Because the Pap smear is a screening tool and not a diagnostic tool, your gynecologist may want to take a closer look at your cervix to determine the cause of your abnormal Pap smear results. The tool your gynecologist uses to get a closer look at your cervix is called a colposcope. The colposcope is used for the colposcopy examination. Reasons your doctor may have for ordering this procedure include Pap smear results which:
- indicate dysplasia or cancer
- show evidence of HPV
- show atypical squamous cells of undetermined significance (ASCUS) or repeated (ASCUS)
Your gynecologist may also order a colposcopy because your cervix appears abnormal during your pelvic exam and Pap smear, or if you have a history of prenatal DES exposure.
During the colposcopy procedure your gynecologist uses the colposcopy to visually exam the cervix. Colposcopy is a simple and painless procedure that is performed in the gynecologist's office. The procedure takes about ten or fifteen minutes.
The colposcopy procedure is similar to the Pap smear. You are positioned on the examination table as in a Pap smear, however acetic acid (such as common table vinegar) is placed on the cervix. This causes the cervical cells to fill with water so light will not pass through them.
Another difference that you will notice is that your physician uses a colposcope to view your cervix. A colposcope is a large, electric microscope that is positioned approximately 30 cm from the vagina. A bright light on the end of the colposcope makes it possible for the gynecologist to clearly see the cervix.
During the colposcopy, the gynecologist focuses on the areas of the cervix where light does not pass through. Abnormal cervical changes are seen as white areas, the whiter the area, the worse the cervical dysplasia. Abnormal blood vessel changes are also apparent through the colposcope. Abnormal vascular changes can occur in dysplasia. Typically, worse the vascular changes are the worse the dysplasia.
If your physician is able to view the entire abnormal area through the colposcope, a tissue sample or biopsy is taken from the whitest abnormal areas and sent to the lab for further evaluation.
Cryosurgery or a freezing of the abnormal cells may be performed next and, in some cases, can make this a diagnostic/ treatment procedure in one. If your physician, is unable to view the entire abnormal area, as when the abnormal area extends inside the cervix, another procedure such as a Cone biopsy or LEEP procedure is performed.
Note: While the colposcopy itself is painless, another procedure such as those discussed above, may be performed during the colposcopy procedure which may be slightly painful and which may cause slight pain, bleeding, or discharge for a few days following the procedure.
