Colposcopy

The basic equipment and supplies necessary for the colposcopic examination have been developed over time to yield the most consistent and reliable results for a wide range of clinicians who practice this procedure.

This discussion will highlight the essential equipment and supplies used by great majority of contemporary colposcopists. It is recognized that there are multiple variations and choices when it comes to choosing equipment to accomplish a basic colposcopy examination. The items presented in this view take advantage of many "tried and true" items which should serve as a reliable and reproducible starting point for the beginning colposcopist.

Módulo 1: THE THEORY

Módulo 2: COMMON INDICATIONS FOR COLPOSCOPY

Módulo 3: GOALS OF COLPOSCOPY

Módulo 4: THE COLPOSCOPE

Basically a mounted operating, low magnification stereo microscope
Magnification ranges best between 4 to 30 power
Single magnification scopes less desirable, but adequate
Many scopes are either multiple powers, such as 5X, 10X, 20X or "ZOOM" (continuously variable) between 5-20X (or greater power)
Light source can be fiber optic-nice "cool" white light or "bulb in head" can get warm or hot to patient if examination prolonged
Mounting methods vary form pedestal, boom, wall mounted
Most have "green-blue" light option
- Helps highlight vascular (reds become black appering)
Focusing methods vary between manufacturers
- "twist the handle", "turn the knob", move the whole scope
Cover "handle/knob" areas of scope to prevent fomite contamination
Bases of colposcope can be multiple styles
- Carpet vs. Tile casters
- Heavy for photo
Optional video screen for patient observationt (as desired) very helpful for patients to view portions of this procedure.

Módulo 5: SATISFACTORY COLPOSCOPY

Módulo 6: COLPOSCOPY DOCUMENTATION

Develop and use an informed consent form
Develop and use a procedure documentation and findings form
Photo/video colposcopy nice for teaching but written diagrams are the standard for documentation

Módulo 7: LOTIONS AND POTIONS OF COLPOSCOPY

Saline solution
- Good dilute and blot off mucus
- Highlights fine vessel patterns without vasoconstriccion
- Use prior to vinegar to avoid small vessel vasoconstriction
Acetic acid
- Fresh white vinegar, 3-5 % acidity
- Grocery store grade is fine
- Areas of concern turn white
Lugol's solution
- Iodine solution
- Turn glycogen containing tissue black
  - Mature squamous epithelium turns black
  - Dysplasia turns less black or no change
  - Apply just prior to biopsies after saline and acetic acid
Monsel's Solution
- Ferrous subsulphate
- Stops bleeding
- Allow to dehydrate and become thick like paste
- Apply only after biopsies done, ruins histology
"Hurricaine" syrup
- 20% topical benzocaine
- Applied topical for pain control on mucous membranes
- Helps control discomfort with ECC
- Optional

Módulo 8: THE HAND TOOLS

Módulo 9: EXAMINATION TABLE

Módulo 10: ROOM HEATER Módulo 11: MISC. ITEMS

Paper towels specimen squares
Specimen bottles with fixative
Toothpicks to retrieve samples
Cytobrush for ECC sample retrieval after curetting
Pap and cervical culture items
- Lab submittal forms
Rapid urine pregnancy screen
K-Y jelly lubrication
Plastic anoscope good for inspecting anal canal
Dental mirror for vaginal inspection
Key punch biopsy device for vulv
Skin hook or tenaculum rarely necessary, but have just in case
Examination gloves for examiner, sterile not necessary
Disinfectant wipes
Juice, coffe, cookies for recovery nice!
Occasionally an oral anxiolytic can be used as deemed necessary
- Get informed consent prior to administration
- Patient needs a ride home
Sometimes a "nanny" to baby-sit an infant while the mother is examined is very helpful. Many patients are young mothers with limited child care resources. (Our nurses fight over this duty!)

Módulo 11: GENERAL COMMENTS

The colposcope examination includes the inspection of the vagina, vulva and peri-anal areas.
Have at least two complete sets of colposcopy instruments available
- Biopsy forceps, Kogan's, ECC curette
- One can be sterilized while one is beging used
Arrange, ahead of time, a resource for instrument sharpening
Don't rush this exam! Having enough time to do a thorough and relaxed examination is essential equipment too!