Colposcopy

Synonym/Acronym:
Cervical biopsy, endometrial biopsy.

Rationale
To visualize and assess the cervix and vagina related to suspected cancer or other disease.

Patient Preparation
There are no food, fluid, activity, or medication restrictions unless by medical direction.

Normal Findings

  • Normal appearance of the vagina and cervix
  • No abnormal cells or tissues.

Critical Findings and Potential Interventions
N/A

Overview

(Study type: Endoscopy; related body system: Reproductive system.) In this procedure, the vagina and cervix are viewed using a colposcope, a special binocular microscope and light system that magnifies the mucosal surfaces. Colposcopy is usually performed after suspicious Papanicolaou (Pap) test results or when suspected lesions cannot be visualized fully by the naked eye. The procedure is useful for identifying areas of cellular dysplasia and diagnosing cervical cancer because it provides the best view of the suspicious lesion, ensuring that the most representative area of the lesion is obtained for cytological analysis to confirm malignant changes. Colposcopy is also valuable for assessing women with a history of exposure to diethylstilbestrol (DES) in utero. The goal is to identify precursor changes in cervical tissue before the changes advance from benign or atypical cells to cervical cancer. Photographs (cervicography) can also be taken of the cervix.

Indications

  • Evaluate the cervix after abnormal Pap smear.
  • Evaluate vaginal lesions.
  • Localize the area from which cervical biopsy samples should be obtained because such areas may not be visible to the naked eye.
  • Monitor conservatively treated cervical intraepithelial neoplasia.
  • Monitor women whose mothers took DES during pregnancy.

Interfering Factors

Contraindications

Patients with bleeding disorders or receiving anticoagulant therapy, especially if cervical biopsy specimens are to be obtained, because the biopsy site may not stop bleeding.

Women who are currently menstruating, as bleeding may obscure abnormal findings.

Factors that may alter the results of the study

  • Inadequate cleansing of the cervix of secretions and medications.
  • Scarring of the cervix.
  • Severe bleeding or the presence of feces, blood, or blood clots, which can interfere with visualization.

Potential Medical Diagnosis: Clinical Significance of Results

Abnormal Findings In:

  • Atrophic changes
  • Cervical erosion
  • Cervical intraepithelial neoplasia
  • Infection
  • Inflammation
  • Invasive cancers
  • Leukoplakia
  • Papilloma, including condyloma

Nursing Implications

Before the Study: Planning and Implementation

Teaching the Patient What to Expect

  • Inform the patient this procedure can assist in assessing the cervix for disease.
  • Review the procedure with the patient. Address concerns about pain and explain that there may be moments of discomfort or pain experienced when the IV line or catheter is inserted to allow infusion of fluids such as saline, anesthetics, sedatives, contrast medium, medications used in the procedure, or emergency medications. Medications to reduce discomfort and to promote relaxation and sedation will be administered.
  • Advise the patient that if a biopsy is performed, she may feel menstrual-like cramping during the procedure and experience a minimal amount of bleeding.
  • Inform the patient that the procedure is performed by a health-care provider (HCP), with support staff, and takes approximately 30 to 60 min
  • Baseline vital signs will be recorded and monitored throughout the procedure. Protocols may vary among facilities.
  • Explain positioning for the study is on an examination table draped in the lithotomy position, and the external genitalia is cleansed with an antiseptic solution.
  • When a Pap smear is performed, the cervix is swabbed and a speculum is inserted into the vagina using water as a lubricant. A lighted magnification scope is used to carefully examine the cervix. Photographs can be taken for future reference.
  • Afterwards, the vagina is rinsed with sterile saline or water to remove the acetic acid and prevent burning after the procedure. If bleeding persists, a tampon may be inserted after removal of the speculum.
  • Biopsy samples are placed in appropriately labelled containers with special preservative solution and promptly transported to the laboratory.

Potential Nursing Actions

Make sure a written and informed consent has been signed prior to the procedure and before administering any medications.

After the Study: Potential Nursing Actions

Avoiding Complications

  • Complications of the procedure may include bleeding, infection, and cardiac dysrhythmias. Monitor for any bleeding. Bleeding may occur after undergoing biopsy and may be controlled by cautery, suturing, or application of silver nitrate or ferric subsulfate (Monsel solution) to the site.

Treatment Considerations

  • Perform postprocedure vital signs as ordered, and indicated. Compare with baseline values. Protocols may vary among facilities.

Followup Evaluation and Desired Outcomes

  • Understands to remove the vaginal tampon, if inserted, within 8 to 24 hr and afterwards to wear pads if there is bleeding or drainage.
  • Acknowledges that there may be slight bleeding and/or a discharge for a few days after removal of biopsy specimens but that persistent vaginal bleeding or abnormal vaginal discharge, an increasing amount of bleeding, abdominal pain, and fever must be reported to the HCP immediately.
  • Agrees to avoid strenuous exercise 8 to 24 hr after the procedure and to avoid douching and intercourse for about 2 wk or as directed by the HCP.

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