ANATOMICAL & CLINICAL DEFINITIONS

The Ectocervix Not synonymous with squamous epith The part of cx visible during clin exam

The Endocervix The part of cervical canal not visible without use of some additional technique Not synonymous with columnar epith

SQUAMOCOLUMNAR JUNCTION
Not synonymous with the external os. Point where the strf. Squamous epithelium meet the glandular epithelium of the cx. VARIATIONS OF SITE OF THE SQUAMO-COLUMNAR JUNCTION Variation in relation to age Variation in relation to shape of the ext os.

UTERINE CERVIX-AGE RELATED

UTERINE CERVIX-AGE RELATED

UTERINE CERVIX

CHANGES IN THE CERVIX DUE TO REAGENTS USED DURING COLPOSCOPY

TECHNIQUE OF COLPOSCOPY

TECHNIQUE OF COLPOSCOPY
OPTICAL CHARACTERISTICS. FRONTAL DISTANCE [FOCAL LENGTH] The distance which separates the frontal lens of the apparatus from the surface of cx. 225 to 250 mm is necessary to permit manipulation of instrument. MAGNIFICATION Varies betw x4 to x60 magnification of x10 to x12.5 is sufficient magnification of x15 is necessary for endocervical examination.

DIAMETER OF THE FIELD

Is an important factor. Smaller when the enlargement is greater. For a good view whole cx is necessary. 18 to 20mm in diameter with x10. DEPTH OF THE FIELD is the distance which separates 2 extreme points situated in the optical axis of the apparatus & seen clearly together. Depth is shorter when magnification is greater

LIGHT SOURCE
Should be sufficient ,about 30,000 Lux.
Should be centered permanently. Should not be changed during examination.

THE STAND -COLPOSCOPE

Should permit easy obsn under max cond for gynaecologist. Easy accessibility vertically and laterally. To be inclined along the axis of vagina. Will depend on the space availability in the exam room& habits of each examiner. GOOD STAND IS JUST AS ESSENTIAL AS A GOOD OPTICAL SYSTEM.

COLPOSCOPE-APPLIANCES
Main objective lens Magnification Changer Binocular tubes Eye pieces Filter Light Source Stand

 Betwn 8th &12th day of menstrual cycle. Anytime with postmenopausal women. Defer colpo when there is severe infection/macroscopic obvious growth. Treat with anti infective therapy locally & systemically. Ethinyl Estradiol 10mcg daily for 8-10days for senile vaginitis along with antiinfective therapy.

WHEN SHOULD COLPOSCOPY BE CARRIED OUT?

INDICATIONS FOR COLPOSCOPY

EVALUATION OF ABNORMAL EPITH A. To localise the lesion. B. To select the biopsy site. C. To manage abnormal pap-preg EVALUATION OF NORMAL PAPSMEAR A.Suspicious cx/vagina B.H/o post coital bleeding C.H/o presence of depigmentation of EG D. Presence of leukoplakia

HOW SHOULD COLPOSCOPY BE CARRIED OUT?

Bivalve speculum 28mm/36mm Introduction of cusco speculum Examination of ext genitalia/vagina Examination before acetic acid Apply lukewarm normal saline Apply 3-5% acetic acid to cx By greenfilter examination[SOS] Apply Schillers/Lugols iodine Documentation