When women have their annual exam, why don't they use a colposcope to look at the cervix while you are already there? It only takes an extra minute to swap the cervix with vinegar (acetic acid) then look for acetowhitening, which would indicate a dysplastic lesion. Instead, they take PAP smear, then you wait for the results; if the smear shows abnomality, you have to go back again for the colposcope and biopsy of acetowhitened area that they could have seen (and biopsied) while you were there the first time.

Could it be they like to be able to charge you (and your insurance company) another $500 for a seperate visit for colposcopy? Anyone have any other ideas as to why this a colposcope is not part of the standard annual exam? If I were a woman, I would demand that this be done.

That's a good point, but the puporse of PAP can not be fully substitued by the colpo. Pap smears goal is to diagnose any general, sexually related abnormalities, including cervix changes.

A colpo can see those changes in the cervix right away but can not identify other problems, i.e. yeast, BV, and other STD/infections/potential problems that show up on the PAP.

A colpo is not necessary unless there is a problem. Usually, these problems are seen if there is a high risk factor, i.e. HPV presence or age related problems. Like the breast exam, is required for women after their 40-s but it is performed rarely on the 20-s.

Also, I think that the PAP procedure is much quicker (wet pap) than the Colpo, so it might have to with resources (both instruments and humans i.e. you need a doctor for the colpo whereas the Pap can be performed by a nurse easily). No big news on the insurance explotation of this problem. Itis the whole medical system here that sucks when it comes to providing reasonably priced health care.

Could not agree with you more piper, though furtiva makes a good point.

Why not do both? Based on my experience, I do not have much faith in the pap smear. Its a fact I have gotten false negatives in the past. True they say eventually it will catch any abnormal cells, if a women goes in regularly. Personally I simply do not understand why they wouldn't just do the colpo for at least the first couple years in oppose to the pap for women with a proven history of CIN regardless of the HPV test results. I also know from my experience that HPV tests can provide false negative results too. If I could I would have a colpo done everytime from now on, if nothing else, for peace of mind.

Again, could not agree with you more piper.

I'm not suggesting that a colpo be used as a substitute for the PAP, but I am suggesting that the it only takes a minute, literally, to use a colposcope to look for acetowhite lesions on the cervix while you are already there. If lesions are present, they could be biopsied at that time. This would eliminate so much wasted time and worry. You point is well taken regarding the range of screens that are provided by the PAP that may not show as an acetowhite lesion under colposcopic examination. I respectfully disagree with the assertion that a doctor is required for colposcopy. Nurses paractitioners and Nurse Colposcopists may do colposcopic examinations.

I agree with you totally and I said the same thing to my husband-I am not 100% sure why they don't do that but perhaps it has something to do with $$$$-I don't know-but I have lost some faith in paps though I will continue to go.

It would really be much better regarding the time and worry all this stuff takes.

hey piperpilot,

I've been reading your posts, and I'm very impressed with how much knowledge you have about this subject. Your girlfriend is very fortunate to have such a supportive and informed partner.

Regarding colposcopy, there is specific training that goes along with colposcopy (see American Society of Colposcopists or something to that effect). Essentially there is the answer to your question. A general practitioner can quite easily perform a pap smear, but is not trained in colposcopy. Further, even ob/gyn's are not all trained in colposcopy (at least not in Canada, I'm sure it is that way in the US as well). Of course, you would want someone who is trained in colposcopy to be performing the procedure - you want to be sure the doctor is trained in knowing what types of changes to look for during the colposcopy, AND the best place to take the biopsy specimen from. There are standards for colposcopy in place, and I know that in my province, doctors who perform colposcopies are tested regularly (and their practice results evaluated regularly).

I know it would be helpful to have a colpo at every smear appointment, but it is simply not practical. Can you imagine how many gp's and ob/gyn's would then have to go and upgrade their education? And, for the large part, most women are going to have normal pap smears - yes, there are false negatives - I believe I had false negative tests for several years before I finally had one come back abnormal.

Hope that helps a little.

Karen