Name of the Procedure:

Colposcopy of the Cervix Including Upper/Adjacent Vagina; with Endocervical Curettage (ECC)

Summary

A colposcopy is a diagnostic procedure where a special magnifying device called a colposcope is used to closely examine the cervix, vagina, and vulva for signs of disease. This particular procedure includes scraping cells from the inside of the cervical canal, known as endocervical curettage (ECC), to obtain a more comprehensive sample for further testing.

Purpose

The procedure addresses abnormalities found in Pap smears or HPV tests. The goal is to detect precancerous changes, cervical cancer, or other abnormalities in the cervix and vagina early, allowing for timely treatment.

Indications

• Abnormal Pap smear results
• Positive high-risk HPV test
• Unexplained bleeding
• Visible abnormalities on the cervix Patient criteria include women with suspicious or unclear cervical screening results.

Preparation

• Patients may be asked to refrain from using tampons, vaginal medications, or douches 24-48 hours before the procedure.
• Scheduling the procedure when not menstruating, if possible.
• Patients should inform their doctor of any medications they are taking and may be advised to take a mild pain reliever like ibuprofen before the procedure.

Procedure Description

1. Patient lies on an examination table with feet in stirrups.
2. A speculum is inserted to open the vaginal canal.
3. The colposcope, positioned outside the vagina, is used for visual examination.
4. Acetic acid or iodine solution may be applied to enhance visibility of abnormal cells.
5. For ECC, a small instrument called a curette is inserted into the cervical canal to scrape cells.
6. Tissue samples are collected and sent to a lab for analysis.

Tools/Equipment: Colposcope, speculum, curette, acetic acid or Lugol's iodine solution.

Anesthesia/Sedation: Typically, local anesthesia is not required, but a topical local anesthetic may be applied in some cases.

Duration

The procedure typically takes about 10-20 minutes.

Setting

Performed in a gynecologist’s office, outpatient clinic, or hospital setting.

Personnel

• Gynecologist or skilled healthcare provider
• Medical assistants or nurses for support

Risks and Complications

• Mild discomfort or cramping
• Light bleeding or spotting
• Infection (rare)
• In very rare cases, heavy bleeding

Benefits

• Early detection of cervical cancer and precancerous changes.
• Targeted treatment can be initiated promptly.
• Less invasive than surgical diagnostic procedures.

Recovery

• Patients may experience mild cramping and light bleeding for a few days.
• Avoiding sexual intercourse, tampons, and douching for about a week.
• Follow-up appointments to discuss results and any further treatment.

Alternatives

• Repeat Pap smear after some time (watchful waiting)
• HPV testing
• Cone biopsy if more extensive tissue sampling is required

Pros of Alternatives: Less invasive in the case of watchful waiting. Cons of Alternatives: Potential delay in diagnosis for watchful waiting; more invasive in the case of cone biopsy.

Patient Experience

Patients might feel mild discomfort or cramping similar to menstrual pain. Pain management such as over-the-counter pain relievers can help. The application of solutions might cause temporary mild stinging or burning. Following the procedure, rest and avoiding strenuous activity can promote comfort and healing.