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More articles by Dr. Soucasaux: Anatomical drawings - Anovulatory cycles - Archetypal aspects of the female genitals - The breasts: some morphological aspects - Colposcopy - Comments on the corpus luteum and related aspects - Comments on some anatomical and symbolic aspects of the female pelvis - The curious relations between androgens and estrogens in women - Drospirenone Oral Contraceptives - Due to prohibition, Brazilian women don't have access to modern medicinal abortion - Endocrinology of menstruation - The Fallopian tubes - Female sexual response - The Gräfenberg Spot (G-Spot) - The Gynecologic Palpation (descendant of "The Touch") - Gynecological assistance: the three basic areas - Gynecology and Gynecologic Surgery - Gynecologist versus obstetrician: what lies behind the combination? - "Gyneco-obstetric-surgical" stubborness and the perpetuation of one of the greatest mistakes of women's medicine - Hypermenorrhea and/or Menorrhagia (Prolonged and/or Excessive Menstrual Bleedings) - Hypertrichosis, Hirsutism and Androgenic Manifestations in Women - Mayer-Rokitansky-Kuster-Hauser (MRKHauser) Syndrome - Menstrual toxin: An old name for a real thing? - Nature and the ovaries - On the Intimate, or Small-Scale, Mechanisms of Menstruation - On the Strange Nature of the Ovaries - Oral hormonal contraceptives (the "Pill") - The Ovaries: Some Functional and Archetypal Considerations - Peculiarities of the Female Genitals' Sensory Innervation - Physiology of menstruation - Polycystic ovaries syndrome - The Possibility of Becoming Pregnant, Its Implications for Women, and Abortion - Premenstrual congestion of the breasts - Premenstrual syndrome (PMS) - The Psychology of Gynecology part 1 (part 2) - Psychosomatic and symbolic aspects of menstruation - Psychosomatic gynecology - Some Details on the Function of the Hypothalamus-Pituitary-Ovaries Axis - Stanislav Grof's Perinatal Matrixes of the Unconscious and Women's Medicine - Symmetric Patterns in the Female Genitals - Thoughts on Female Sexual Psychology - Uninterrupted use of hormonal contraceptives for menstrual suppression: why I do not recommend it - The uterine cervix - Uterine contractility - The Uterus and the Female "Passive-Active" - Women's corporeal consciousness and experience - Women's Experience of the Breasts - Women's Undesired Pregnancies and Women's Right to Abortion and see his Art of Menstruation


Colposcopy

Dr. Nelson Soucasaux, Brazilian gynecologist

Developed by Hinselman in Germany for helping in the early detection of cervical cancer (and always used in conjunction with the current cytological - cell - examinations), the colposcope is an optical device that allows the observation of the uterine cervix (as well as vagina and vulva) with a magnification of about 10X to 15X. Through the colposcope we can easily visualize small details of the tissues of the uterine cervix in their normal and abnormal aspects, typical and atypical, benign, pre-malignant and malignant.

   
 The colposcope, right, at the business end of an examination table. The colposcope ready to use. 

Though in clinical practice the current cytological examinations (the "Pap tests" or "Pap smears") are much more important than colposcopy for the early detection of all cervical cellular atypias (and therefore for the early diagnosis of cervical cancer), colposcopy is also fundamental for any correct clinical examination of the uterine cervix. Here we must emphasize that there are also several usually slight cervical epithelial atypias with normal cytological results that can only be detected through colposcopy. Despite the importance of the normal cytological results, cases like these may require more attention, as, for instance, cervical cytological examinations carried out more often, with smaller intervals. We also cannot forget the existence of false-negative results in some cytological examinations.

Sometimes we can rule out a false-negative cytological result simply through the colposcopic observation of areas of accentuated atypical epithelium on the cervix. Colposcopy is also essential for the clinical evaluation and correct management of the usual inflammatory processes of the uterine cervix, of the very frequent "eversions" of the endocervical mucosa and their process of resurfacing at the ectocervical epithelium, as well as for the detection of small lesions caused by the HPV (human papillomavirus).

Whenever a cervical biopsy has to be performed, colposcopy is fundamental for guiding the procedure to the areas of the uterine cervix that visually exhibit more accentuated epithelial abnormalities. It is important to emphasize that all cervical biopsies that are not performed under a careful colposcopic control can be considered as "blindly-performed biopsies" and, therefore, as not reliable.

Before continuing, let us briefly introduce some basic concepts on cervical pathology. As I observed in my article "The Uterine Cervix," published here at the MUM, in the uterine cervix there is a strange focus of epithelial "unquietness" related to a physiological process by which the usual eversions of the endocervical mucosa are resurfaced by the squamous stratified epithelium typical of the ectocervix, giving rise to the so-called "transformation zones." A collection of irritative, inflammatory and infectious factors collaborate for making the area of these eversions the site of sometimes problematic histological changes. The main infectious factor responsible for the development of cervical epithelial atypias is the HPV (human papillomavirus).

Fortunately, in most cases this epithelial "unquietness" is benign, and the new squamous stratified epithelium that develops for resurfacing the ectopic area of glandular epithelium is entirely normal. In such cases, the result is the formation of what we call a "typical transformation zone." However, with some frequency this cellular proliferation gives rise to several degrees of epithelial atypias and abnormalities, resulting in the development of "atypical transformation zones." Among the abnormalities that may develop there are, in increasing order of severity, the slight, moderate and accentuated "cervical dysplasias" and the carcinoma in situ of the cervix. The carcinoma in situ of the cervix is the initial stage of cervical cancer, while it is still restricted to the epithelium. At this stage it is non-invasive and can be easily and successfully treated through very small surgical procedures. The formerly known "cervical dysplasias" are presently named "cervical intraepithelial neoplasias" ("CIN") or "squamous intraepithelial lesions" ("SIL").

As to the aforementioned eversions of the endocervical mucosa, they appear as reddish areas surrounding the external cervical orifice, in sharp contrast with the clear pink colour of the ectocervical and vaginal mucosa. The reddish aspect is simply the normal colour of the glandular mucosa, covered by a single-layered columnar epithelium. On the other hand, the clear pink colour is that of the squamous stratified epithelium that covers the ectocervix and the vagina. The enormous differences between the two kinds of epithelium that surface the uterine cervix are clearly seen at the colposcopic examination. While the glandular epithelium exhibits a reddish irregular surface that looks like a multitude of very small "bunches of grapes," the squamous stratified epithelium exhibits an entirely smooth clear pink surface.

Eversions of the endocervical mucosa are very frequent mostly in young women and, in the absence of inflammation and other alterations, are considered as normal and physiological. The ectopic glandular epithelium that characterizes these endocervical eversions usually is gradually replaced by the squamous stratified epithelium typical of the ectocervix, and the several stages of this physiological process can be easily observed through the colposcope.

As already mentioned, the result of the replacement of the ectopic glandular epithelium by the squamous stratified one is the development of an area known as "transformation zone." A typical transformation zone can be easily recognized at the colposcopic examination as an area of squamous stratified epithelium usually containing remnants of glandular epithelium that appear as small glandular openings and the so-called Naboth cysts.

 
This is what your doctor sees through his colposcope - although only the most organized woman would have numbers in place.

Nevertheless, the physiological process through which the transformation zones are formed frequently gives rise to several kinds of epithelial atypias, resulting in "atypical transformation zones". Some of these epithelial atypias may give rise to cervical cancer, therefore the importance of their early recognition. Even so we must remark that, fortunately, most of them do not evolve to cancer, and this fact must be strongly emphasized for not scaring women unnecessarily. The fundamental thing here is permanent control through the periodic preventive examinations.

Besides the obvious aspect of carcinomatous tissue, the most important atypias of the uterine cervix easily observed at colposcopy are epithelial thickenings and abnormal blood vessels. The colposcopic aspects described as "epithelial thickenings" include several alterations such as leukoplasias, "mosaics" and "white epithelium," and we must observe that they are very frequent. Nevertheless, these alterations usually only require a biopsy in the presence of important cytological abnormalities and/or accentuated degrees of thickness verified at colposcopy (as well as atypical blood vessels ). Here we must remark that the simple presence of areas of slight epithelial thickenings in the uterine cervix is a very common colposcopic finding and, in such cases, the results of repeated cytological examinations are almost always normal.

Before finishing this very brief introductory article on colposcopy, we must emphasize that, despite the enormous importance of this procedure on the study of the uterine cervix, the definitive and correct diagnosis of any important cervical pathology only can be obtained through cytological and histo-pathological examinations. This means that colposcopy alone cannot precisely establish the correct diagnosis of any cervical epithelial atypia, as well as any other important cervical lesion, and this must be very clear.

Copyright 2003 Nelson Soucasaux (text, illustrations and photographs )

__________________________________________

Nelson Soucasaux is a gynecologist dedicated to clinical, preventive and psychosomatic gynecology. Graduated in 1974 by Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Brazil, he is the author of several articles published in medical journals and of the books "Novas Perspectivas em Ginecologia" ("New Perspectives in Gynecology") and "Os Órgãos Sexuais Femininos: Forma, Função, Símbolo e Arquétipo" ("The Female Sexual Organs: Shape, Function, Symbol and Archetype"), published by Imago Editora, Rio de Janeiro, 1990, 1993.

Web site (Portuguese-English): www.nelsonginecologia.med.br <http://www.nelsonginecologia.med.br>

Email: nelsons@nelsonginecologia.med.br

NEWS | homepage | LIST OF ALL TOPICS | MUM address & What does MUM mean? | e-mail the museum | privacy on this site | who runs this museum?? |
Amazing women! | the art of menstruation | artists (non-menstrual) | asbestos | belts | bidets | founder bio | Bly, Nellie | MUM board | books: menstruation and menopause (and reviews) | cats | company booklets directory | contraception and religion | costumes | menstrual cups | cup usage | dispensers | douches, pain, sprays | essay directory | extraction | famous women in menstrual hygiene ads | FAQ | founder/director biography | gynecological topics by Dr. Soucasaux | humor | huts | links | masturbation | media coverage of MUM | miscellaneous | museum future | Norwegian menstruation exhibit | odor (olor)| pad directory | patent medicine | poetry directory | products, current | religion | your remedies for menstrual discomfort | menstrual products safety | science | shame | slapping, menstrual | sponges | synchrony | tampon directory | early tampons | teen ads directory | tour of the former museum (video) | underpants directory | videos, films directory | Words and expressions about menstruation | Would you stop menstruating if you could? | What did women do about menstruation in the past? | washable pads
More articles by Dr. Soucasaux: Anatomical drawings - Anovulatory cycles - Archetypal aspects of the female genitals - The breasts: some morphological aspects - Colposcopy - Comments on the corpus luteum and related aspects - Comments on some anatomical and symbolic aspects of the female pelvis - The curious relations between androgens and estrogens in women - Drospirenone Oral Contraceptives - Due to prohibition, Brazilian women don't have access to modern medicinal abortion - Endocrinology of menstruation - The Fallopian tubes - Female sexual response - The Gräfenberg Spot (G-Spot) - The Gynecologic Palpation (descendant of "The Touch") - Gynecological assistance: the three basic areas - Gynecology and Gynecologic Surgery - Gynecologist versus obstetrician: what lies behind the combination? - "Gyneco-obstetric-surgical" stubborness and the perpetuation of one of the greatest mistakes of women's medicine - Hypermenorrhea and/or Menorrhagia (Prolonged and/or Excessive Menstrual Bleedings) - Hypertrichosis, Hirsutism and Androgenic Manifestations in Women - Mayer-Rokitansky-Kuster-Hauser (MRKHauser) Syndrome - Menstrual toxin: An old name for a real thing? - Nature and the ovaries - On the Intimate, or Small-Scale, Mechanisms of Menstruation - On the Strange Nature of the Ovaries - Oral hormonal contraceptives (the "Pill") - The Ovaries: Some Functional and Archetypal Considerations - Peculiarities of the Female Genitals' Sensory Innervation - Physiology of menstruation - Polycystic ovaries syndrome - The Possibility of Becoming Pregnant, Its Implications for Women, and Abortion - Premenstrual congestion of the breasts - Premenstrual syndrome (PMS) - The Psychology of Gynecology part 1 (part 2) - Psychosomatic and symbolic aspects of menstruation - Psychosomatic gynecology - Some Details on the Function of the Hypothalamus-Pituitary-Ovaries Axis - Stanislav Grof's Perinatal Matrixes of the Unconscious and Women's Medicine - Symmetric Patterns in the Female Genitals - Thoughts on Female Sexual Psychology - Uninterrupted use of hormonal contraceptives for menstrual suppression: why I do not recommend it - The uterine cervix - Uterine contractility - The Uterus and the Female "Passive-Active" - Women's corporeal consciousness and experience - Women's Experience of the Breasts - Women's Undesired Pregnancies and Women's Right to Abortion and see his Art of Menstruation