Cervical Pathology and Colposcopy
Cervical lesions can be categorized as those caused by an HPV infection and those unrelated to an HPV infection.
We can tell them apart by performing an HPV test with a special smear. We can perform this smear at Ginekologija Meglič.
The common pathologies not caused by an HPV infection are bleeding after sexual intercourse, intense discharge, and changes in Pap smear. In all these cases, colposcopy must be performed.
The most common pathologies caused by HPV infection are pathological Pap smear, some precancerous lesions, and cancer.
With a Pap smear, we cytologically assess the cells of the cervix. With this knowledge, we can make a better decision about the following diagnostic steps, whether it be colposcopy, biopsy, HPV testing, etc. The Pap smear was introduced in 1941 by Georgios Papanikolaou, a gynecologist working in New York.
Dr. Hans Hinselman, the head of the Gynecology clinic in Hamburg, invented the colposcope in 1925. It is an instrument with a light source with which we can look at the tissue of the cervix, vagina, and vulva with some 10fold magnification. With some modifications and additions, colposcopy is still used today.
Colposcopy is not painful, and with it, we can determine the nature of lesions during the examination. If we determine the seen lesion needs further pathohistological assessment (to determine if it’s a precancerous or even a cancerous lesion), we take small tissue samples for biopsy, which most patients experience as touch and not pain.
Colposcopy can be safely performed on pregnant women; however, this examination is reserved for the most experienced colposcopists as it is a demanding procedure.
HPV RELATED LESIONS
Human papillomavirus (HPV) is a family of viruses that can infect the skin and mucosa that constitutes a border with the outside world: mouth, pharynx, cervix, anus. There are more than 200 different genotypes of HPV. Some types are transmitted through sexual contact.
According to the type of problems a particular type causes, they are divided into high-risk and low-risk HPV strains.
HPV infection is transmitted through contact with infected skin. The virus is located on the genitalia or its surroundings. More than 8 out of 10 people will be infected in their lifetime. Most of the infections do not cause problems and symptoms because the immune system fights off the infection. One person can be infected with multiple strains of HPV. Inflammation occurs more often in people with immune deficiencies. The course of the infection is worse for smokers.
Vaccination can prevent HPV infection if one gets vaccinated before becoming sexually active. It is proven that vaccination prevents recurrent disease in people who have already been infected. You can get vaccinated at Ginekologija Meglič.
People infected with HPV are mostly unaware of it. For 90% of women, the infection heals spontaneously in 8 to 12 months. A small portion (10%) develop a persistent HPV infection. For these women, the risk of developing higher grade precancerous lesions and cervical cancer is higher.
Dysplasia with lower risk caused by HPV is called LSIL (Low-grade squamous intraepithelial lesion); those with higher risk are called HSIL (High-grade squamous intraepithelial lesion). LSIL is common with adolescents. In 98%, HPV infection clears spontaneously in 2 to 3 years. Up to 10% of these in 16 months progress to HSIL.
HSIL regresses slowly in 32%, in 46%, it stagnates, and in 22%, HSIL progresses to cervical cancer.
With excellent cytology (Pap smear), HPV testing, colposcopy, and biopsy, we are managing the cervix changes very well in Slovenia. We are one of the top 5 countries in the world regarding managing cervical cancer. With vaccination against HPV, we are bound to get even
Yearly there are 500 LSIL and 1800 HSIL patients in Slovenia.
A special part of colposcopy is cervicoscopy, in which, due to a pathological PAP smear, we look at the cervical canal and take samples for pathohistological examination. An ambulatory hysteroscope is used for the examination. It is mainly used when no changes are found during colposcopy that would explain a pathological PAP smear, especially when glandular cells are identified as pathological.
Cervical canal of a woman of reproductive age
Cervical canal of a postmenopausal woman