – squamous epithelial lesionhigh degree expressiveness;
ASC-H – atypical squamous epithelial cells;
AGC – atypical glandular cells;
AIS- precancerous changes in the cervical canal.

Suspicious areas of altered epithelium on the cervix, detected during a routine gynecological examination. In this case, the purpose of colposcopy is to identify small foci of changes that are inaccessible to the naked eye.
To clarify the diagnosis if you suspect certain diseases of the cervix:

cervical condylomas;
suspicion of cervical cancer.

Dispensary observation women with cervical pathologies.
Control after treatment of cervical diseases.

Contraindications for colposcopy are:

The first 4 weeks after childbirth and cervical surgery;
Intolerance to iodine and acetic acid preparations during extended colposcopy.

Colposcopy technique

Colposcopy is performed in a gynecological office. The woman is placed on a gynecological chair. The doctor dilates the vagina with a speculum to gain access to the cervix. The vaginal walls and cervix are cleaned of secretions with a tampon soaked in saline solution.

The colposcope is installed at a distance of several centimeters from the entrance to the vagina.

First stage. The gynecologist examines the cervix at different magnifications to detect pathological areas of the epithelium. At this stage, conventional colposcopy ends. If there is a need for a more thorough examination of the mucous membrane, then an extended colposcopy is performed, the stages of which are described below.

Second phase. Treatment with 3% acetic acid solution. A tampon moistened with an acid solution is left in the vagina for 30-40 seconds. Then it is removed and the mucous membrane continues to be examined under different magnifications. Under the influence of acetic acid, the altered areas of the epithelium turn white - aceto white epithelium . Its presence may indicate infection with the human papillomavirus or dysplasia. A biopsy may be required to confirm the diagnosis. The doctor can take a tissue sample right there.

Third stage. Schiller's test or treatment with an aqueous solution of iodine. A tampon soaked in iodine solution is lubricated on the surface of the cervix. Healthy mucous membrane is uniformly colored dark brown color. The changed epithelium looks lighter. Areas with ectopia - foci of columnar epithelium - are not stained. These are the so-called iodine-negative zones.
If colposcopy reveals areas of suspicious epithelium, a tissue sample is taken from each of them for biopsy.

How to prepare for cervical colposcopy?

The colposcopy procedure does not require special preparation. However, it is advisable to avoid exposures that could lead to injury to the cervical mucosa.
Two days before the scheduled procedure, you must refrain from:

from sexual intercourse;
using tampons;
douching;
introducing vaginal creams or suppositories without a doctor’s prescription.

Before visiting a gynecologist, you must take a shower and perform the usual toileting of the external genitalia. The inside of the vagina should not be washed. Detergents may cause irritation and distort colposcopy results.

What are the possible results of colposcopy?

U healthy woman with conventional colposcopy, the doctor sees a uniform, shiny surface of the cervix. In the first half of the menstrual cycle it is pale pink. In the second half it acquires a bluish, cyanotic hue. External os nulliparous women rounded, in those who have given birth - has the shape of a slit. When treated with acetic acid, healthy mucous membranes briefly lighten, and after 2 minutes they acquire their normal color. After irrigation with iodine solution, normal mucous membranes uniformly turn brown. In this case, the gynecologist reports that the result of colposcopy is normal.

If deviations are found during the study, the doctor records them in detail. As a result of colposcopy, a woman receives a report containing information about the condition of the cervix. In most cases these can be standard verbal descriptions and a schematic drawing indicating areas of change.
The description may contain the following items:

Evaluation criteria	Norm	Deviations
Cervical shape	Conical	Irregular shape
Size	Not hypertrophied	Hypertrophied – increased in volume, atrophied – reduced.
Transformation zone	It is not visible if it is located inside the cervical canal, or it is normal.	Large with open or closed glands, large nabothian cysts.
Junction - the boundary between stratified squamous and columnar epithelium	Clear	Blurred
Glands	Not identified	Closed or open glands detected
Retention cysts are Nabothian glands, the ducts of which are closed by squamous epithelium	No	Eat
Vessels	Typical	Atypical: short, tortuous, corkscrew-shaped, comma-shaped, without anastomoses (connections)
Keratosis – leukoplakia – areas of increased keratinization and destruction of stratified squamous epithelium	No	Eat
Mosaic is a vascular anomaly that occurs when the growth of atypical epithelium is blocky	No	Delicate or rough mosaic
Puncture is a vascular anomaly. Pinpoint capillaries visible through the epidermis	There is a tender	Rough punctuation.
Borders of abnormal epithelium	Normally undetectable	Clear, fuzzy
Atrophy of the mucous membrane - thinning of the upper layer of the mucosa. Basal layer preserved	No	Eat. Thin epithelium. Unevenly stained with Lugol's solution.
Ectopia – emergence of columnar epithelium onto the vaginal surface	No	Eat
Acetowhite epithelium of the epidermis, which turned white after treatment with acetic acid	No	Eat
Iodine-negative zone - areas of the mucosa that are weakly stained with iodine solution due to the lack of glycogen in the cells	No	Eat
Endometriosis – benign disease, in which cells inner shell the cervix grows beyond this layer	No	Eat

What diseases can be detected by this study?

Disease	Definition	Signs detected during colposcopy
Cervical intraepithelial neoplasia or dysplasia	A disease of the cervix in which the cells of the stratified squamous epithelium are damaged. Accompanied by the appearance of atypical cells, it is therefore considered a precancerous condition.	Areas of acetowhite epithelium. Leukoplakia is dense white plaques that rise above the surface of the mucosa. Puncture: gentle when initial stages dysplasia, and with a high degree of damage - gross. When stained with iodine, clear boundaries of the affected area are determined.
Congenital ectopia	A congenital condition in which the border between columnar and stratified squamous epithelium is located at outer surface vaginal part of the cervix. If there are no complications, then it is physiological state, not a disease.	Simple colposcopy: the mucous membrane around the external pharynx is bright red. The area of redness has a regular round shape. After acid treatment, the ectopic area does not turn pale, has clear, even boundaries, and is evenly covered with columnar epithelium. There is no transformation zone. Lightly stained with Lugol's solution.
Acquired ectopia, or pseudoerosion	Displacement of the columnar epithelium on the vaginal part of the cervix. An acquired condition associated with viruses, infections, injuries, pregnancy, changes in ovarian function.	The columnar epithelium has a granular surface. The spot has clear boundaries and uneven outlines. In the complicated form, closed or open glands are found.
True cervical erosion	Temporary rejection of the upper layers of stratified squamous epithelium as a result of chemical and physical damage, inflammation, and hot douching.	Areas of epithelial damage. The bottom of the erosion is located below the surface of the mucosa. It has an uneven relief and a bright red surface.
Eroded ectropion	Eversion of the mucous membrane of the cervical canal.	Deformation of the cervix. A significant increase in organ volume is possible. Overgrowth of scar tissue is visible. Erosion, open and closed glands are formed along the periphery. In a complicated course, there are signs of inflammation - swelling, redness, uneven staining with iodine.
Endometriosis	Extension of endometrial cells beyond the inner lining of the cervix.	Rounded lesions of the endometrium, rising above the mucosa. IN different days cycle change color from pink to bluish. Do not change under the influence of acid and iodine.
Condylomas	Small growths of mucous membrane that appear when infected with the human papillomavirus.	Exophytic condylomas - appear above the surface of the mucosa. They have a mushroom-shaped body on a stalk in the form of a dome, papilla or cone. The result of tests with acid and iodine depends on the size of condylomas and the degree of keratinization of the epithelium. Flat condylomas do not rise above the surface. Weakly noticeable during conventional colposcopy.
Polyps of the mucous membrane of the cervical canal	Proliferation of the mucous membrane of the cervical canal.	Round or lobed formations in the area of the external pharynx. The color is red. Do not change under the influence of acid and iodine.
Erythroplakia of the cervix	Pathological condition, in which areas of atrophy and dyskeratosis appear on the mucous membrane of the cervix. Causes: infections, immune disorders, hormonal status, chemical or mechanical influences.	Bright red areas of thinned squamous epithelium that bleed easily when touched. Blood vessels are visible through the epithelium. Erythroplakia turns pale when treated with acetic acid. Does not stain with iodine.
Atypical transformation zone	A term describing changes and pathologies in the zone of transformation of columnar epithelium into squamous epithelium. Depending on the severity of the process, the zone of atypical transformation may be borderline with normal or have high level atypia (a large number of atypical cells) and indicate a precancerous condition.	Vivid hyperemia – redness of the mucous membrane. Hypertrophy is an increase in the volume of the cervix. Multilayered squamous epithelium with inflammatory changes, deformed transformation zone. Delicate mosaic – pinpoint hemorrhages, delicate punctures. Dilated branching vessels. Open and closed glands may be detected. Areas of chronic inflammation are weakly stained with iodine.
Cervicitis	Inflammation of the mucous membrane of the cervix.	The contours are not clear. Closed glands and large Nabothian cysts are detected. Located on the periphery open ducts iron There are foci of leukoplakia, acetowhite epithelium, atypical vessels (short tortuous capillaries), mosaic and punctation.
Cervical cancer	Malignant tumor cervix.	Glassy, swollen areas where growths may form various shapes. Atypical capillaries in the form of a corkscrew, comma, and hairpin are visible. The capillaries do not connect to each other and do not disappear when exposed to acid. Coarse mosaic and coarse punctation are detected. When treated with acid, the areas become white.
Leukoplakia of the cervix	A pathology manifested by areas of increased keratinization of the stratified squamous epithelium of the vaginal part of the cervix.	White spot, rising above the surrounding epithelium or at its level. Has unclear boundaries.

What to do after colposcopy?

Colposcopy is a non-contact procedure during which the mucous membrane of the genital organs is not injured. Therefore, after colposcopy there are no restrictions. You can return to normal life the same day. Allowed physical exercise and sexual intercourse. There is no need to use any medications.
After extended colposcopy, brown vaginal discharge is possible for 1-3 days. This is not blood, but iodine residues. To protect your laundry from contamination, you can use a pad.
If during colposcopy a biopsy was performed and polyps and condylomas were removed, there will be bleeding and slight pain in the vaginal area and lower abdomen. In this case, for 1-3 weeks you will have to limit physical and sexual activity and follow other instructions from the gynecologist.

What is extended colposcopy?

Extended colposcopy is an examination using a colposcope during which the surface of the cervix is treated first with a weak solution of acetic acid, and then with an aqueous solution of iodine. After each stage, the gynecologist examines the cervix, recording changes.

1. Test with acid. Use a 3% acetic acid solution or a 0.5% salicylic acid solution. Under the influence of acid, cell swelling, swelling of the epithelium, and contraction of healthy blood vessels occur (pathological ones do not respond to acid and remain clearly visible). The stratified squamous epithelium uniformly turns pale. The columnar epithelium remains red and looks like grapes. Its boundaries have clear contours. After 2 minutes, healthy mucous membranes acquire the usual pale pink color. Slight uniform whitening of large areas is not considered an abnormal sign. However, the more white the tissue becomes and the longer the effect lasts, the deeper the damage.

An acid test is the most important stage of extended colposcopy, as it provides maximum information about the condition of the cervix. It allows you to identify:

boundaries of stratified and columnar epithelium;
the slightest changes in the squamous epithelium, which look like whitening of varying intensity and duration;
atypical vessels that do not change after treatment with vinegar;
areas affected by human papillomavirus;
small foci of cervical intraepithelial neoplasia - a precancerous condition;
foci of leukoplakia (keratosis) differ in color from foci of neoplasia;
adenocarcinoma and squamous cell carcinoma of the cervix.

Signs of pathologies detected during acid treatment:

Areas of whitish or white epithelium may be signs of inflammation and cervicitis.
Whitish epithelium appears in areas of mucosal atrophy. In this case, the whitening is weak and short-lived. The contours of the areas are blurry.
Areas where regeneration (recovery) of the mucous membrane after damage occurs slightly turn white. For example, at the site of true erosion.
Thick white epithelium indicates precancerous changes in the squamous epithelium.
Pathological branched capillaries do not contract.
Lekoplakia areas have a rich white color. The effect of the acid lasts for more than 5 minutes.

2. Schiller's test with an aqueous solution of iodine or Lugol's solution. Used to detect pathological epithelium deprived of glycogen. Such cells stain weakly or are completely unaffected by iodine. After treatment of the mucous membrane, healthy areas are uniformly painted dark brown.

Signs of pathologies detected during iodine treatment

Atrophied, thinned epithelium is stained unevenly.
Benign changes differ slightly in color from healthy tissue and have fuzzy, blurred contours. For example, metaplastic, cylindrical and atrophic epithelium are weakly or partially stained.
Small areas of inflammation are partially stained.
Iodine-negative (not completely stained) – cervical dysplasia, areas with chronic inflammation, significant atrophy caused hormonal disorders.
Leukoplakia is also iodine negative. It has the appearance of a light shiny film with a smooth or rough surface.
Gray, mustard-colored, contrasting areas with clear, sharp contours are considered an unfavorable sign. Atypical cells are often found in such areas of the epithelium.

A targeted biopsy is taken from areas that do not respond to iodine to rule out the development of a cancerous tumor in the cervix.

Colposcopy in gynecology is an endoscopic technique for diagnosing the condition of the genital organs. The procedure is carried out using a special illuminated device - a colposcope. Almost every gynecological office has this equipment. Why is a colposcopic examination prescribed and when is it best to do it?

Colposcopy as a method of examining the cervix

The method allows you to examine the cervix, vagina and vaginal opening. By examining the epithelial surface, it is possible to establish accurate diagnosis and choose the optimal therapeutic method.

Examination using a binocular microscope allows you to examine the mucous membrane of the vagina and cervix, magnifying the areas under study by 6–40 times. The device was specifically developed to detect cervical cancer and precancerous tissue conditions.

With the help of a colposcope, not only oncological diseases are detected tumor processes, but also benign. During the procedure, a biopsy is often performed for histological examination of the material. In addition, you can capture the affected areas of the mucosa by photographing them, or do a Chrobak test by pressing on the suspicious area with a probe. If neoplastic formations are present, the site of pressure will bleed.

A slight increase during diagnosis allows the gynecologist to determine the presence of problems and assess their extent. The specialist examines the damaged mucous membrane, significantly enlarging the picture. To get a good look at the vessels, a special green filter is turned on. Several specialists can participate in the diagnosis at once, examining the area under study on the monitor.

Colposcopy is recommended annually, and for women over 35 years of age - twice a year. Why do colposcopy so often? This procedure is an irreplaceable and mandatory type of diagnostics that allows us to identify pathologies at the very beginning of their appearance.

Diagnostic examination is carried out exclusively in the first half of the menstrual cycle. It is recommended to come for the procedure 3 days after the end of the procedure, then the results of the examination will be the most accurate. There are two types of colposcopic examination:

simple - a visual assessment of the cervix and cervical canal is made, the doctor also notes existing ruptures, scars and neoplasms;
extended - this type of study is carried out with a detailed study of the vessels; for this, the mucous membrane is treated with acetic acid, fluorochrome, Lugol's solution, iodine and potassium.

Indications for prescribing the study

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Colposcopy is often prescribed by a gynecologist after examining the patient. The reason for the procedure is atypical vaginal discharge(With unpleasant smell or blood), pain during and after sex, periodic appearance nagging pain lower abdomen.

There are a number of ailments when a colposcopic examination is mandatory:

cervical erosion - examination is necessary to identify all cracks in the mucosa;
leukoplakia – the epithelial layer is examined;
endometriosis - checks for endometrial formation outside the uterus;
polyps - these neoplasms are easily detected using a colposcope;
oncology - a colposcopic procedure allows you to detect a tumor on the cervix at an early stage of development.

Contraindications for colposcopy

Is it possible to do a colposcopy during menstruation? No, the procedure is not carried out under regulations. The result of such a violation will be pain during the examination, and due to poor visibility of the vagina and cervix, the results obtained will be unreliable.

Women should not undergo colposcopy for a month after surgical intervention, including abortion and cryodestruction. Inspection using a binocular microscope is allowed after restoration of the epithelial tissue and cessation of bleeding.

Do women undergo colposcopy after childbirth? Typically, mothers who have recently given birth are not prescribed the test. Within two months, the vagina undergoes a restoration process, and if examined, the results will be questionable. Contraindications also include:

inflammatory process (after completion of treatment, you must wait 3 weeks before examination);
atrophied vaginal mucosa;
discharge mixed with pus;
ovulation period - under the influence of hormones, a lot of viscous mucus is formed, which makes examination difficult and negatively affects its results.

Why is colposcopic diagnosis performed during pregnancy, since any intervention is dangerous for its course? The procedure is prescribed only if polyposis or erosion is suspected. Since the immune strength of pregnant women is significantly reduced, and hormonal background changes dramatically, this contributes to the development of any disease. In this case, treatment of expectant mothers is carried out without the use of aggressive chemical substances, and biopsy is performed only in exceptional cases. If there are damage to the mucosa, therapeutic measures are taken after childbirth.

Preparing for the study

restriction of sexual intercourse on the eve of the study (the minimum period of abstinence is 24 hours);
refusal of tampons before the procedure;
planning the examination must be carried out taking into account the menstrual cycle - you can choose any day before the onset of ovulation, but it is better in the first week after the end of menstruation;
douching, the use of local contraceptives, vaginal suppositories and tablets before the procedure are unacceptable;
taking painkillers on the eve of the examination is allowed;
Before the examination, you need to empty your bowels and bladder, and also carry out hygiene procedures with baby soap.

How is a diagnostic examination performed?

Colposcopy is painless, but a feeling of pressure and cramping may still be present. It lasts about twenty minutes. The woman sits in a special chair. First, the specialist will install the mirror, and then the colposcope itself.

Sometimes after the examination, the cervix is treated with tweezers and a cotton swab soaked in acetic acid or Lugol. The patient needs to lie down for a few minutes, then the gynecologist will examine how evenly the areas are colored. If he finds suspicious areas, he will recommend a biopsy - taking a tiny sample of tissue, which is performed using long forceps. In some cases, a self-absorbing suture is applied.

Before the biopsy, the patient will be given a pain-relieving injection. Also, sampling of material is necessary if there are large polyps, scars that bleed, or erosion with eversion.

How to behave after the study?

The restrictions mainly apply to cases where the procedure was combined with a biopsy. A woman must abstain from sexual intercourse for two weeks. In addition, it is forbidden to douche, use tampons, and overexert yourself physically.

After colposcopic diagnosis (without biopsy), you should:

abstain from sex and douching for at least five days;
maintain personal hygiene (do not take a bath);
give up menstrual cup and tampons, use only pads;
do not take acetylsalicylic acid tablets or other blood thinning medications.

After colposcopy, especially if it was performed with a biopsy, women often complain of a dull, nagging painful sensation. Discomfort may persist for two weeks. In addition, it may be accompanied by spotting bloody discharge. Sometimes they have a greenish or brown tint, depending on the drug used during the procedure.

The described conditions are considered normal and do not require medical care. However, when too heavy discharge, chills, increased body temperature, intense pain or discharge with a foul odor, medical intervention is necessary. Symptoms may indicate bleeding or infection of the genital tract. Quite often, after an examination, gynecologists schedule a second appointment to assess the results of treatment and exclude a possible relapse.

What will the result tell us?

The smooth surface of the cervix with a pink tint indicates the patient’s health and the absence of pathologies. If the gynecologist noted abnormal changes in the blood vessels, found red spots on the mucous membrane, or as a result of treatment of the cervix, iodine-negative areas became visible, this indicates the presence of diseases. Based on the results of colposcopy, the following diagnoses are made: