Colposcopy

A colposcope is a free-standing, binocular microscope on wheels that is most commonly used for direct visualization of the cervix (using a bivalve speculum) after the detection of abnormal cervical cytology. Many centers, particularly those in the United States, advocate the use of the colposcope for external and, where relevant, internal genital and/or anal assessments of complainants of sexual assault.

The colposcope undoubtedly provides considerable advantages over gross visualization. First, it provides magnification (5-30 times) and greater illumination, enabling detection of more abnormalities. Slaughter and Brown (123) demonstrated positive colposcopic findings in 87% of female complainants of nonconsensual penile penetration within the previous 48 h, whereas gross visualization has historically identified positive genital findings in only 1040% of cases (37-39,124,125).

Second, with the attachment of a still or video camera, the colposcope allows for a truly contemporaneous, permanent video/photographic record of the genital/anal findings without resorting to simultaneous dictation, which has the potential to distress the complainant. If a video is used, it will document the entire genital examination and will show any dynamic changes, such as reflex anal dilatation. If appropriate, the medical findings can be demonstrated to the complainant and carer; some teenagers have apparently appreciated the opportunity to have any fears of genital disfigurement allayed by the use of this equipment.

Finally, if a remote monitor is used, the whole examination can be viewed by another doctor for corroboration or teaching purposes without additional parties having to be present during the intimate examination. This facility is obviously more pertinent when video recording is not available.

Obviously, it is important that in all cases the colposcopic evidence be interpreted in the context of the limited information that is currently available regarding colposcopic assessments after consensual sexual acts (90,126,127).

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