VIA

(Visual Inspection with Acetic Acid Aplication)

Preparation of Steps

Dwiana Ocviyanti
• Department of Obstetrics and Gynecology Faculty of
Medicine University of Indonesia
• National Clinical Training Network of Reproductive
Health/NCTN-RH
 VIA can be considered for use in low-
resource settings because it:
• Can effectively identify most precancerous
lesions
• Is noninvasive, easy to perform and inexpensive
• Can be performed by all levels of healthcare
workers in almost any setting
• Provides immediate results that can be used to
inform decisions and actions regarding treatment
• Requires supplies and equipment that are readily
available locally
 Who Should Be Tested
• Testing for cervical cancer or its precursors is
recommended for any woman between the
ages of 30 and 45.
• Cervical cancer rates peak among women
between the ages of 40 and 50, so testing
should take place during the ages in which
detecting a precancerous lesion is most likely,
normally 10 to 20 years earlier
 When To Perform Via
• VIA can be performed at any time in the
menstrual cycle, including during menses,
during pregnancy and at a postpartum or
postabortion checkup
• It can be performed in a woman suspected or
known to have an STI or HIV/AIDS.
REPRODUCTIVE HISTORY
Age Parity o Currently pregnant (weeks) Example of Cervical Map

Current contraceptive Age of first intercourse

Menstrual Bleeding Pattern
o Regular (23–35 day interval)
o Irregular
o Postcoital spotting or bleeding
STI History
Number of sexual partners: o Had an STI
Patient Patient
Spouse Spouse
Risk Factors
o Smoker o Previous abnormal Pap smear
o HIV/AIDS o Mother or sister(s) with cervical cancer
o Chronic corticosteriod use

EXAMINATION
xx
Bimanual examination
xxx
xxx
Vulva Uterus
Vagina Adnexa
Cervix Rectovaginal examination
(if indicated)
Outline of squamocolumnar junction (SCJ)
xx
xx White epithelium
Actual cervical os
Cancer
 Instruments And Supplies
• Examining table
• Light source
• Bivalved speculum (Cusco or Graves)
• Instrument tray or container
o Cotton swabs
o New examination gloves or high-level disinfected surgical
gloves
o New wooden spatula and/or condom
o Dilute (3–5%) acetic acid solution (white vinegar is
acceptable)
o 0.5% chlorine solution for decontaminating instruments
and gloves
o A record form for recording the findings
 Client Assessment and Getting Ready
• Before performing the VIA test, discuss the
procedure with the woman
• Explain why the test is recommended and exactly
what will take place during the examinatio
• Discuss with her the nature of the most likely
findings and the followup or treatment that
might be required.
• Make sure that all necessary instruments and
supplies are available
• Bring the woman into the examination area
 The VIA Test
• Inspect the external genitalia
• Insert the speculum fully so that the entire cervix
can be seen
• Look at the cervix and check for evidence of
cancer or infection (cervicitis)
• Soak a clean swab in dilute acetic acid solution
and apply it to the cervix
• Once the cervix has been washed with the acetic
acid solution, wait at least 1 minute for it to be
absorbed and any acetowhite reaction to appear
• Inspect the SCJ carefully
Normal Cervix and Cervical Cancer

Normal Cervix Cervical Cancer

VIA CLASSIFICATION CLINICAL FINDINGS

Test-positive Raised and thickened white plaques or

acetowhite epithelium, usually near the SCJ

Test-negative Smooth, pink, uniform and featureless;

ectropion, polyp, cervicitis, inflammation,
Nabothian cysts

Cancer Cauliflower-like growth or ulcer; fungating

mass
Normal Cervix and Cervix with VIA Test
positive after Acetic Acid Aplication

Normal Cervix VIA Test Positive

Adapted from: International Agency for Research on Cancer (IARC).
 Clinical Significance and Location of
Acetowhite Lesions:
Insignificant Lesions
Line-like
Far away from SCJ acetowhitening at
brim of endocervix

Faint acetowhite
areas without sharp Dot-like pale areas in
outline endocervix

Streak-like
acetowhitening
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 Clinical Significance and Location of
Acetowhite Lesions:
Significant Lesions

Thick, well-defined acetowhite areas,

like leukoplakia, appearing very close
to SCJ, jutting into ectocervix or
endocervix or both

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 Discussion after VIA test
• If the VIA test is positive or cancer is
suspected, tell the woman what the
recommended next steps are
• If the VIA test is negative, tell the women that
she can return for VIA the next five years and
than every 5 years