eMedicine Specialties > Obstetrics and Gynecology > General Gynecology

Colposcopy: Follow-up

Author: Stephen A Metz, MD, PhD, Associate Professor, Department of Obstetrics and Gynecology, Tufts University School of Medicine; Adjunct Associate Professor, School of Public Health Sciences, University of Massachusetts; Consulting Staff, Baystate Medical Center; Private Practice, Division of Surgery, Hampden County Physician Associates
Contributor Information and Disclosures

Updated: Aug 12, 2008

Future and Controversies

The colposcope can also be helpful in evaluating lesions of the vagina or vulva. The vaginal epithelium is a nonkeratinizing squamous epithelium similar to that of the exocervix. Acetowhite changes and vascular patterns can be observed that are similar to those found on the cervical portio. Because vaginal lesions do not originate in metaplastic tissue, vascular patterns previously described are not diagnostically reliable. When premalignant changes are suspected, all acetowhite lesions should be biopsied. The vagina is more sensitive to pain than the cervix, so prebiopsy injection of local anesthesia should be considered.

The vulva is also a potential site for development of preinvasive disease. These tissues also can show acetowhite changes, but, because of the thickness of the epithelium and its keratin surface, acetic acid should be applied for a greater length of time and in a higher concentration (eg, 5%) to be effective in bringing about this change. Altered vascular patterns are uncommon on the vulva; but, when they are observed, biopsies should be performed liberally. Again, because of the sensitivity of these tissues, all biopsies should be obtained under local anesthetic.

Another use of the colposcope is in the evaluation of a victim of sexual assault. This has gained popularity, especially in the evaluation of children suspected of being assaulted. At low magnification, the colposcope can assist in identifying tissue trauma that might be too subtle to be detected by the naked eye. Careful, thorough, and gentle examination, especially of hymenal tissues, can usually be accomplished with minimal discomfort. Attached cameras for recording findings can be helpful from an evidentiary perspective.

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Alissa Zuellig, BS; Bophal Hong, BS; Shironda Stewart, BS; and Michael P Grossman, MD to the development and writing of this article.



More on Colposcopy

Overview: Colposcopy
Workup: Colposcopy
Treatment: Colposcopy
Follow-up: Colposcopy
Multimedia: Colposcopy
References
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References

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Further Reading

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Keywords

colposcopy, vagina, cervical cancer, colposcope, Papanicolaou test, Pap smear, human papillomavirus, HPV, transformation zone, TZ, dysplasia, acetic acid, acetowhite epithelium, endophytic lesions of the cervix, exophytic lesions of the cervix, cervical carcinoma, cervical dysplasia, Bethesda system, atypical squamous cell, ASC, atypical squamous cell of undetermined significance, ASCUS, ASCH, low-grade squamous intraepithelial neoplasia, LGSIL, high-grade squamous intraepithelial neoplasia, HGSIL, cervical lesions, cone biopsy of the cervix

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Contributor Information and Disclosures

Author

Stephen A Metz, MD, PhD, Associate Professor, Department of Obstetrics and Gynecology, Tufts University School of Medicine; Adjunct Associate Professor, School of Public Health Sciences, University of Massachusetts; Consulting Staff, Baystate Medical Center; Private Practice, Division of Surgery, Hampden County Physician Associates
Stephen A Metz, MD, PhD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Society for Colposcopy and Cervical Pathology, American Urogynecologic Society, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Serdar H Ural, MD, Associate Professor of Obstetrics and Gynecology and Radiology, Director, Division of Maternal-Fetal Medicine, Medical Director, Labor and Delivery Suite, Penn State University College of Medicine
Serdar H Ural, MD is a member of the following medical societies: American Association of Gynecologic Laparoscopists, American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American Medical Association, Association of Professors of Gynecology and Obstetrics, and Society for Maternal-Fetal Medicine
Disclosure: GSK Honoraria Speaking and teaching; Ortho Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michel E Rivlin, MD, Professor, Coordinator of Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

 
 
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