Colposcopy is the direct magnified inspection of the surface of a woman’s 

genitalarea, including
the cervix, vagina, and vulva, using a light source and a binocularmicroscope. Doctors use the
test to evaluate potentially cancerous areas, typically after a Pap smear has indicated the
possibility of such a problem. Your doctor also may perform a biopsy (take a sample) of
an abnormal area during the procedure.

Colposcopy also can be used to detect inflammatory or infectious changes, harmless or

cancerous growths, and traumatic injuries to the cervix, vagina, and vulva. Because the
procedure is highly specialized, you should make sure that your doctor has performed many such
examinations.

Risks

The procedure is relatively safe. Major risks include bleeding, infection, and pelvic orabdominal

pain. Colposcopy during pregnancymay cause complications with the pregnancy, including
early labor.

Although colposcopy greatly improves your doctor’s ability to sample diseased tissue, there
always is a chance the physician may not be able to determine the problem nor be able to take
biopsies from the appropriate area.

Colposcopy Preparation

Preparation for a colposcopy is similar to preparing for any gynecological exam. 

 You should schedule an exam when you are not menstruating. 

 Avoid douching, sexual intercourse, vaginal medications, and tampons for 24 hours

before the exam. 

 If you are not allergic to acetaminophen(Tylenol, Panadol), your doctor may recommend
taking some for pain 1 hour before the procedure. Aspirin or ibuprofenmay also be used, but
may increase bleeding from the procedure due to these drugs' anti-platelet effect.

During the Procedure

You will be asked to remove your undergarments, then you will lie on an examination table with
your legs placed in stirrups. The procedure may last up to 30 minutes. 

 Inspection: Your doctor will insert aspeculum into your vagina, using only water for
lubrication, because lubricating jelly may interfere with the laboratory analysis of any
specimens obtained. The speculum will remain in place for the duration of the exam. 

o Your doctor will inspect your vagina and cervix using a magnified lens. An
assistant may insert a small amount ofsaline solution (salt water) into the vagina to
moisten the surface. The saline may feel cool. 
 o Immediately following the inspection, an acetic acid preparation will be applied
to your cervix. The acid also may feel cool but will not burn. The doctor then will
reinspect your vagina and cervix and will decide whether to perform a biopsy (take a
tissue sample). 

o Special stains may be required to see certain areas in the cervix. The most
common stain is an iodine solution, which may feel cool but will not hurt.

 Biopsy: If any abnormalities appear, the doctor will take a biopsy. You may feel a pinch
and some discomfort for several seconds. The examiner also may perform an endocervical
curettage—a gentle scraping of the cervical canal that may cause a cramping sensation. Any
specimens obtained from these procedures then will be sent to a lab for examination under a
microscope.

After the Procedure

Following the colposcopy, you should wear a sanitary pad. Small amounts of bleeding may occur
for 3-5 days. You may see on the pad dark fluidlike material, sometimes green, resembling
coffee grounds. The fluid is normal because you are expelling the solutions used during the
exam. However, you should avoid douching, sexual intercourse, vaginal medications, or tampons
until the bleeding stops.
Colposcopy is a medical diagnostic procedure to examine an illuminated, magnified view of
the cervix and the tissues of the vagina and vulva.[1] Many
premalignant lesions and malignant lesions in these areas have discernible characteristics which
can be detected through the examination. It is done using a colposcope, which provides an
enlarged view of the areas, allowing the colposcopist to visually distinguish normal from
abnormal appearing tissue and take directed biopsies for further pathological examination. The
main goal of colposcopy is to prevent cervical cancer by detecting precancerous lesions early and
treating them. The procedure was developed in 1925 by the German physician Hans Hinselmann.
[2]

A specialized colposcope equipped with a camera is used in examining and collecting evidence
for victims of rape and sexual assault.

Indications for colposcopy

Most women undergo a colposcopic examination to further investigate a cytological abnormality

on their pap smears. Other indications for a woman to have a colposcopy include:

 assessment of diethylstilbestrol (DES) exposure in utero,

 immunosuppression such as HIV infection, or an organ transplant patient
 an abnormal appearance of the cervix as noted by a primary care provider
 as a part of a sexual assault forensic examination [3] done by a Sexual Assault Nurse
Examiner
Many physicians base their current evaluation and treatment decisions on the report "Guidelines
for the Management of Cytological Abnormalities and Cervical Cancer Precursors", created by
the American Society for Colposcopy and Cervical Pathology, during a September 2001
conference.[4]

The procedure

During the initial evaluation, a medical history is obtained, including gravidity (number of prior

pregnancies), parity (number of prior deliveries), last menstrual period, contraception use, prior
abnormal pap smear results, allergies, significant past medical history, other medications, prior
cervical procedures, and smoking history. In some cases, a pregnancy test may be performed
before the procedure. The procedure is fully described to the patient, questions are asked and
answered, and she then signs a consent form.

A colposcope is used to identify visible clues suggestive of abnormal tissue. It functions as a

lighted binocular microscope to magnify the view of the cervix, vagina, and vulvar surface. Low
power (2× to 6×) may be used to obtain a general impression of the surface architecture. Medium
(8× to 15×) and high (15× to 25×) powers are utilized to evaluate the vagina and cervix. The
higher powers are often necessary to identify certain vascular patterns that may indicate the
presence of more advanced precancerous or cancerous lesions. Various light filters are available
to highlight different aspects of the surface of the cervix. Acetic acid solution and iodine solution
(Lugol's or Schiller's) are applied to the surface to improve visualization of abnormal areas.

Colposcopy is performed with the woman lying on her back, legs in stirrups, and buttocks at the
lower edge of the table (a position known as the dorsal lithotomy position). A speculum is placed
in the vagina after the vulva is examined for any suspicious lesions.

Three percent acetic acid is applied to the cervix using cotton swabs. The transformation zone is
a critical area on the cervix where many precancerous and cancerous lesions most often arise.
The ability to see the transformation zone and the entire extent of any lesion visualized
determines whether an adequate colposcopic examination is attainable.

Areas of the cervix which turn white after the application of acetic acid or have an
abnormal vascular pattern are often considered forbiopsy. If no lesions are visible,
an iodine solution may be applied to the cervix to help highlight areas of abnormality.

After a complete examination, the colposcopist determines the areas with the highest degree of
visible abnormality and may obtain biopsies from these areas using a long biopsy instrument.
Most doctors and patients consider anesthesia unnecessary, however, some colposcopists now
recommend and use a topical anesthetic such as lidocaine or a cervical block to diminish patient
discomfort, particularly if many biopsy samples are taken.

Following any biopsies, an endocervical curettage (ECC) is often done. The ECC utilizes a long
straight curette or a cytobrush (like a small pipe-cleaner) to scrape the inside of the cervical
canal. The ECC should never be done on a pregnant woman. Monsel's solution is applied with
large cotton swabs to the surface of the cervix to control bleeding. This solution looks
like mustard and turns black when exposed to blood. After the procedure this material will be
expelled naturally: women can expect to have a thin coffee-ground like discharge for up to
several days after the procedure. Alternatively, some physicians achieve hemostasis with Silver
Nitrate.

Complications

Significant complications from a colposcopy are not common, but may include bleeding,
infection at the biopsy site or endometrium, and failure to identify the lesion. Monsel's solution
and silver nitrate interfere with interpretation of biopsy specimen, so these substances should not
be applied until all biopsies have been taken. Some patients experience a degree of discomfort
during the curettage, and many experience discomfort during the biopsy.
WHAT IS ESOPHAGOSCOPY?
This is the name given to a technique for examining the esophagus. The viewing
instrument, the esophagoscope, consists of a long, flexible tube fitted with an eyepiece, lenses,
and its own fiberoptic light source which illuminates the field of vision. The procedure may form
part of an endoscopic examination of the upper airway and digestive tract, known as
panendoscopy. Esophagoscopy is usually carried out in a daycare facility or in the hospital
special
procedures room. A local anesthetic is used, although a child may be given a sedative as well.

WHY IS IT PERFORMED?
Esophagoscopy provides a direct view of the mucosa (lining tissues) of the esophagus. In
ENT medicine it is invaluable for the investigation, diagnosis, and, in some cases, treatment of
many conditions. The pharynx (throat) divides above the larynx ("voice box") to form the upper
airway - the trachea - and the upper digestive tract - the esophagus. The esophagus is located
behind the larynx, and any swelling of the upper esophagus may interfere with normal
swallowing,
breathing, or speech. Inspection by esophagoscopy is indicated for dysphagia (difficulty in
swallowing), hoarseness, and breathing difficulties caused, for example, by a foreign object
lodged
in the esophagus that can be seen and removed by means of the scope. Or, the esophagoscope
can
be used to obtain a biopsy (tissue sample) of a benign or
malignant growth.

RISKS AND BENEFITS

Esophagoscopy is the procedure of choice for investigating disorders of the esophagus. It
is very versatile and allows direct viewing, taking of biopsy samples, and treatment in some
cases
with little risk to the patient and without the need for surgery. Risks include perforation, bleeding
and infection.

THE PROCEDURE

PREPARING FOR ESOPHAGOSCOPY

You will be asked to fast for about four hours before esophagoscopy so that your
stomach is empty. If you are coming to the daycare facility, you should have a relative or friend
bring you to the hospital and take you home afterwards as you will be given a sedative. You may
be given lozenges to suck which contain a local anesthetic to numb your throat. This eliminates
the gag reflex and enables the esophagoscope to be passed without discomfort. Alternatively, the
back of your throat may be sprayed with a local anesthetic. Any dentures are removed. Finally,
you may be given a premedication to relax you.

IN THE PROCEDURES ROOM

You will be given an intravenous injection which will relieve any discomfort
caused by fiberoptic esophagoscopy. You will feel sleepy but still able to cooperate with the
operator's requests. A gag is placed between your teeth to prevent damage to them or to the
esophagoscope. You may be asked to lie on your left side, your knees drawn up slightly, or you
may be seated or asked to lie on your back. As the tip of the esophagoscope is placed in your
mouth and directed down your throat, you will be asked to swallow. The tube is slowly advanced
and careful observations are made - and any procedures carried out - as the esophagoscope is
being withdrawn. In the course of the examination, the operator will inject small amounts of air
into your esophagus.

AFTER ESOPHAGOSCOPY
 The examination is at an end when the esophagoscope is withdrawn completely. You will
be helped off the examining table and taken to the recovery area. At first you may feel
lightheaded, but this should pass presently. It takes a few hours for the effects of any local
anesthetic to wear off, and you must not eat or drink anything until sensation has returned fully.
If
a biopsy has been taken, you may be given an appointment to come back when your doctor has
received the laboratory reports.