Definition
Colposcopy is a diagnostic medical procedure used to closely examine the cervix, vagina, and vulva for signs of disease. It involves the use of a colposcope, a specialized instrument with a magnifying lens and light, which allows healthcare providers to identify abnormal or precancerous cells.
Colposcopy is often recommended after abnormal results from a Pap smear or HPV test and can help diagnose conditions such as cervical dysplasia, genital warts, or cervical cancer. If abnormalities are detected, a biopsy may be performed during the procedure for further analysis.
Purposes
- To identify or rule out the existence of any precancerous cervical tissue.
- To confirm the diagnosis, if the cervix looks abnormal during a routine examination.
- To remove cells or tissues to be examined under a microscope (biopsy) and usually done following a Pap smear examination.
- To examine victims of sexual assault or abuse and to document any physical evidence of vaginal injury.
Articles (sterile)
- A colposcope.
- A monitor and printer.
- Bowl with cotton swabs.
- Sponge holding forceps.
- Kidney tray.
- Gloves.
- Draping sheet.
- Perineal pads.
- Cusco’s speculum.
- Acetic acid 5%.
- Normal saline.
- Lignocaine 2%.
- Surgical scissors to cut a condom, if required.
- Punch or gun biopsy as required.
- Condom to place on the speculum, if required.
Procedure
| Nursing action | Rationale | |
| 1. | Explain to patient the need, purpose, and procedure. | To relieve anxiety and to promote cooperation. |
| 2. | Ensure that informed consent is obtained. | To avoid legal problems. |
| 3. | Instruct the woman to empty her bladder. | To avoid injury to bladder and discomfort during procedure. |
| 4. | Assemble equipment near the patient. | To save time and for smooth performance of procedure. |
| 5. | Prepare the test area (treatment room) and provide privacy for patient. | To avoid embarrassment. |
| 6. | Assist the woman to lie down in dorsal recumbent position at the edge of the examination table. | To facilitate performance of procedure steps. |
| 7. | Clean the vulva and perineum with saline-soaked cotton balls. | To prevent chances of infection and to obtain good specimen for test. |
| 8. | Drape the area with sterile perineal sheet. | To avoid contamination of perineal area. |
| 9. | Lubricate the speculum with lignocaine jelly. | Lubricating reduces discomfort due to friction during insertion. |
| 10. | Insert speculum and open it in the vagina. | Facilities visualizing cervix. |
| 11. | Instruct mother to take deep breaths during speculum insertion. | Promotes relaxation and lessens discomforts. |
| 12. | With swabs soaked in diluted acetic acid (vinegar), swabs the cervix and vagina. | Use of acetic acid helps identify cells that are abnormal. |
| 13. | Physician visualizes the cervix and vagina with the colposcope placed near the patient’s body and connected to a monitor. | Abnormal areas are identified as they turn white instead of a normal pink color. |
| 14. | Using the punch or gun biopsy forceps, cervical or vaginal tissues/ cells may be taken. | To test for precancerous changes in the cells. |
Postprocedural care
| Nursing action | Rationale | |
| 1. | Switch off the colposcope and remove speculum. | Completes viewing and specimen collection. |
| 2. | Clean perineal area and apply perineal pad. | Enhances hygiene and comfort. |
| 3. | Assist patient to comfortable position and help to redress. | Promotes rest following the procedure. |
| 4. | Inform her that it may be normal to have some spotting. | Reduces anxiety and fear. |
| 5. | Discard waste (used cotton swabs). | Avoids chance of spreading infection. |
| 6. | Wash all instruments and articles, dry and keep ready for autoclaving. | Keeps ready for next use. |
Postprocedural instructions
Advice the mother to call her doctor if she notices any of the following symptoms:
- Heavy vaginal bleeding (more than one sanitary pad an hour).
- Fever, chills or an unpleasant vaginal odor.
- Lower abdominal pain.
Contraindications for procedure
- Pregnancy: Placenta previa.
- Vulvovaginitis.
- Active cervicitis.
Special considerations
If an abnormal area is seen on examination, it may be followed with other procedures, such as:
- Biopsy of the tissue.
- Diathermy (high heat).
- Cryosurgery (extreme cold).
- Laser application.
- Cone biopsy (removal of a conical section of the cervix for examination).
- Loop electrosurgical excision procedure (LEEP) using low voltage, high-frequency radio waves to excise tissue.
- A condom opened at both ends may be placed on the speculum to avoid friction and discomfort while insertion.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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