AUTHOR: DR. RAMÓN M. BOTACIO P.
Keywords:
HPV: Human Papillomavirus
HPVI: Human Papillomavirus Infection
DNA: Deoxyribonucleic Acid
CIN: Cervical Intraepithelial Neoplasia
 

Etymologically, Colposcopy comes from the Greek: Kólpos = Vagina, and Skopein = To See.

COLPOSCOPY is the evaluation of the epithelial lining of the Lower Genital Tract: cervix, vagina, and vulva, with an instrument known as COLPOSCOPE; which allows us to identify, in precise amplified form, normal or abnormal findings.

Modern medicine mandates colposcopies to be performed by Colposcopy And Pathology Of The Lower Genital Tract Certified Physicians. This certification ensures that the studies will be performed in an ideal and professional way.

The patient is placed in gynecological position, a small speculum is gently inserted to extend the vagina; without causing discomfort. The colposcope is directed towards the genital area without directly contacting the patient (focal length of 30 cm). Afterward, the Colposcopist Physician, with the help of the colposcope, observes and analyzes small lesions of the cervix, vagina, and vulva, performing a high precision diagnosis.

  • It doesn’t cause pain
  • No biopsy required
  • The diagnosis is immediate
  • No special preparation required
  • Allows precise treatment to be prescribed
  • It can be done during menstruation
  • Allows a timely and effective diagnosis
  • The patient observes diagnosis in vivo
  • Offers tranquility and confidence to the patient
  • Every woman who has ever experienced sexual intercourse.
  • When the exfoliative cytology (Pap smear test) reports the following findings:
  • Inflammatory process
  • Atypical squamous cells of uncertain significance (ASCUS)
  • Atypical glandular cells of uncertain significance (AGUS)
  • Human Papillomavirus infection (HPVI)
  • Mild, Moderate, or Severe Dysplasia
  • In situ cancer
  • Invasive carcinoma
  • In the following clinical symptoms:
    • Persistent vaginal discharge (Leukorrhea).
    • Abnormal vaginal hemorrhage (Metrorrhagia).
    • History of HPVI, dysplasia and cancer treatment.
    • Previous electrocution (burn), cryotherapy (freeze) or caustic (acid) application.
    • Chronic pelvic pain
    • Before a pregnancy
    • Two months postpartum or C-section
    • Programmed to have a hysterectomy performed
    • When a more accurate assessment is considered
  • Patients who were treated for gynecologic cancer:
  • Cervical cancer
  • Vaginal cancer
  • Vulvar Cancer
  • Ovarian cancer
  • Endometrial cancer

 

  • Carrier of disease that compromises the immune system:
  • Systemic lupus erythematosus, HIV (AIDS), multiple sclerosis, rheumatoid arthritis, long-standing diabetes, etc.
  • Organ transplant carrier
  • Treatments that compromise the immune system:
    • Prolonged corticotherapy, chemotherapy and radiotherapy.

Colposcopy is a harmless procedure, which can be performed during pregnancy, and does not interfere with the fetus development. During pregnancy, colposcopy should be performed by an expert colposcopist, because during this stage, the hormonal effect exaggerates the physiological changes in the cervix; which can be mistaken for malignant lesions.

  • Flujo vaginal persistente (Leucorrea).
  • Hemorragia vaginal anormal (Metrorragia).
  • Antecedente de tratamiento por IVPH, displasia y cáncer.
  • Aplicación previa de fulguración (quemar), crioterapia (congelar) o de cáustico (ácido).
  • Dolor pélvico crónico
  • Antes de un embarazo
  • Dos meses post-parto o cesárea
  • Programada para realizarle histerectomía
  • Cuando se considere una evaluación más precisa

Modern knowledge tells us that colposcopy should not be done in virgin women because this group has no risk for the development of cervical cancer; For the development of this type of cancer, a causative agent is required, the HPV, which is acquired through sexual contact. Although exceptional and isolated cases have been reported in the world literature related to cervical cancer in virgin women.

In a recent study of 100 Virgin Women, through a 2-year follow-up,  HPV was positive only in the DNA of those women who initiated an active sexual life.

Colposcopy is not only to placing a colposcope in front of a patient, taking a biopsy, expecting a histopathological result, and then selecting an inadequate procedure.

Modern Colposcopy consists on a program that must be fulfilled with a high degree of responsibility.

  • Decrease the incidence and mortality rate from Lower Genital Tract cancer: cervix, vagina, vulva and anus.
  • To Strengthen the Lower Genital Tract Second Pathology Care Level (Formal Colposcopy Clinics).
  • To have Human Resources, with working spirit, specialized and certified in Colposcopy and Pathology of the Lower Genital Tract, whose main mission is: to carry out precise and timely diagnoses and treatments.
  • To have Colposcopy Reference Centers, consisting of appropriate physical infrastructures and high-tech equipment, for preventive and effective care.
  • To carry out quality control taking into account the following indicators: evaluation and academic updating of the human resource that works for the institution, calibration of equipment, review of inputs and evaluation of the relevant clinical cases that require joint sessions.
  • To offer personalized and professional care to patients during their evaluation, to guide them with proper scientific knowledge meaningful to their clinical situation.
  • To have a constant coordination between the first care level and the second care level (Colposcopy Reference Center), for clinical cases consultations or references for patients with clinical alterations or abnormal cytological results.
  • Precise orientation for the general population, in terms of prevention of the different Lower Genital Tract pathologies, by means of documentaries, lectures and bulletins, based on scientific research and international norms.
  • To organize academic Colposcopy and Pathologies of the Lower Genital Tract updating activities: congresses, symposiums, seminars, courses and scientific conferences.

DIAGNOSES THAT CAN BE PERFORMED IN THE LOWER GENITAL TRACT.

TRACTO GENITAL INFERIOR

Through colposcopy, we can identify all stages of cervical cancer natural history. It is done with the experience and dexterity of the Colposcopist Physician, supported by an established working methodology. Which is oriented by the World Colposcopy Classification, proposed by the International Federation of Cervical Pathology and Colposcopy (I.F.C.P.C.) at the XIV Colposcopy World Congress, Rio de Janeiro, Brazil, 2011.

  • NORMAL.
  • LOW-GRADE SQUAMOUS INTRAEPITHELIAL LESIONS
    • Infection with the human papillomavirus.
    • Grade I cervical intraepithelial neoplasia (mild dysplasia).
  • HIGH-GRADE SQUAMOUS INTRAEPITHELIAL LESIONS
    • Grade II cervical intraepithelial neoplasia (mild dysplasia).
    • Grade III cervical intraepithelial neoplasia (severe dysplasia).
    • Carcinoma in situ.
  • INVASIVE CANCER.
  • OTHERS.
    • Glandular eversion
    • Endocervical polyp
    • Endocervical fibroma
    • Nabothian cyst
    • Edometriosis
    • Atrophy
  • Normal
  • Vaginal infections: fungus, bacteria, Trichromatic Vaginalis, Gardnerella Vaginalis.
  • Benign tumors: leiomyoma, fibroepithelial polyp.
  • Pseudotumors: inclusion cyst, endometriotic cyst, Gardner cyst.
  • Infection with human papillomavirus (flat lesions and condylomas).
  • Vaginal intraepithelial neoplasia (VAIN)
  • Vaginal cancer.

The vaginal dome is the area at the bottom of the vagina, where the cervix was located prior to hysterectomy. In the dome we can find abnormal findings that also occur in the cervix (lesions by papillomavirus, dysplasias and cancer).

After hysterectomy (months or years), we can find granuloma in the vaginal dome, which is a benign inflammatory neoplasm caused by a reaction to suture used for the closure of the dome during the hysterectomy.

  • Normal
  • Vulvitis infecciosa: Hongo (Candida), Trichomona vaginalis, Herpes tipo II
  • Infecciones por virus del Papiloma Humano (lesiones planas y condilomas)
  • Neoplasia intraepitelial vulvar (VIN).
  • Cáncer de Vulva
  • Otras:
    • Molusco contagioso
    • Quistes sebáceos
    • Liquen plano y escleroso
    • Sífilis (nódulos)
    • Vulvodinia
    • Vitiligo
  • Normal
  • Infection with human papillomavirus (flat lesions and condylomas)
  • Perianal intraepithelial neoplasia (AIN)
  • Anus cancer
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