VIA (Visual Inspection with Acetic Acid Aplication)

Preparation of Steps

Dwiana Ocviyanti• Department of Obstetrics and Gynecology Faculty of

Medicine University of Indonesia• National Clinical Training Network of Reproductive

Health/NCTN-RH

VIA can be considered for use in low-resource settings because it:

• Can effectively identify most precancerous lesions

• Is noninvasive, easy to perform and inexpensive

• Can be performed by all levels of healthcare workers in almost any setting

• Provides immediate results that can be used to inform decisions and actions regarding treatment

• Requires supplies and equipment that are readily available locally

Who Should Be Tested

• Testing for cervical cancer or its precursors is recommended for any woman between the ages of 30 and 45.

• Cervical cancer rates peak among women between the ages of 40 and 50, so testing should take place during the ages in which detecting a precancerous lesion is most likely, normally 10 to 20 years earlier

When To Perform Via

• VIA can be performed at any time in the menstrual cycle, including during menses, during pregnancy and at a postpartum or postabortion checkup

• It can be performed in a woman suspected or known to have an STI or HIV/AIDS.

REPRODUCTIVE HISTORY

Age Parity o Currently pregnant (weeks) Example of Cervical Map

Current contraceptive Age of first intercourse

Menstrual Bleeding Pattern

o Regular (23–35 day interval)

o Irregular

o Postcoital spotting or bleeding

STI History

Number of sexual partners: o Had an STI

Patient Patient

Spouse Spouse

Risk Factors

o Smoker o Previous abnormal Pap smear

o HIV/AIDS o Mother or sister(s) with cervical cancer

o Chronic corticosteriod use

EXAMINATION

Bimanual examination

Vulva Uterus

Vagina Adnexa

Cervix Rectovaginal examination

(if indicated)Outline of squamocolumnar junction (SCJ)

White epithelium

Actual cervical os

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Cancer

Instruments And Supplies

• Examining table• Light source• Bivalved speculum (Cusco or Graves)• Instrument tray or container

o Cotton swabso New examination gloves or high-level disinfected surgical

gloveso New wooden spatula and/or condomo Dilute (3–5%) acetic acid solution (white vinegar is

acceptable) o 0.5% chlorine solution for decontaminating instruments

and gloveso A record form for recording the findings

Client Assessment and Getting Ready

• Before performing the VIA test, discuss the procedure with the woman

• Explain why the test is recommended and exactly what will take place during the examinatio

• Discuss with her the nature of the most likely findings and the followup or treatment that might be required.

• Make sure that all necessary instruments and supplies are available

• Bring the woman into the examination area

The VIA Test

• Inspect the external genitalia • Insert the speculum fully so that the entire cervix

can be seen• Look at the cervix and check for evidence of

cancer or infection (cervicitis)• Soak a clean swab in dilute acetic acid solution

and apply it to the cervix• Once the cervix has been washed with the acetic

acid solution, wait at least 1 minute for it to be absorbed and any acetowhite reaction to appear

• Inspect the SCJ carefully

Normal Cervix and Cervical Cancer

Normal Cervix Cervical Cancer

VIA CLASSIFICATION CLINICAL FINDINGS

Test-positive Raised and thickened white plaques oracetowhite epithelium, usually near the SCJ

Test-negative Smooth, pink, uniform and featureless;ectropion, polyp, cervicitis, inflammation,Nabothian cysts

Cancer Cauliflower-like growth or ulcer; fungatingmass

Normal Cervix and Cervix with VIA Test positive after Acetic Acid Aplication

Normal Cervix VIA Test Positive

Adapted from: International Agency for Research on Cancer (IARC).

Clinical Significance and Location of Acetowhite Lesions:

Insignificant Lesions

14

Far away from SCJ

Faint acetowhite areas without sharp outline

Streak-like acetowhitening

Line-like acetowhitening at brim of endocervix

Dot-like pale areas in endocervix

Clinical Significance and Location of

Acetowhite Lesions:

Significant Lesions

15

Thick, well-defined acetowhite areas, like leukoplakia, appearing very close to SCJ, jutting into ectocervix or endocervix or both

Discussion after VIA test

• If the VIA test is positive or cancer is suspected, tell the woman what the recommended next steps are

• If the VIA test is negative, tell the women that she can return for VIA the next five years and than every 5 years