Colposcopy

What is colposcopy?

Colposcopy is a procedure to check your cervix, vagina and vulva for abnormal tissue.

Your healthcare provider will use a special tool called a colposcope. It has a bright light and works like a microscope to make the area look bigger. This helps them see the cells in the area more clearly.

If your provider finds anything that doesn’t look normal, they can take a small piece of tissue (called a biopsy). They’ll send the tissue sample to a lab to be checked.

A colposcopy mainly looks for cells that could turn into cancer (called cervical dysplasia). It can also test for genital warts and growths called cervical polyps.

You may need a colposcopy if you:

• Had abnormal Pap smear results
• Had abnormal results during a pelvic exam
• Had a positive HPV test
• Have symptoms like abnormal vaginal bleeding or vulvar itching

How does the procedure work?

A colposcope has a built-in light and binocular-like lenses. It makes it easy for your provider to view your cervix while remaining seated at your feet. The colposcope remains outside your vagina the whole time.

If your healthcare provider sees abnormal cells through the colposcope, they take a biopsy. This is typically a punch biopsy or an endocervical curettage (ECC).

A punch biopsy removes a circular piece of tissue. Your provider uses a specialized tool that has a circular scalpel on the end. They remove the sample in one movement.

With an ECC, your provider scrapes the lining of your cervix with a spoon-shaped tool.

How do I prepare for a colposcopy?

Your healthcare provider will tell you how to prepare for a colposcopy. In general, you should:

• Tell your provider if you’re pregnant: You can have a colposcopy during pregnancy. But you may be at a greater risk of bleeding.
• Schedule your colposcopy when you’re not on your period: Your provider will have an easier time seeing your cervix if you’re not bleeding.
• Not put anything in your vagina for 48 hours before the colposcopy: Avoid intercourse. Don’t use tampons or vaginal medications, like creams or suppositories. All these things can affect the results of the test.
• Discuss pain management for the procedure: Ask your provider how you can manage potential pain. They’ll likely recommend taking a pain reliever on the day of the procedure, like acetaminophen or ibuprofen. But they may offer other forms of pain management.
• Plan to provide a pee sample: If you have a menstrual cycle, your provider will have you take a pregnancy test before the procedure. Come to the appointment with a full bladder.

What happens during this procedure?

During a colposcopy, you can generally expect the following steps:

1. You’ll lie on an examining table with your feet in stirrups.
2. Your provider will insert a speculum with lubrication. It’ll widen your vagina, so your cervix is visible.
3. Your provider may give a local anesthesia injection or apply a lidocaine spray to help manage pain.
4. They’ll look through the colposcope to take a closer look at your cervix, vaginal walls and vulva.
5. They’ll use a cotton swab to apply a vinegar solution (acetic acid) to your cervix. It may cause a slight burning sensation. The solution helps highlight any suspicious areas.
6. If your provider sees any areas of abnormal tissue, they’ll do a biopsy to remove the tissue for testing.
7. If necessary, your provider will apply medication at the biopsy site(s) to stop bleeding.

You can get a colposcopy in a medical office or clinic. It usually lasts 10 to 20 minutes. You should be able to go home the same day.

How painful is a colposcopy procedure?

Everyone experiences pain differently. So, it’s impossible to predict how painful a colposcopy procedure will be for you. Various parts of the procedure may cause pain, including:

• Putting in the speculum or leaving it in for a while: This may feel like uncomfortable pressure.
• Applying the acetic acid solution: This may give a slight burning sensation.
• The biopsy: You may feel a pinching or cramping sensation if you get a biopsy. This is typically the most painful part of a colposcopy.

Before the procedure, talk to your healthcare provider about your pain management options. Taking an over-the-counter (OTC) pain reliever before it can help. Your provider may also offer a local anesthetic injection or a topical lidocaine spray. In rare cases, general anesthesia may be an option.

What are the risks of this procedure?

A colposcopy procedure is generally safe and low risk. But it can sometimes cause significant bleeding or an infection. These complications are treatable.

How long does it take for your cervix to heal after a colposcopy?

It can take a few days for your cervix to heal if you had a biopsy. You might experience:

• Light vaginal bleeding that lasts a few days
• Pain in your vagina that lasts a few days
• Vaginal discharge that may appear black or brown (from the acetic solution)

You can use pads to manage any vaginal discharge or bleeding. Allow your cervix time to heal. Don’t insert anything into your vagina. Avoid penetrative sex and tampons. Ask your provider about how long you should avoid these things to ensure enough recovery time.

If you didn’t have a biopsy, you should be able to go back to your normal activities after the procedure. You may have mild spotting for a few days.

When should I know the results of the test?

Biopsy results usually arrive within two to 10 days. Ask your provider about when you should expect results and how you’ll learn about them.

What type of results do you get and what do they mean?

You’ll get a normal or abnormal result from your colposcopy.

A normal result means the biopsy didn’t show any abnormal cells. This means you don’t need treatment. But you’ll still need routine cervical cancer screening. Your healthcare provider will let you know how often to get it.

An abnormal result means the biopsy showed abnormal cells. This means you’ll likely need treatment or close monitoring. If you get an abnormal result, it’s typically precancerous cells. In rare cases, a colposcopy can lead to a cervical cancer diagnosis.

If the results are abnormal, what are the next steps?

Your healthcare provider will explain the next steps in detail. They depend on the type and severity of the abnormal cells.

If the results reveal mild cervical dysplasia, your provider will ask you to repeat the Pap test periodically. Mild dysplasia may go away on its own (tissue returns to normal without treatment).

Treatments for more advanced precancerous cells include:

• Cone biopsy
• Loop electrosurgical incision procedure (LEEP)
• Laser surgery

If you have cervical cancer, you’ll meet with a team of healthcare providers to figure out your treatment plan.

When should I call my doctor?

Colposcopy is a relatively safe procedure with few side effects. But you should call your provider if you notice any of the following symptoms:

• Severe pain in your pelvis or lower belly
• Heavy bleeding (more blood loss than you usually have during your period)
• Symptoms of an infection, like a foul-smelling vaginal discharge that’s thicker than usual, fever and chills