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PATIENT STORY

A 21-year-old woman presents for her well-woman examination. She has been followed by her provider for many years and has no complaints. She has been sexually active for a little more than 2 years with one mutually monogamous partner. She does not smoke, has never had a sexually transmitted disease (STD), and uses oral contraceptive pills for contraception. On speculum examination, her cervix appears normal (Figure 90-1) and a Papanicolaou (Pap) test is performed.

FIGURE 90-1

Normal cervix as seen through a colposcope without the application of vinegar. The red color around the os is produced by columnar cells and the lighter pink on the remainder of the cervix result from normal squamous cells. The presence of visible columnar cells outside the internal os is called ectropion and is a normal finding in young women and women on estrogen-containing contraception. The junction between the two cell types and colors is the squamo-columnar junction. (Reproduced with permission from E.J. Mayeaux, Jr., MD.)

INTRODUCTION

The colposcope is an optical instrument using light and magnification that helps distinguish dysplasia and cancer from benign cervical and vaginal findings (Figure 90-2). Colposcopy (colpo: vagina; scope: to look) literally means to look into the vagina. Primary indications for colposcopy include certain abnormal Pap test results or an abnormal appearing cervix. Colposcopically directed biopsies have a higher yield than biopsies done without the benefit of a colposcope, thereby decreasing the risk of false-negative biopsies.

FIGURE 90-2

The family physician is looking at the cervix directly through the colposcope lenses, and the image is also visible on the monitor for learners and/or the patient to see. (Reproduced with permission from E.J. Mayeaux, Jr., MD.)

SYNONYMS

  • Nabothian cysts are also called mucinous retention cysts or epithelial cysts.

  • An ectropion is also known as a persistent juvenile transformation zone or cervical erosion.

EPIDEMIOLOGY

  • Colposcopy is the diagnostic test to evaluate patients with an abnormal cervical screening test (cytology and/or human papillomavirus high-risk HPV [HR-HPV] testing) or abnormal-appearing cervix. The Papanicolaou test (Pap smear, Pap test) is a commonly employed screening test for dysplasia and cancer of the vagina and uterine cervix. More than 50 million Pap tests are performed each year in the United States.1 The Pap test is a cytologic examination of cells taken from the cervical transformation zone (Figures 90-3 and 90-4) with or without a HR-HPV test.

  • Nabothian cysts are common and benign and are considered a normal feature of the adult cervix. They may occur singly, or multiple cysts may be found simultaneously (Figures 90-4 and 90-5).2

  • Infections of the lower ...

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