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A 21-year-old woman presents for her well-woman examination. She has been followed by her physician 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 88-1) and a Papanicolaou (Pap) test is performed.
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The colposcope is an optical instrument using light and magnification that helps distinguish dysplasia and cervical cancer from benign cervical findings (Figure 88-2). Colposcopy (colpo: vagina; scope: to look) literally means to look into the vagina. Primary indications for colposcopy include certain abnormal Pap 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.
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Nabothian cysts are also called mucinous retention cysts or epithelial cysts.
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An ectropion is also known as a persistent juvenile transformation zone or cervical erosion.
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- The Papanicolaou smear (Pap smear, Pap test) is a commonly employed screening test for dysplasia and cancer of the uterine cervix. More than 50 million Pap smears 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 88-3 and 88-4). Colposcopy is the diagnostic test to evaluate patients with an abnormal cervical cytologic smear or abnormal-appearing cervix.
- 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 (Figure 88-4).2
- Infections of the lower female genital tract are common and can produce a number of cervical epithelial changes (Figure 88-5).
- Cervical epithelial atrophy may occur in hypoestrogenic states and cause the cervix to appear pale and the squamocolumnar junction to retract into the cervical os (...