If your doctor finds an abnormal result after a routine Pap smear or pelvic exam, they may recommend a cervical biopsy. Undergoing a cervical biopsy involves removing a small piece of tissue that can help rule out or confirm cancer.

Having this procedure doesn’t automatically mean you have cervical cancer.

Read more about what a cervical biopsy entails, and everything you need to know about the possible risks, recovery, and more.

A cervical biopsy is a surgical procedure in which a small amount of tissue is removed from the cervix. The cervix is the lower, narrow end of the uterus located at the end of the vagina.

A cervical biopsy is usually done after an abnormality has been found during a routine pelvic exam or Pap smear. Abnormalities can include the presence of the human papillomavirus (HPV), or cells that are precancerous. Certain types of HPV can put you at risk for developing cervical cancer, and is the most common cause of this type of cancer worldwide.

A cervical biopsy can find precancerous cells and cervical cancer. Your doctor or gynecologist may also perform a cervical biopsy to diagnose or treat certain conditions, including genital warts or polyps (noncancerous growths) on the cervix.

Three different methods are used to remove tissue from your cervix:

  • Colposcopic (punch) biopsy. In this method, small pieces of tissue are taken from the cervix with an instrument called “biopsy forceps.” Your cervix might be stained with a dye to make it easier for your doctor to see any abnormalities.
  • Cone biopsy. This surgery uses a scalpel or laser to remove large, cone-shaped pieces of tissue from the cervix. You’ll be given a general anesthetic that will put you to sleep.
  • Endocervical curettage (ECC). During this procedure, cells are removed from the endocervical canal (the area between the uterus and vagina). This is done with a hand-held instrument called a “curette.” It has a tip shaped like a small scoop or hook.

The type of procedure used will depend on the reason for your biopsy and your medical history.

Your doctor may recommend a cervical biopsy if your initial cervical cancer screening results are abnormal and if you’re experiencing unusual symptoms, such as painful intercourse or unusual vaginal bleeding between menstrual periods. A biopsy may also help remove genital warts or cervical polyps.

Additionally, your doctor will ask you about your personal and family medical history to see if you’re at a higher risk of developing cervical cancer. They may also feel your lymph nodes to see if there’s any unusual swelling.

Schedule your cervical biopsy for the week after your period. This will make it easier for your doctor to get a clean sample. You should also make sure to talk with your doctor about any medication you take.

You may be asked to stop taking medications that could increase your risk of bleeding, such as:

  • aspirin
  • ibuprofen
  • naproxen
  • warfarin

Avoid using tampons, douches, or medicated vaginal creams for at least 24 hours before your biopsy. You should also avoid having sexual intercourse during this time.

If you’re undergoing a cone biopsy or another type of cervical biopsy that requires a general anesthetic, you’ll need to stop eating at least 8 hours before the procedure.

On the day of your appointment, your doctor may suggest you take acetaminophen (such as Tylenol) or another pain reliever about 30 minutes before you come to their office. You may experience some light bleeding after the procedure, so you should pack some sanitary pads.

It’s also a good idea to bring a family member or friend along so they can drive you home, especially if you’re given general anesthesia. General anesthesia may make you drowsy after the procedure, so you shouldn’t drive until the effects have worn off.

The appointment will begin as a normal pelvic exam. You’ll lie down on an exam table with your feet in stirrups. Then your doctor will give you a local anesthetic to numb the area. If you’re undergoing a cone biopsy, you’ll be given a general anesthetic that will put you to sleep.

Your doctor will then insert a speculum (a medical instrument) into the vagina to keep the canal open during the procedure. The cervix is first washed with a solution of vinegar and water. This cleansing process may burn a bit, but it shouldn’t be painful.

The cervix may also be swabbed with iodine. This is called Schiller’s test, and it’s used to help your doctor identify any abnormal tissues.

The doctor will remove the abnormal tissues with forceps, a scalpel, or a curette. You may feel a slight pinching sensation if the tissue is removed using forceps.

After the biopsy is finished, your doctor may pack your cervix with absorbent material to reduce the amount of bleeding you experience. Not every biopsy requires this.

Punch biopsies are outpatient procedures, which means you can go home right after the surgery. Other procedures may require you to remain in the hospital overnight.

Expect some mild cramping and spotting as you recover from your cervical biopsy. You may experience cramping and bleeding for as long as a week. The bleeding may also transition to clear discharge for up to 3 weeks. Overall, complete recovery from a cone biopsy is the longest, and may take 4 to 6 weeks.

Depending on the type of biopsy you’ve undergone, certain activities may be restricted. For example, heavy lifting of objects weighing more than 10 pounds, sexual intercourse, and the use of tampons and douches are not allowed for several weeks after a cone biopsy. Running and other high-intensity activities are also discouraged during recovery.

You may have to follow the same restrictions after a punch biopsy and ECC procedure, but for only 1 week.

Let your doctor know if you:

These symptoms can be signs of an infection.

The need for a cervical biopsy outweighs any potential risks. However, you should discuss the potential complications with your doctor, such as:

  • light bleeding, which can occur from any one of the three biopsy methods
  • cramps (punch biopsy, ECC)
  • pain (punch biopsy, ECC)
  • infections (cone biopsy)
  • narrowing of the cervix (cone biopsy)
  • premature birth or miscarriage due to cervical scarring (cone biopsy)

Also, a cone biopsy may cause temporary menstrual changes, where your next period may be heavier than usual. It may also occur later than your normal cycle.

Your doctor will contact you about your biopsy results and discuss next steps with you. A negative test means that everything is normal, and further action is usually not required until your next Pap smear.

Pap testing is usually recommended every 3 years for ages 21 to 65. Your doctor may also recommend HPV testing every 5 years. However, if you recently had a cervical biopsy, you may need repeated Pap and HPV testing sooner.

A positive test, on the other hand, means that cancer or precancerous cells have been found and further diagnosis and treatment may be needed. Imaging tests, such as CT and MRI scans may help your doctor see if cervical cancer has spread.

Your doctor may want to see you 4 weeks after your cervical biopsy to rule out any complications and to make sure you’ve recovered properly.

A cervical biopsy is an important follow-up procedure to an abnormal Pap test or pelvic exam. This outpatient procedure may also be used to help remove genital warts or cervical polyps.

Your doctor or gynecologist will provide specific instructions to prepare for one of the three biopsy options.

Full recovery may take several weeks. If cancerous cells are confirmed, they will review next steps with you right away.