The Colposcopic Examination

Jennifer E. Frank, MD


J Midwifery Womens Health. 2008;53(5):447-452. 

In This Article

Visualization with Colposcopy

Colposcopic examination includes gross visualization of the vulva and vagina, examination of the cervix before and after application of acetic acid (common household vinegar), biopsy of suspicious lesions, and endocervical sampling in certain women (Figure 1).[2,17] Both a regular white light (such as used during a Pap test) and a green light are used during colposcopy. The green filter enhances visualization of blood vessels by making them appear darker in contrast to the surrounding epithelium.[4]

Figure 1.

Surgical tray containing the most commonly used supplies for performing a colposcopy.

A speculum is inserted into the vagina while examining the perineum, vulva, vagina, and cervix for lesions using the colposcope's white light and magnification (Figure 2). Some colposcopists may repeat a Pap test during the examination; however, both retrospective and prospective studies have shown limited clinical utility in repeating either liquid-based or conventional cytology at the time of colposcopy.[18,19,20] Screening for gonorrhea and chlamydia may be considered in high-risk populations.[21,22,23]

Figure 2.


The entire cervix is viewed under both low- and high-power magnification.[16,17] Higher-power magnification is required to view smaller features.[16] Satisfactory colposcopy is defined as visualization of the entire squamo-columnar junction and margins of any visible lesions.[24] The squamo-columnar junction may be difficult to visualize in its entirety, which is a requirement of a satisfactory colposcopic examination. A small, double-blind, randomized controlled trial demonstrated the efficacy of vaginal misoprostol in converting an unsatisfactory colposcopy to a satisfactory colposcopy in nonpregnant patients.[25]

Dilute acetic acid is used to enhance any epithelial findings. It is applied to the entire cervix, causing abnormal tissue and some normal tissue to turn white.[16] Under white light, the cervix is visualized for acetowhite changes. A record is made of the location of the squamo-columnar junction, transformation zone, abnormal and atypical vessels, and areas of acetowhite changes.


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