What Is a Colposcope? How It Helps in Advanced Cervical Screening

Colposcope and colposcopy — quick answers

What is a colposcope?

A colposcope is a lighted, magnifying instrument (like a large binocular microscope on a stand) that gives the gynaecologist a magnified view of the cervix, vagina and vulva. It stays outside the body; nothing about it is inserted.

Why would I need a colposcopy?

Most often because a Pap smear showed abnormal cells or an HPV test was positive. It is also used to investigate bleeding after intercourse, a cervix that looks abnormal on examination, or persistent unexplained discharge.

Does colposcopy hurt?

The examination itself feels like a slightly longer Pap smear. The solutions applied may sting briefly. If a small biopsy is taken there is a short pinch or cramp, and mild spotting for a day or two.

Is colposcopy a test for cancer?

It is a test for the pre-cancerous changes (CIN) that come years before cancer. Finding and treating these changes is how cervical cancer is prevented. Actual cancer is found at colposcopy only rarely.

How long does a colposcopy take?

About 10 to 15 minutes. You can go home immediately and return to normal activity the same day.

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Cervical cancer is one of the few cancers that can be prevented almost entirely, because it develops slowly from pre-cancerous changes that screening can detect. The Pap smear and HPV test are the first step. The colposcope is what comes next: it lets the doctor see exactly where those abnormal cells are, judge how serious they look, and take a precise sample so that treatment can be planned before cancer ever develops.

The instrument

A colposcope combines a bright light source with magnifying lenses, usually 4 to 40 times, and green filters that make abnormal blood vessels stand out. Modern digital colposcopes add a camera, so images can be recorded, compared over time and shown to the patient. The instrument is positioned about 30 cm from the body; a speculum holds the vaginal walls apart, exactly as for a Pap smear, and the doctor looks through the colposcope at the cervix.

What happens during colposcopy

1. You lie as for a routine pelvic examination and a speculum is placed.
2. The cervix is cleaned with saline and examined under magnification.
3. Acetic acid (dilute vinegar) is applied. Abnormal areas with rapidly dividing cells turn white for a minute or two ("acetowhite"), while normal tissue stays pink. The doctor notes the location, borders and intensity of any white areas and looks at the pattern of blood vessels.
4. Lugol's iodine may be applied. Normal cervical cells rich in glycogen stain dark brown; abnormal cells do not take up the stain and stay pale.
5. If an abnormal area is seen, a punch biopsy of 2 to 3 mm is taken from the most suspicious spot and sent to the laboratory. Sometimes a scraping from inside the cervical canal (endocervical curettage) is taken as well.

The whole process takes 10 to 15 minutes. You may have light bleeding or a dark discharge from the iodine for a day or two, and you are asked to avoid intercourse, tampons and douching for a few days if a biopsy was taken.

What the colposcopist is looking for

The area of the cervix where cancer develops is the transformation zone, where two types of cell meet. The colposcopist grades any abnormality by how white it turns, how sharp its edges are, and whether the blood vessels show patterns called punctation or mosaic. These features separate low-grade changes, which usually resolve on their own, from high-grade changes (CIN 2 and CIN 3), which need treatment.

What the results mean

• Normal. Return to routine screening, or a repeat test in 12 months if your HPV test was positive.
• CIN 1 (low grade). Usually monitored with a repeat HPV test or Pap smear in 12 months, because most cases clear naturally.
• CIN 2 or CIN 3 (high grade). Treated, most often by LLETZ / LEEP, which removes the transformation zone with a thin electrical loop under local anaesthetic in about 15 minutes, or by cold-knife cone biopsy in selected cases. Treatment cures more than 90 percent of high-grade lesions and preserves the ability to have children.
• Cancer. Rare at colposcopy, and if found, it is usually at an early, very treatable stage. You would be referred to a gynaecologic oncologist for staging and treatment.

Why this matters

Screening finds women at risk; colposcopy finds the exact problem; and simple outpatient treatment removes it years before it could become cancer. Together they have cut cervical cancer rates dramatically wherever screening is widely available. An abnormal Pap smear is not a diagnosis of cancer: it is an invitation to a colposcopy that, in most cases, ends with reassurance or a minor treatment.

At Iswarya Hospital in OMR, Chennai, colposcopy is performed by gynaecologists trained in gynecologic oncology, with LLETZ and other treatments for pre-cancerous changes available in the same clinic, and HPV vaccination and screening for women who have not yet started.