Colposcopy and cervical biopsy
5 steps
Magnified inspection of the cervix after acetic acid, to find and biopsy the lesion an abnormal screen predicts.
Consent and trauma-informed practice
- Explain what the examination involves, why it is proposed, and what the alternatives are, in plain language, before anyone undresses.
- Ask for permission, and make clear the patient can stop at any point, by saying so or by raising a hand. Stopping is honoured immediately, without persuasion.
- Offer a chaperone and record the offer and the response; a student never examines without the supervising clinician present and the patient's specific agreement to the student's involvement.
- Privacy: a door that locks or a sign, a sheet, undressing only what is needed, time to undress and dress alone.
- Trauma-informed: assume a history you have not been told. Explain each step before it happens, keep talking, avoid sudden touch, ask about pace, and notice dissociation or distress and pause.
- Never examine a patient under anaesthesia for teaching without their specific prior consent to that examination.
The sequence
5 steps- 01
Speculum and low-power view
The cervix in green-filter light to see vessels.
- 02
Acetic acid
Applied for a minute: dysplastic epithelium turns white (acetowhite), with patterns (punctation, mosaic, atypical vessels) that grade the concern.
- 03
Iodine
Normal glycogenated squamous epithelium stains brown; dysplasia does not.
- 04
Biopsy
Punch biopsies of the most abnormal areas; endocervical curettage when the transformation zone is not fully seen.
- 05
Plan
CIN 1 is observed; CIN 2 or 3 is treated by loop excision (LEEP) or ablation. In pregnancy, colposcopy is safe and treatment is deferred unless invasion is suspected.
Indications
- Abnormal screening results per programme rules
- A suspicious cervix at any time
Preparation
- Consent; the same care as any speculum examination, with time for questions because anxiety is high
- Colposcope, acetic acid 3 to 5 percent, Lugol's iodine, biopsy forceps, haemostatic agents
Complications
- Bleeding, discharge, cramping
- After excision: a small increase in preterm birth risk in a later pregnancy, cervical stenosis
Watch for
- Atypical vessels or a raised, ulcerated lesion: possible invasion, biopsy and refer
- An unsatisfactory colposcopy (junction not seen): excisional sampling may be needed