Colposcopy of cevicovaginitis

1. Benha University Hospital, Egypt
Elnashar53@hotmail.com
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2. 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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3. 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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4. 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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5. 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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6. 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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8. 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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9. 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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10. B. Secondary inflammation (20%)
1. Infected TTZ
2. Infected ectopy
3. Infected ATZ
4. Infected polyp
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11. Colposcopy of bacterial vaginosis
Punctate vaginitis with small regular points
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12. 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
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13. Colposcopy of HPV
1. Florid
2. Spiked
3. Flat: Subclinical HPV
4. Condylomatous cervicitisa
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14. 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
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15. Colposcopy of TV
1. Red punctate vaginitis
2. Tiny non-staining areas
3. Focal vaginitis
4. Speckeled appearance
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17. 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
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18. 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.
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19. 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.
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20. 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.
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