Colposcopy of the cervix: what it is and what it shows

You have received a referral for a colposcopy, or the report after screening mentions changes in cells — and you want to understand what this examination is and how serious it is. Take a breath: a colposcopy is a clarifying examination, not a sentence. Below is what it shows and how to read the result.

What cervical colposcopy is

Colposcopy is a diagnostic examination of the vaginal opening, its walls, and the vaginal portion of the cervix with a special device — a colposcope, which is a binocular with a lighting device. The cervix is the lower part of the uterus that opens into the vagina. The device itself is not inserted inside: it stays outside, and the doctor sees the cervix under magnification.

Why colposcopy is ordered and who needs it

Most often, colposcopy is offered if screening (a smear, cytology) has revealed altered cervical cells associated with human papillomavirus (HPV). These cells are not cancer, but without treatment they can over time develop into cervical cancer. The examination is also offered if two consecutive screenings failed to produce a clear result. In addition, colposcopy helps determine the cause of unusual vaginal bleeding, for example spotting after sex.

How the examination is performed: simple and extended colposcopy

The procedure usually takes 15–20 minutes in a hospital or clinic, and afterward you can go home. Simple colposcopy is an examination without medications; extended colposcopy involves tests that help visualize altered areas. The test with 3% acetic acid is considered mandatory and the most clinically significant: it constricts unchanged vessels. The Schiller test with Lugol's solution is also used — iodine reveals glycogen in the epithelium. During the examination, the doctor assesses tissue color, vascular pattern, epithelial disturbances, the presence and shape of glands, and the borders of lesions. If necessary, a tiny tissue sample is taken — a biopsy.

What colposcopy shows: colposcopic patterns

Among colposcopic patterns, atypical epithelium is distinguished: simple (leukoplakia, its base, mosaic fields) and increased (coarse leukoplakia, papillary base, elevated keratinizing fields, atypical transformation zone). Atypical vessels are described separately — giant capillaries, bizarre plexuses, "spikes," "corkscrews." During the examination, a small tissue sample (biopsy) may be taken for further diagnosis.

• Unchanged mucosa — a variant of normal.
• Benign lesions: colpitis, atrophy, true erosion, ectopy, transformation zone, polyps.
• Atypical epithelium: simple and increased, with atypical vessels.

How to read the report: normal and altered picture

If no altered cells are found, the doctor usually reports this immediately. Routine screening in the future is still needed. If a biopsy was taken, the result takes 4–8 weeks. The report may contain cytology terms: ASC-US and LSIL — mild changes, ASC-H and HSIL — more serious, AGC — change in glandular cells. For a number of such results, colposcopy is recommended, sometimes with biopsy.

When additional examinations are needed after colposcopy

If the doctor sees abnormal cells, they may suggest removing them — this reduces the risk of cervical cancer. Most often LLETZ (large loop excision of the transformation zone) is used with local anesthesia, about 15 minutes. If a large area needs to be removed, conization with general anesthesia is offered.

Colposcopy itself is not a reason to call an ambulance; 103/112 — for very heavy vaginal bleeding that does not stop.

If after the procedure you develop foul-smelling discharge or abdominal pain that does not go away after painkillers or returns, see a doctor urgently.

This material is for reference and does not replace a doctor's consultation: discuss your own report and further follow-up plan with your doctor.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer