{"id":317,"date":"2020-08-13T17:52:29","date_gmt":"2020-08-13T17:52:29","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=317"},"modified":"2023-09-30T10:07:18","modified_gmt":"2023-09-30T10:07:18","slug":"colposcopy","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/basic_obgyn\/technical-skills\/colposcopy\/","title":{"rendered":"3.05 Colposcopy"},"content":{"rendered":"<p><iframe loading=\"lazy\" title=\"vimeo-player\" src=\"https:\/\/player.vimeo.com\/video\/111985676\" width=\"640\" height=\"480\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration 5:01<\/p>\n<input type='hidden' bg_collapse_expand='69e9c84e0d19f7081033528' value='69e9c84e0d19f7081033528'><input type='hidden' id='bg-show-more-text-69e9c84e0d19f7081033528' value='Comment on Followup Paps'><input type='hidden' id='bg-show-less-text-69e9c84e0d19f7081033528' value='Close'><button id='bg-showmore-action-69e9c84e0d19f7081033528' class='bg-showmore-plg-button bg-red-button bg-arrow '   style=\" color:#fafafa;\">Comment on Followup Paps<\/button><div id='bg-showmore-hidden-69e9c84e0d19f7081033528' ><\/p>\n<p>Follow up Pap tests (following abnormal Paps, high risk HPV infection, and cervical dysplasia) are now performed at no less than 1 year intervals. There are only rare exceptions to this Pap screening interval and they are beyond the scope of this 3rd year level of training.<\/div>\n<p>&nbsp;<\/p>\n<input type='hidden' bg_collapse_expand='69e9c84e0d2ce8069946838' value='69e9c84e0d2ce8069946838'><input type='hidden' id='bg-show-more-text-69e9c84e0d2ce8069946838' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9c84e0d2ce8069946838' value='Hide Transcript'><button id='bg-showmore-action-69e9c84e0d2ce8069946838' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#fcfcfc;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9c84e0d2ce8069946838' ><\/p>\n<p>The cervix is located at the end of the vagina at the opening of the uterus.<\/p>\n<p>Invasive cancer of the cervix is frequently visible. Pre-cancerous changes are usually invisible to the unassisted eye.<\/p>\n<p>Pap smears are used to screen for cancer and pre-cancerous changes when abnormalities are found.<\/p>\n<p>Colposcopy with directed biopsies can provide a definitive diagnosis. This patient&#8217;s pap smear showed atypical squamous cells of undetermined significance, or ASCUS. When the atypia persisted, she was brought into the office for colposcopy evaluation.<\/p>\n<p>I started by positioning her at the edge of the exam table, inserting a vaginal speculum and visualizing the cervix. I sprayed her cervix with 4 percent acetic acid. This sometimes causes mild stinging. Acetic Acid can bring out colposcopically useful patterns such as aceto white epithelium and mosaic.<\/p>\n<p>These images show the effect of the acetic acid on this patient&#8217;s cervix. In another patient, the change from an invisible lesion to a visible lesion is dramatic.<\/p>\n<p>The colposcope has adjustable magnification, binocular vision and a powerful light source. Either normal light or red free light can be used.<\/p>\n<p>After carefully evaluating the exocervix with the colposcope, I turned my attention to the endocervical canal. This is important to make sure that I&#8217;ve seen the proximal extent of any visible lesion. An endocervical speculum can help me in viewing the endocervix.<\/p>\n<p>Next, I use an endocervical curette to sample the endocervical canal. The endocervical curette usually creates a small clot, this clot as a rich source of endocervical cells from my biopsy specimen. I retrieved the clot using long forceps.<\/p>\n<p>Then I take exocervical biopsies of any suspicious areas I&#8217;ve identified during my colposcopy exam. I make sure that I have biopsied the most suspicious looking areas. Suspicious areas would include acetowhite epithelium changes, mosaic patterns, abnormal vessels or exophytic lesions.<\/p>\n<p>In this patient, I took three biopsies of the exocervix and in other patients I might take more or fewer or none.<\/p>\n<p>Monsel solution does a very good job of stopping oozing from biopsy sites. The solution is essentially iron with quite a bit of air whipped into it. It is sticky and tenacious and over time turns gritty black. This patient continued some minor oozing, so I applied a second coat of Monsel&#8217;s solution.<\/p>\n<p>I told the patient she could expect a little bit of bleeding and a gritty black discharge for the next several days. I then applied direct pressure for about a minute to achieve complete hemostasis.<\/p>\n<p>The pathology report showed only chronic cervicitis as I suspected from my colposcopy evaluation.<\/p>\n<p>I asked her to return in six months for another pap smear.<\/p>\n<p><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Duration 5:01 &nbsp;<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":781,"menu_order":305,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-317","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/317","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/comments?post=317"}],"version-history":[{"count":4,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/317\/revisions"}],"predecessor-version":[{"id":1267,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/317\/revisions\/1267"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/781"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/media?parent=317"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}