Colposcopy of cevicovaginitis

Benha University Hospital, Egypt

[email protected]

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The colposcope is basically low power stereoscopic

microscope with a focal length between 20 & 30 cm &

magnification between 6 & 40

Colposcopy mainly evaluates the changes in:

•Terminal vascular network of the cervix &

•Surface epithelium after application of acetic acid.

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The most common indications of colposcopy

are evaluating patients with

1. Abnormal cytology.

2. Clinically suspicious cervix

It locates the site of the lesion.

It confirms or rule out invasive cancer.

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Recent recommendations of FIGO for management of abnormal smear( Benedet,2000)

Persistent inflam., persistent ASCUS, LSIL, HSIL, AGCUS,Invasive

Colposcopy±biopsy

Normal or LSIL HGSIL Invasive

6 mo smear x 2 LEEP Appropriate TT

Normal Persistent

Annual screening

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Cervicovaginitis is the most common gynecological

disorder, affecting half of women some time during

adult life.

Cervicitis represents a problem of considerable

complexity, because

1. Inflammation is not always of primary origin in the

cervix

2. It is often associated with other cervical

pathological states e.g. lacerations, erosion or

ectropion.

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3. Cervicitis, erosion, ectropion are terms which are

used without any real attempts at accurate

diagnosis.

Thanks to Colposcopy, now, we can diagnose the

different cervical changes very accurately

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A. Primary inflammation (10%)

I. Vaginitis:

1. Red punctate:

T.V(50%), Candida (25%), B. V.(20%)

2. White punctate

Candida (95%), T.V (4%), B.V. (1%)

3. Focal

T.V (98%)

4. Mixed:

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5. Rare:

Vesicular: HSV, febrile illness

Follicular: CT

Hypertrophic (Granular): secondary to focal vaginitis

Emphysematous: metabolic or toxic factors

Desquamating: viral

II. Erosion: Specific Non specific

III. Ulceration: specific Non specific

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B. Secondary inflammation (20%)

1. Infected TTZ

2. Infected ectopy

3. Infected ATZ

4. Infected polyp

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Colposcopy of bacterial vaginosis

Punctate vaginitis with small regular points


Colposcopy of Chlamydia trachomatis

Follicular (hypertrophic) cervicitis

Lymphoid follicles: creamy white, raised rounded

swellings

Not altered after application of actic acid or Shiller s

iodine


Colposcopy of HPV

1. Florid

2. Spiked

3. Flat: Subclinical HPV

4. Condylomatous cervicitisa


Colposcopy of HSV

seen only if the patient has vulval HSV & vulval pain

1. One or more vesicles: short duration (24-36 hr),

ulcers

2. Sometimes ulcers coalesce to form one large ulcer

with some appearance of invasive cancer

3. Increased surface vacularity


Colposcopy of TV

1. Red punctate vaginitis

2. Tiny non-staining areas

3. Focal vaginitis

4. Speckeled appearance


1. Colposcopy is useful in diagnosing some kinds of

infections on the first visit:

T. vaginalis HPV

2. There are many other cases in which we must

treat the acute inflammation first in order to perform

satisfactory colposcopy at a second opportunity


3. Areas of true erosion can be easily recognized, &

the visualization of the free connective tissue is a

very important diagnostic element

4. Colposcopy is very useful for determining the

origin of menopausal spotting in cases of atrophic

vaginitis.


5. Also, in cervicitis of pregnancy complicated by

cervical bleeding from little capillaries, colposcopy

establishes the nature of the spotting

6. Traumatic lesions (f. bodies or decubitus) can be

recognized.


7. In chronic cervicitis

any abnormalities in vascular net distribution make a

biopsy mandatory.

8. In some cases of chronic cervicitis, the vascularity

& the proliferative tendency is so marked that it leads

to suspicion of cancer. Biopsy under colposcopic

direction is an accurate method of determining the

cervical pathology.


Colposcopy of cevicovaginitis

Health & Medicine

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