What is a colposcopy?

A colposcopy (kol-POS-kuh-pee) is a method of examining the cervix, vagina, and vulva with a surgical instrument called a colposcope.

The procedure is usually performed if the results of a Pap smear (the screening test used to identify abnormal cervical cells) are unusual. A colposcope is a large, electric microscope with a bright light that enables your doctor to see your cervix more clearly and under magnification.

If your doctor spots any abnormal areas, they will take a tissue sample (biopsy). The procedure to retrieve a tissue sample from inside the opening of the cervix is called endocervical curettage (ECC). The samples are sent to a lab for examination by a pathologist.

You may feel nervous if your doctor orders a colposcopy, but understanding the test and knowing what to expect can ease your anxiety. The test is generally quick and minimally uncomfortable.

Your doctor may suggest a colposcopy if:

  • your Pap smear results are abnormal
  • you experience bleeding after intercourse
  • you have an abnormal growth visible on your cervix, vulva, or vagina

A colposcopy can be used to diagnose:

  • abnormal cervical cells, or precancer or cancer of the cervix, vagina, or vulva
  • genital warts
  • inflammation of the cervix (cervicitis)

There is little to do to prepare for this test. However, here are a few things you should keep in mind:

  • Ask your doctor to explain the test in detail.
  • Tell your doctor if you think you may be pregnant.
  • Schedule the test for a time when you aren’t menstruating heavily. Light bleeding at the beginning or end of your period is usually fine, but check with your doctor.
  • Don’t douche, use tampons, or have sexual intercourse for 24 to 48 hours prior to the exam.
  • Some doctors recommend a mild over-the-counter pain reliever before the test in case they will take biopsies. Discuss this with your doctor prior to the test day.
  • For comfort, empty your bladder and bowels before the test.

A colposcopy is usually performed in a doctor’s office and takes 10 to 20 minutes. It requires no anesthetic. Here’s what you can expect:

  1. You lie on your back on a table with your feet in stirrups, just like during a pelvic exam or Pap smear.
  2. Your doctor positions the colposcope a few inches away from your vulva and places a speculum into your vagina. The speculum holds the walls of your vagina open so that your doctor can see your cervix.
  3. Your cervix and vagina are swabbed with cotton and a solution of vinegar to clear away mucus and highlight abnormal cells.
  4. The colposcope doesn’t touch you. Your doctor may take photographs and biopsy any areas that appear suspicious.
  5. After biopsy, a solution is often applied that helps control bleeding. This is called Monsel’s solution and often causes a dark discharge that looks like coffee grounds after the procedure and for several days.

Some women find the insertion of the speculum uncomfortable. Others report a stinging sensation from the vinegar solution. If you feel anxious during the test, concentrate on taking slow, deep breaths to relax your body.

Biopsy accompanying a colposcopy

If you’re having a biopsy, how the procedure feels will depend on the location being tested.

Cervical biopsy

Having a colposcopy is generally painless, but having a cervical biopsy may cause cramping, discomfort, bleeding, and pain in some women.

Your doctor may suggest you take a pain reliever 30 minutes before the procedure. Also, the doctor may numb the cervix before the biopsy. Speak to your doctor about the best plan of action.

Vaginal biopsy

Most of the vagina has very little sensation, so you won’t feel pain during a biopsy. The lower part of the vagina has more sensation, and your doctor may use a local anesthetic in that area before proceeding.

The risks following a colposcopy and biopsy are minimal, but rare complications include:

  • bleeding that is very heavy or lasts longer than two weeks
  • fever or chills
  • infection, such as heavy, yellow-colored, or bad-smelling discharge from your vagina
  • pelvic pain

If you experience any of these symptoms, call your doctor immediately.

A colposcopy and biopsy won’t make it more difficult for you to become pregnant.

Ask your doctor when you can expect the test results and follow-up if you don’t receive the information in a timely manner. The results will help determine if you need additional tests or treatment.

If the results show no abnormalities, your doctor may recommend additional testing to see why your Pap smear was abnormal. Or they may suggest a follow-up exam.

Abnormal biopsy results

A pathologist will examine the tissue samples from the biopsy and look for abnormalities.

Biopsy results may help to diagnose abnormal cervical cells, precancer, cancer, and other treatable conditions. Your doctor will make recommendations based on the results of colposcopy and biopsy. Schedule time with your doctor to have all of your questions answered. Don’t hesitate to seek a second opinion.

After a colposcopy, you may have dark vaginal discharge for up to three days, and some bleeding for up to a week. Your vagina may be sore, and you may experience mild cramping for 1 to 2 days.

If no biopsy was taken, you may resume normal activity right away.

If you had a biopsy, avoid the use of tampons, douches, vaginal creams, and vaginal intercourse for a week. You may shower or bathe right away. Discuss any concerns with your doctor.

Regardless of the results, it’s important to continue regular gynecological exams and Pap smears, as your doctor recommends.