Colposcopy

What Is Colposcopy?

Colposcopy is a diagnostic method that allows the cervix and vagina to be examined in detail with the help of a special magnifying device called a colposcope. Used after abnormal smear (PAP smear) results or a positive HPV test, this method plays a critical role in detecting cervical cancer at an early stage. At the clinic of Prof. Dr. Melahat Atasever, this procedure is performed with care for definitive diagnosis and accurate treatment planning.

Colposcopy is a term derived from the Greek words “kolpos” (vagina) and “skopein” (to examine). It is the examination of the cervix, vagina, and vulva with a magnifying device called a colposcope, at a magnification of 10 to 40 times. The colposcope does not enter the patient’s body; it is positioned in front of the vaginal opening and captures the image from there. In this way, areas of abnormal cells that the physician cannot detect with the naked eye become clearly visible.

During the procedure, acetic acid at a concentration of three to five percent is applied to the cervix. Normal cells remain unchanged by this acid, while abnormal cells turn white; this appearance is called “acetowhite epithelium.” Additionally, Lugol’s iodine solution (Schiller’s test) may be applied; normal cells turn brown, while abnormal cells do not take up the stain. These staining techniques highlight the areas to be examined and ensure that the biopsy is taken from the correct spot.

Colposcopy is a diagnostic tool, not a screening test. It is the evaluation step that follows a finding such as an abnormal smear or HPV result. A biopsy can be taken from the suspicious area during the procedure; in that case, the diagnosis is confirmed through pathological examination.

Why and When Is Colposcopy Performed?

The most common reason for colposcopy is an abnormal PAP smear result. When atypical squamous cells (ASC-US, ASC-H), a low-grade lesion (LSIL), or a high-grade lesion (HSIL) is detected in the smear test, the cervical area needs to be evaluated under magnification. Not every woman with an abnormal smear result needs colposcopy; this decision is based on the degree of abnormality, age, and HPV status.

A positive HPV (Human Papillomavirus) test — especially the detection of high-risk HPV types (primarily HPV 16 and HPV 18) — constitutes a strong indication for colposcopy. These types are the strains most frequently associated with cervical cancer. In addition, suspicious cervical lesions noticed visually or during a routine examination, unexplained vaginal bleeding, and recurrent vaginal infections may also create an indication for colposcopy.

Periodic colposcopy follow-up is recommended for women with a history of cervical cancer or prenatal exposure to diethylstilbestrol (DES). Detecting cervical cancer at an early stage directly affects the treatment process; therefore, regular evaluation is of great importance for women in risk groups.

Preparation Before Colposcopy

No extensive preparation is required for colposcopy. Avoiding sexual intercourse, vaginal creams, and tampon use for 24-48 hours before the procedure allows a clearer view of the cervix. The ideal timing is a period without active menstrual bleeding, since bleeding can negatively affect image quality.

Patients using aspirin or blood thinners should inform the physician in advance. Taking a mild pain reliever (paracetamol or ibuprofen) 30-60 minutes before the procedure reduces possible discomfort. At her clinic in Ankara, Prof. Dr. Melahat Atasever provides comprehensive information to every patient before the procedure, with clear explanations of the process, the sensations that may be experienced, and whether a biopsy will be needed.

How Is Colposcopy Performed? Steps of the Procedure

The procedure is performed on a gynecological examination table, with the feet placed in stirrups. A speculum is inserted into the vagina to make the cervix visible, and the colposcope is positioned in front of the vaginal opening. The cervix is first gently cleaned with cotton or an applicator.

Acetic acid is applied to the cervix, and one to two minutes are allowed to pass. During this time, any areas of abnormal epithelium turn white and are observed under magnification through the colposcope. When needed, Lugol’s solution is applied to support the diagnosis. If an abnormal area is identified, millimeter-sized tissue samples are taken with a biopsy instrument; a momentary pain or cramp may be felt at that point.

Endocervical curettage (ECC) can also be performed in the same session; in this procedure, a tissue sample is taken from the inner surface of the cervical canal. The samples are sent to the pathology laboratory. The entire procedure usually takes 10 to 20 minutes. If there is bleeding from the biopsy site, it is stopped with Monsel’s solution or silver nitrate.

What Is a Colposcopic Biopsy?

A colposcopic biopsy is the removal of a small piece of tissue from an area that appears abnormal during the procedure. This sample is examined in the pathology laboratory to determine the degree of cervical changes and the risk of cancer. Taking a biopsy can be a routine part of colposcopy; however, a biopsy is not required in every colposcopy. If the images appear completely normal, the procedure can be completed without a biopsy.

A momentary pinching or cramping sensation may occur during the biopsy; it lasts only briefly. Biopsy and colposcopy are not the same concepts; colposcopy is a magnified imaging procedure, while a biopsy is the tissue sample taken under this imaging guidance. Pathology results are usually prepared within one to two weeks.

The Process After Colposcopy

After the procedure, light spotting or dark brown discharge (related to Monsel’s solution) may last for a few days; this is normal. If a biopsy was taken, mild cramping may be felt for one to two days; it is easily managed with pain relievers. For three to five days after the procedure, avoiding sexual intercourse, tampon use, and swimming pools is recommended.

The next step is determined based on the pathology results. If the result is normal or a low-grade lesion, periodic smear and HPV follow-up is planned. If a high-grade lesion (CIN 2-3) is detected, treatment methods such as LEEP (loop electrosurgical excision), cryotherapy, or conization are considered. Prof. Dr. Melahat Atasever shares pathology results with her patients in detail and prioritizes a shared decision-making process.

What Do Colposcopy Results Mean?

Colposcopy results are evaluated as normal (negative), low-grade abnormality, or high-grade abnormality. A normal result means there are no abnormal cell changes and routine follow-up can continue. Since low-grade findings (CIN 1) mostly regress on their own, close follow-up may be sufficient.

High-grade findings (CIN 2 and CIN 3) require treatment because they carry the potential to progress to cervical cancer. At this point, LEEP, conization, or a hysteroscopic procedure is planned. If cervical cancer (invasive) is detected, a multidisciplinary treatment process is initiated with the oncology team. In lesions caught early, treatment options can be more numerous and less invasive; this is what makes regular smear and colposcopy follow-up so valuable.

Prof. Dr. Melahat Atasever evaluates colposcopy and biopsy results in detail, avoids unnecessary surgical interventions, and plans precise, appropriate treatment only for lesions that carry a cancer risk.

Prof. Dr. Melahat Atasever offers integrated management of the entire process in Ankara, from colposcopy through to any necessary treatment.