During the initial evaluation, a medical history is obtained. The procedure is fully described to the patient. In some cases, a
pregnancy test may be performed before the procedure, and the patient then signs a consent form. Colposcopy is performed with the woman lying 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. A colposcope is used to identify visible clues suggestive of abnormal tissue. It functions as a lighted binocular or monocular
microscope to magnify the view of the cervix, vagina, and vulvar surface. Low magnification (2× to 6×) may be used to obtain a general impression of the surface architecture. 8× to 25× magnification are utilized to evaluate the vagina and cervix. High magnification, together with a green filter, is often used to identify certain vascular patterns that may indicate the presence of more advanced pre-cancerous or cancerous lesions. The squamocolumnar junction, or "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.
Acetic acid solution is applied to the surface of the cervix using cotton swabs to improve visualization of abnormal areas. Areas of the cervix that turn white (acetowhiteness) after the application of acetic acid or have an abnormal
vascular pattern are often considered for
biopsy. 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, such as a punch forceps,
SpiraBrush CX or
SoftBiopsy. Most
doctors and patients consider
anesthesia unnecessary if a biopsy is not performed; however, some colposcopists now recommend and use a
topical anesthetic such as
lidocaine or a
cervical block to decrease patient discomfort, particularly if biopsy samples are taken or endocervical curettage is done since the latter procedures often cause more pain than a diagnostic colposcopy without biopsy.. However, oral
nonsteroidal anti-inflammatory drugs (e.g., ibuprofen) and topical anesthetics, such as benzocaine, are no more effective than a placebo for pain relief during colposcopy procedures. Local injection of anesthetics (e.g., 1% lidocaine) with a
paracervical block significantly reduces pain compared to receiving no anesthesia during the procedure. Colposcopy-related pain is usually mild to moderate, but some women experience severe pain with the procedure. Biopsy techniques may include a punch biopsy of visible abnormalities or an endocervical
curettage (ECC), which samples the endocervical canal as it cannot be directly visualized during the colposcopy. The ECC utilizes a long straight
curette, a
Soft-ECC curette employing fabric to simultaneously collect tissue, or a
cytobrush (like a small pipe-cleaner) to scrape the inside of the cervical canal. The ECC should never be done on a patient who is pregnant.
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: Patients 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. ==Interpretation==