Because the Pap smear can only screen for potential problems, not diagnose them, your gynecologist may want to take a closer look at your cervix to determine the cause of your abnormal Pap smear results. He will perform an examination called a colposcopy. Your doctor may order this procedure if you have Pap smear results that:
- indicate cervical dysplasia or cervical cancer
- show evidence of HPV
- show first-time or repeat atypical squamous cells of undetermined significance(ASCUS)
Your gynecologist may also order a colposcopy if your cervix appears abnormal during your pelvic exam and Pap smear, or if you have a history of prenatal DES exposure.
Colposcopy is a simple, 10- to 15-minute procedure that is painless and performed in a gynecologist's office. You are positioned on the examination table like you are for a Pap smear, and an acetic acid (such as common table vinegar) is placed on the cervix.
Your physician will use a colposcope -- a large, electric microscope that is positioned approximately 30 cm from the vagina -- to view your cervix. A bright light on the end of the colposcope lets the gynecologist 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 vascular (blood vessel) changes are also apparent through the colposcope. Typically, the worse that the vascular changes are, the worse the dysplasia.
If your physician can 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.
If you experience any pain during the procedure, it is not from the colposcopy itself -- it's the result of other procedures sometimes performed during colposcopy. These other procedures may cause discomfort, vaginal bleeding or discharge. These procedures include:
ACOG Patient Education Pamphlet AP135. Colposcopy. http://www.acog.org/publications/patient_education/bp135.cfm. Accessed 07/14/09.