**7. Visual inspection using acetic acid**

In areas with limited resources a resort to inspection of the cervix have assisted in the screening process without application of acetic acid (unaided). When the cervix is painted with 3-5% Acetic acid it causes reversible coagulation of nuclei proteins and prevention of the penetration of light hence abnormal tissues appearing as "aceto-white areas". This has been used with good outcome in areas like India and other less developed countries where there are absence of technical manpower such as pathologist to analyze cytology specimens. This method is simple easy to perform, cheap and acceptable by most patients and can be done by nurses, paramedics amongst others and removes the need for histological confirmation. The method enables a one stop treatment of suspected cases of premalignant lesions however there is the danger of overtreatment of postmenopausal patients when this method is applied because of non visualization of the transformation zone. This screening method has similar sensitivity to PAP but lower specificity of 64-79%. Visualization of the cervix can be aided by the use of a X4 magnification glass (Aviscope) and is said to have better sensitivity compared to VIA

#### **7.1. Colposcopy**

Following the invention of an optical device by Dr Hans Hinselmenn in 1925, the visualization of the cervix using the colposcope is now an integral part of gynaecological oncology prac‐ tice.The method involves direct visualization of the cervix using a colposcopy, which a magnification of the epithelium of the cervix with the aim of identifying abnormal patterns after staining with 3-5% acetic acid under 4-40x magnification. The aim of colposcopy is to examine the transformation zone, which is the origin of cervical cancer. It should not be used as a primary screening tool but used when there is an abnormality in the smear or bleeding.
