Colposcopy when -A tool which is sparingly used

Pap smear ore of two kinds:-

A)      Traditional pap or B) LBC Such tests are  recommended every 5 yearly. B)  If Pap (any method ) is positive then HPV co-testing done, &  repeat 5 yearly.  All cervices should have a PAP smear after 23 yrs and preferably 5 yearly  as per countries guidelines.. C) Any abnormality in the cytology or smear warrants a colposcopy. D) It is also important to monitor girls who are vaccinated for HPV. D) How long to monitor à Till the age of 65 (previous 3 normal reports, But in the meantime if any Cx  that looks  suspicious(to a trained eye) and particularly bleeds on touch regardless of previous normal smears should undergo Cx biopsy ”  All VIA positive cases we should subject them to colposcopy SOS biopsy

B)         Triaging of suspicious cases and eventually cervical biopsy is sometimes done by  colposcopy:-How to select cases who most suitable colposcopy?- In our country for reasons best known to many of us,  childbirth trauma is very common . As such, large number of middle aged   Indian rural women, report to us with visible cervical lesions for which we insist on Pap smear and appropriate stain. It is a common experience of all of us in most cases the report comes as negative. But in most cases there is associated parametrial thickening on either side. Often, the lower endocervix is visibly exposed & raw.

C)         Facilities of Liquid based Pap & exclusion of HR-HPV (High Risk HPV virus) do not exist in  set up more so in small towns. Can such cases be put for cases for colposcopy as an alternative to  HR-HPV (High Risk HPV virus)  Therefore which are the cases that mandate colposcopy evaluation?