What is colposcopy?

Colposcopy is a detailed visual examination of the cervix, vagina, and vulva, performed using an optical device called a colposcope.
The device magnifies the image of the cervix several times, allowing the doctor to observe areas with possible cellular changes.
For clearer visualization, the doctor applies special solutions, such as acetic acid (weak vinegar solution) or Lugol’s solution.

Who does it and where is it performed?

Colposcopy is performed by an obstetrician-gynecologist trained in colposcopy, in public institutions designated by the Ministry of Health – territorial reference centers, municipal and district institutions, as well as at the Oncology Institute.

The woman is scheduled for colposcopy by the family doctor and the screening nurse, within 14 days of receiving the abnormal Pap test result.

The service is free for all eligible women, regardless of health insurance status.

See the contact page of the centers and specialists

How the examination is conducted

The examination takes place in a doctor’s office, in an environment similar to that of a Pap smear, and usually takes between 15 and 30 minutes, depending on the complexity. The doctor inserts a speculum to view the cervix and examines the area using a colposcope. If changes are observed, the doctor may take a small tissue sample (biopsy) for analysis in a laboratory.

Colposcopy does not require anesthesia and usually does not cause pain.

Before performing the colposcopy or biopsy, the doctor provides explanations and obtains the woman’s informed consent.

How to prepare for colposcopy

For the results to be accurate, it is important to:

• avoid sexual contact 48 hours before the examination;
• do not use tampons, douches, creams or vaginal washes in the previous 48 hours;
• do not go for colposcopy during menstruation;
• if you are pregnant, notify the doctor – the examination is safe, but without a biopsy;
• regular hygiene is sufficient.

What is biopsy?

If during colposcopy the doctor notices a changed area, he or she may take a small tissue sample called a biopsy.

The sample is examined in the laboratory by a cytopathologist, who analyzes the cells to confirm whether there are any lesions.

The biopsy may cause mild discomfort or minor bleeding, which will subside shortly. The biopsy result is sent to your family doctor in approximately 4–6 weeks.

What are precancerous lesions and how are they treated?

Precancerous lesions are changes in the cells of the cervix that can slowly develop into cancer if left untreated.

If detected early, these lesions can be completely treated.
Treatment is determined based on the results of the colposcopy and biopsy and may include:

• monitoring and repeating the test every 6–12 months, if the changes are minor;
• excisional treatment – ​​removal of the affected portion of the cervix, performed by a gynecologist in public institutions;
• referral to the Oncology Institute, if a malignant lesion is confirmed.

All procedures are free for women included in the screening program.

After colposcopy

• you can return to daily activities immediately;
• if a biopsy was done, slight spotting or discharge may occur for 1–2 days;
• avoid sexual contact and the use of tampons for 48 hours after the procedure;
• Your family doctor will let you know when the results are ready and what to do next.

Colposcopy and biopsy are verification steps, not treatments.
They help the doctor confirm whether the observed changes need to be treated or just monitored.

Most women who undergo colposcopy do not have cancer, and the lesions detected can be completely treated.

Explanatory note: colposcopy should not be confused with colonoscopy, which is an investigation of the large intestine.

Treatment and monitoring after colposcopy

If changes in the cells of the cervix are confirmed following a colposcopy or biopsy, the specialist will determine the appropriate treatment. Most of these lesions can be completely treated, and the woman will be monitored periodically to prevent the problems from recurring.

Once the colposcopy or biopsy results are ready, the colposcopist sends the findings to the family doctor. The family doctor, together with the screening nurse, informs the woman about the result and guides her on the next steps.

Depending on the result, there may be three situations:

• no lesions were confirmed – the woman returns for routine testing every three years;
• mild lesions – monitoring and repeating the Papanicolaou test after 6–12 months is recommended;
• precancerous or high-grade lesions – specialized treatment in a referral center is recommended.

How are injuries treated?

The goal of treatment is to remove or destroy abnormal cells on the cervix to prevent cancer from developing.
Treatment is indicated by the gynecologist, depending on the type and severity of the lesion:

• removal of a small portion of the cervix, called excisional treatment (for example, conization);
• destruction of the lesion by local methods, called ablative treatments (e.g., cryotherapy or laser);
• medical follow-up, if the changes are minor and can return to normal without intervention.

Treatment is performed in territorial reference centers or at the Oncology Institute, by specialized gynecologists.
Before the intervention, the woman is informed and signs the consent for the treatment. The woman has the right to accept or refuse the intervention, after full information.

The services are free and financed from the state budget, within the National Cancer Control Program.

After treatment

Slight leakage or bleeding may occur for a few days after the procedure.

It is recommended to avoid sexual contact, hot baths, and the use of internal tampons for two to three weeks.
If bleeding persists or a fever occurs, the woman should see a doctor.

The result of the histological analysis is sent to the family doctor, usually within 4–6 weeks, depending on the laboratory.

Post-treatment monitoring

The family doctor, together with the nurse responsible for screening, ensures that the woman undergoes check-ups at the intervals recommended by the specialist.

The first check-up usually takes place six months after treatment.
If the results remain normal, the woman can return to routine testing every three years.

The results are recorded in the National Cervical Screening Registry, where the IT system is active.

Lesions discovered on time are treated effectively.
Regular check-ups after treatment help women maintain their health and prevent the recurrence of changes.

Cervical cancer

Cervical cancer occurs when some cells on the cervix gradually change and begin to multiply uncontrollably. It is a serious disease, but it is important to know that in most cases it can be prevented.

By getting vaccinated against HPV, getting regular cervical screening tests, and treating precancerous lesions on time, the risk of developing cervical cancer is significantly reduced.

Why does it appear?

The most common cause is persistent infection with the Human Papillomavirus (HPV). The virus is transmitted through intimate skin-to-skin contact, including sexual contact.
In most cases, the body clears the virus on its own. However, sometimes the infection persists and can cause changes in the cells of the cervix. If these changes are not detected and treated in time, they can develop into cancer.

Factors that may increase the risk

• persistent HPV infection;

• smoking;

• lack of HPV vaccination;

• low immunity, for example in case of HIV infection;

• early onset of sexual life;

• multiple sexual partners;

• multiple births;

• long-term use of oral contraceptives;

• lack of regular screening testing.

How it develops

Cervical cancer does not appear suddenly. It usually develops slowly:

• Normal cells of the cervix can become abnormal cells, called precancerous lesions;

• These lesions, known as cervical intraepithelial neoplasia (CIN 1–3), can be low-grade or high-grade;

• Untreated, some of them can progress to invasive cancer.

Cervical screening aims to identify these changes early, before they become a serious problem.

Possible symptoms

In the early stages, cervical cancer usually does not cause symptoms.
As the disease progresses, the following may occur:

• bleeding between periods, after sexual intercourse or after menopause;

• vaginal discharge with an unpleasant odor or changed color;

• pelvic or lumbar pain;

• discomfort during sexual intercourse.

The appearance of these symptoms does not automatically mean cancer, but it is important to see a doctor for a checkup.

How to treat

Treatment is determined individually, depending on the stage of the disease, the woman’s age, and the desire to have children.
It may include:

• surgical interventions, such as conization, removal of affected tissue, or, in advanced cases, hysterectomy;

• radiotherapy;

• chemotherapy;

• combinations of these methods.

The decision regarding treatment is made by the oncologist, after confirming the diagnosis through biopsy.
In the Republic of Moldova, diagnosed women benefit from free treatment within the programs coordinated by the Ministry of Health and the Oncology Institute.

How can it be prevented?

Cervical cancer is one of the most preventable forms of cancer. Prevention includes:

• regular Pap smear testing;

• HPV vaccination, free for girls aged 9 to 14;

• timely treatment of precancerous lesions;

• avoiding smoking and maintaining a healthy lifestyle.

In most cases, cervical cancer is preventable. Participation in screening and HPV vaccination are the main methods of protection.
Women who regularly get Pap tests and follow their doctor’s recommendations have a very good chance of maintaining their health.