Editing Colposcopy (section)

== Procedure ==
[[Image:Colposcope.jpg|250px|right|thumb|Colposcope]]
[[File:Transformation zone types.png|thumb|240px|Transformation zone types:<ref>International Federation for Cervical Pathology and Colposcopy (IFCPC) classification. References:<br>-{{cite web|url=https://www.rcpa.edu.au/Library/Practising-Pathology/Structured-Pathology-Reporting-of-Cancer/Docs/Transformation_zone|title=Transformation zone (TZ) and cervical excision types|website=[[:en:Royal College of Pathologists of Australasia|Royal College of Pathologists of Australasia]]}}<br>- {{cite journal|last1=Jordan|first1=J.|last2=Arbyn|first2=M.|last3=Martin-Hirsch|first3=P.|last4=Schenck|first4=U.|last5=Baldauf|first5=J-J.|last6=Da Silva|first6=D.|last7=Anttila|first7=A.|last8=Nieminen|first8=P.|last9=Prendiville|first9=W.|title=European guidelines for quality assurance in cervical cancer screening: recommendations for clinical management of abnormal cervical cytology, part 1|journal=Cytopathology|volume=19|issue=6|year=2008|pages=342–354|issn=0956-5507|doi=10.1111/j.1365-2303.2008.00623.x|pmid=19040546|s2cid=16462929|doi-access=free}}</ref><br>Type 1: Completely ectocervical (common under hormonal influence).<br>Type 2: Endocervical component but fully visible (common before puberty).<br>Type 3: Endocervical component, not fully visible (common after menopause).]]

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.{{citation needed|date=September 2020}} Colposcopy is performed with the woman lying back, legs in [[Stirrup (disambiguation)|stirrups]], and buttocks at the lower edge of the table (a position known as the [[Anatomical terms of location#Dorsal and ventral|dorsal]] [[lithotomy position]]). A [[speculum (medical)|speculum]] is placed in the vagina after the [[vulva]] is examined for any suspicious [[lesion]]s.{{citation needed|date=September 2020}}

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. <ref>{{cite book|author=Kelly M. Pyrek|title=Forensic Nursing|url=https://books.google.com/books?id=-eDKBQAAQBAJ&pg=PA157|date=2006-01-13|publisher=CRC Press|isbn=978-1-4200-0291-1|pages=157–}}</ref><ref>{{cite book|author=Margaret M. Stark|title=Clinical Forensic Medicine: A Physician's Guide|url=https://books.google.com/books?id=bAAhI7jUZ1IC&pg=PA103|date=2011-09-22|publisher=Springer Science & Business Media|isbn=978-1-61779-258-8|pages=103–}}</ref>

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 green filter is often used to identify certain vascular patterns that may indicate the presence of more advanced pre-cancerous or cancerous lesions.{{cn|date=March 2023}}

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.{{citation needed|date=September 2020}}

[[Acetic acid]] solution is applied to the surface of the cervix using cotton swabs to improve visualization of abnormal areas.{{citation needed|date=September 2020}}. Areas of the cervix that turn white (acetowhiteness) after the application of acetic acid or have an abnormal [[Blood vessel|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.{{cn|date=March 2023}}

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, [[Instruments used in obstetrics and gynecology|SpiraBrush CX]] or [[Instruments used in obstetrics and gynecology|SoftBiopsy]]. Most doctors and patients consider [[anesthesia]] unnecessary; however, some colposcopists now recommend and use a [[topical anesthetic]] such as [[lidocaine]] or a [[Anesthesia|cervical block]] to decrease patient discomfort, particularly if many biopsy samples are taken.{{citation needed|date=September 2020}}

Following any biopsies, an endocervical [[curettage]] (ECC) is often done. The ECC utilizes a long straight [[curette]], a [[Instruments used in obstetrics and gynecology|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. [[Ferric subsulfate solution|Monsel's solution]] is applied with large cotton [[wikt:Special:Search/swab#Noun|swabs]] to the surface of the cervix to control bleeding. This solution looks like [[mustard (condiment)|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]].{{citation needed|date=September 2020}}