CHAPTER 4: SCREENING FOR CERVICAL CANCER

PS 11: Colposcopy, Punch Biopsy and Endocervical Curettage 14911. Take cervical biopsies of the most abnormal areas, and place tissues in separatelabelled bottles containing formalin.12. If necessary, perform an endocervical curettage. Hold the curette like a pen andscrape the endocervical canal in short firm strokes until it is completely sampled.Keep the curette inside the canal during the entire procedure. At the end, removethe curette, place the curettings on gauze or brown paper, and immediately immersein 10% formalin.13. If active bleeding is noted, apply Monsel’s paste to the bleedingareas.14. Withdraw the colposcope and gently remove the speculum.After the procedure15. Explain what you saw and, if you took biopsies and endocervical curettings, whatthese may reveal.16. Advise the woman how to take care of herself when she goes home:a. She should abstain from sexual intercourse until she has no moredischarge or bleeding. If this is not possible, she should use condoms.b. She should not insert anything in the vagina for 3 or 4 days.c. Tell her the signs and symptoms of complications: activebleeding, serious cramping or lower abdominal pain, pus-likedischarge, fever. If she experiences any of these, she needs toreturn to the centre or go to hospital.17. Provide condoms and teach her how to use them.18. Give a specific date for the return visit. Laboratory reports should be available within2–3 weeks, so a follow-up visit should be planned 2–3 weeks after the colposcopy.19. Explain when the results will be available, and the importance of returning to theclinic for them.20. Document the findings. Use appropriate forms to record the colposcopic assessment.21. Send labelled biopsies and curetted tissue to the laboratory.Annex 9Monsel’s paste22. If you noted something you cannot handle, refer the woman immediately to a higherlevel for further examinations or tests.PS5Condom usePS 11Practice Sheet 11: Colposcopy, Punch Biopsy and Endocervical Curettage