Cervical Endoscopy (Colposcopy)

Colposcopy (Greek: kolpos: vagina; skopia: viewing) is a gynecological examination of the vagina (vagina) and cervix uteri (cervix) using a special microscope. This procedure, in combination with cytodiagnostics (examination of cells from a vaginal smear), is used primarily for the early detection of cervical carcinoma (lat. Carcinoma cervicis uteri), also called collum carcinoma (lat. Collum for “neck“) or cervical cancer). It also enables photographic documentation. As a clarifying colposcopy, it is the gold standard of diagnosis of early cervical carcinoma and its precursors.

Indications (areas of application)

  • Colposcopy based on cytological findings (= clarification colposcopy):
    • Any type of suspected carcinoma
    • Suspicion of mild or higher grade dysplasia (deviation of the tissue structure from the normal picture)
    • Glandular atypia (glandular epithelial atypia, possibly due to inflammation (deviations from the norm), which do not meet the criteria of dysplasia).
    • Unclear findings of cytological smears (Pap smear; thin-layer cytology).
    • Conspicuous smears in patients who are under immunosuppression (suppression of the body’s own defenses), eg due toHIV infection or organ transplants.
  • Colposcopy due to other findings:
    • Proven infection with HPV (human papillomaviruses: viruses that can cause cervical cancer).
    • Contact bleeding (bleeding when mucosal contact, for example, after intercourse).
    • Persistent fluor vaginalis (persistent vaginal discharge).
    • Macroscopic conspicuous cervix (changes visible to the naked eye).
    • Cervical polyps (benign protrusions of the mucosa in the cervical canal).
    • HIV initial diagnosis

The procedure

The examination was first described by Prof. Dr. Hans Hinselmann from Bonn in 1925 and is still a recognized and practiced method today.The part of the cervix that protrudes into the vagina is examined. This part is also called the portio vaginalis (or cervix for short). The examining physician inserts specula (metal spatulas) to dilate the vagina. A colposcope is a microscope that illuminates the mucosa of the cervix uteri (also called cervix for short; neck of the uterus) and magnifies it 3.5 to 30 times. Because most mucosal defects are not easily seen in a native colposcopy (without staining the mucosa), the following methods are used:

  • Acetic acid sample
    • The mucosa of the portio vaginalis is dabbed with 3% acetic acid solution. The acetic solution causes precipitation of the mucus covering the surface (cervical mucus). This makes the “teardrop structures” of the cervical glandular epithelium as well visible as the gray-white areas of metaplastic epithelium, which stand out clearly from the gray-red normal squamous epithelium.
    • In a leukoplakia (keratinizing process), the acetic acid can not penetrate the epithelium, a reaction is therefore not expected (The keratinization thus shows as a whitish “coating”).
    • In atypical epithelium (eg, cervical dysplasia, carcinoma in situ) and cervical carcinoma comes in addition to the intense whitish discoloration still an opaque swelling.
  • Schiller iodine sample
    • The portio is dabbed with the so-called Schiller iodine solution (3% iodine-potassium iodide solution). The healthy mucosa is discolored brown because the iodine reacts with the glycogen (multisugar) on the surface (“iodine positive”). The altered mucosa does not stain at all or only very little (“iodine negative”).
  • Green filter
    • The view through the filter allows better visualization of the vessels.

If a conspicuous mucosal change (suspicious portio findings) is found, a biopsy (tissue sample) is taken and a histological examination follows. Colposcopy is used not only for general examination, but also for control during surgical procedures (eg conization) on the female genital tract.Colposcopy provides valuable information especially in the early detection of cervical carcinoma (cervical cancer), which allows effective treatment.Clarification colposcopy may only be provided if appropriate authorization has been obtained from the Association of Statutory Health Insurance Physicians.