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Re: Colposcopy Concerns/AggravationFrom: D. Ashley Hill, M.D. (anonymous@obgyn.net)Sat, 16 Aug 1997 21:56:59 -0500 (CDT)
Here's a little info on colposcopy. Colposcopy is essentially a "super Pap smear" that takes about 5-15 minutes and is performed in the doctor's office. There are a couple of reasons a doctor would suggest colposcopy. The most common is an abnormal Pap smear. Contrary to popular belief, Pap smears are not really done to look for cervical cancer. Rather, they look for abnormalities that may, if untreated, lead to cancer down the road. Thus, the overwhelming majority of "bad" Pap smears are not cancer, but are sometimes "precancer" that needs appropriate treatment. Pap smears are screening tests. Colposcopy is a better (but more expensive) method to evaluate the cervix, so it is done in cases of abnormal Pap smears. Other reasons to perform colposcopy include evaluation of abnormal appearing areas on the vulva or on the walls of the vagina, to remove an embedded foreign object, to investigate possible sexual abuse or assault, or whenever a close up view of the genital organs are necessary. The procedure itself involves having the patient in the Pap smear position, in stirrups. A speculum is inserted into the vagina then opened, and a magnifying device is placed near the vagina and adjusted to the doctor's eyes. A light vinegar solution is applyed to the genital tissues in order to bring out any abnormal areas (they turn white under the green or blue light from the magnifying lens). A biopsy may be performed, depending on what the cervix (or other area) looks like. There are distinct patterns that may mean a precancerous area, and we look for these areas. If a biopsy is performed, the good news is that the outer cervix does not have nearly the number of pain nerves as other genital organs, so *most* women (in my experience) do not report much, if any, pain during a cervical biopsy. The bad news is that this is painful for some women, and there is no way to predict beforehand which patient will have pain and which will not. So, many doctors spray or inject a little novocaine into the cervix to numb it before doing a biopsy. The actual amount of tissue that is removed is surprisingly small, much less than a pencil eraser. Sometimes we also perform a quick scraping of the first 1/2 inch of the inner cervix, which almost always produces a significant "period cramp" type feeling. Chances are this is the part of the procedure that will hurt some, but it's very fast (less than 5 seconds) and the pain almost always diminishes rapidly. There is almost certainly someone reading this that has had a painful colposcopy. The above statements are based on my experience with many of these procedures, and while a small number of patients will surely have pain, the overwhelming majority report either a little discomfort, a sharp cramp with the scraping procedure (called an ECC), or no pain at all. You may want to ask your doctor about taking ibuprofen or a similar medication about an hour before the procedure to reduce the cramping sensation. Your doctor may put a dab of a thick, yellow (looks like Chinese mustard) solution onto the cervix to cauterize the blood vessels where the biopsy was taken. If so, expect to have a light, blackish discharge for a few days. I usually advise patients that they can resume sexual activity and tampon use after 3 or 4 days, but this will depend on the exact procedure, so please ask your doctor. Finally, infection is very rare with this procedure, but if you notice a malodorous vaginal discharge that begins about a week after the procedure, contact your doctor for antibiotics. Otherwise, the procedure is very safe, and a colposcopy should not hamper your ability to have children, use tampons, have sexual relations, or anything else. Expect about 1-2 weeks for the biopsy results to return, and rest assured that the diagnosis is just about always a treatable condition that will likely prevent you from getting cervical cancer.
-- Ashley Hill D. Ashley Hill, M.D. Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency Orlando, FL I apologize, but I am unable to answer personal e-mail due to time constraints.
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