All women who have had cervical smears showing mild dyskaryosis which does not resolve spontaneously, or those women with a single smear showing moderately or severely dyskariotic cells, should undergo Colposcopy.
The colposcope is a binocular microscope. An illuminated, three-dimensional view of the cervix is obtained, magnified between 6 and 40. This technique identifies both the severity of the abnormality giving rise to an hence, it allows the clinician to assess the suitability for local ablative therapy.
The patient is examined in the lithotomy position, and a bivalve speculum is used to expose the cervix. A further cervical smear is usually taken prior to the colposcopic examination. Cotton wool swabs are then used to clean mucus off the cervix before applying 5% acetic acid to stain the abnormal areas white (acetowhite). If the upper limit of the transformation zone lies within the endocervical canal, forceps may be useful in exposing the whole area. If the upper of the transformation zone cannot be visualized then the examination must be considered incomplete. This occurs in less than 10% of women aged 25 years or less, but in more than 30% of women over the age of 40 years. Punch biopsy forceps can be used to obtain a sample from colpospically abnormal areas to make a histological diagnosis. Once the results of this are known , ablative treatment such as SEMM cautery or laser can be applied. Loop excision of the transformation zone is being increasingly used. For women with moderate or severely dyskaryotic (abnormal) smears and colposcopic changes consistent with this, the treatment process removes the abnormality and produces a good sample for histological analysis therefore enabling assessment and treatment at one visit .