You may need a colposcopy to investigate your symptoms or as a follow-up evaluation after an abnormal pelvic exam or Pap smear. During a colposcopy, your healthcare provider may also take a tissue sample (biopsy) for further examination.
This article details the colposcopy procedure, including why and how it is performed, and what you can expect during the test. It also discusses a colposcopy biopsy and what the results may mean.
Purpose of a Colposcopy
A colposcopy allows your healthcare provider to get a better look at your cervix and vaginal walls. It is used to examine lesions or abnormalities with the aid of magnification. A biopsy is sometimes taken during a colposcopy.
According to the American College of Obstetricians and Gynecologists, a colposcopy is recommended if a Pap smear of pelvic examination showed:
Cancer or precancer: These changes can be detected on a routine Pap smear and require further investigation and, perhaps, treatment. Cervicitis: Inflammation of the cervix can be caused by illness, infection, irritation, or physical abrasion. Polyps: Growths on the cervix often need to be removed but are typically not cancerous. Genital warts: Warts, typically caused by human papillomavirus (HPV) infection, can be present on the vagina or cervix and may lead to serious problems, such as cancer. Painful or irregular bleeding: These can be signs of conditions and diseases involving the cervix.
Colposcopy Risks and Contraindications
In general, colposcopy is considered safe. With that said, if you are pregnant, a biopsy is usually avoided because it can cause cramping and may increase the risk of complications, such as premature labor or miscarriage.
If you are prone to bleeding or take an anticoagulant (blood thinner), you may experience heavy bleeding after a biopsy.
Before a Colposcopy
If you need to have a colposcopy, your healthcare provider will schedule it for a time when you are not having your period, as this can change the appearance of the cervix and the bleeding may interfere with optimal visualization.
It’s also important to not place anything into your vagina for at least one day prior to the procedure, so you will be instructed to abstain from sexual intercourse, using vaginal creams, douching, or using tampons.
Timing
You might have your colposcopy in your healthcare provider’s office as part of your gynecologic examination. If this is the case, you should expect the procedure to last for about 10 to 20 minutes.
Location
A colposcopy is done in the healthcare provider’s examination room.
What to Wear
You can wear whatever is comfortable on your way to the test. You will be asked to undress from the waist down and may be asked to change into a gown.
Food and Drink
There are no food or drink restrictions associated with colposcopy.
Cost and Health Insurance
If you are having a colposcopy, your health insurance company may require a pre-authorization, which your healthcare provider’s office should take care of. You may also need to pay a co-pay, and your health insurance company and healthcare provider’s office will be able to tell you the amount.
What to Bring
You should be sure to bring your test order form, your health insurance card, a form of identification, and a method of payment if you need it.
During the Colposcopy Procedure
A colposcopy is typically performed by a gynecologist or other healthcare provider. An assistant or nurse may be on hand to assist.
Pre-Test
You will need to fill out some paperwork, including a consent form for the procedure, authorization for payment, and patient privacy forms.
You may be asked to change into a gown, and your nurse may ask you if you need to empty your bladder so that the test will be more comfortable. Once on the examination table, you will be asked to lie down and place your feet in stirrups.
Throughout the Test
Your healthcare provider will place a speculum into your vagina. Once the device is in position, your healthcare provider may gently cleanse your cervix with saline, either using a spray bottle or a cotton swab.
Typically, your practitioner will also place a 3% to 5% dilute acetic acid solution on your cervix to better visualize the area and distinguish between normal and abnormal tissue.
Next, the colposcope will be positioned close to your vaginal opening, so that the light is shining on the vagina and cervix. Your healthcare provider will then take careful note of what they can see. Blood vessel enlargement, bleeding, or irregularities are often visible through the colposcope.
Your healthcare provider may insert Lugol’s solution, which is composed of iodine and potassium iodide. Normal cervical tissue usually appears brown when it comes in contact with Lugol’s solution, and pre-cancerous cells usually appear yellow.
Finally, your healthcare provider may take a tissue sample, if necessary, from the abnormal areas, You may feel mild discomfort or cramping during the biopsy, but this should only last a few minutes.
Be sure to tell your healthcare provider if you experience severe pain or discomfort as this can be a sign of cervical inflammation or infection.
Post-Colposcopy
Once your healthcare provider removes the speculum, you may need a few minutes to rest. If a sample was collected, it will be prepared to be sent to a lab.
Your healthcare provider might discuss some of the test results with you right away or a couple of weeks later. You can empty your bladder if you need to, and your nurse may give you a sanitary pad if you have any bleeding.
Normally, you can be discharged to go home at that time.
Colposcopy Recovery
If you have a colposcopy without a biopsy, you may have very mild spotting. If you had a colposcopy with a biopsy, recovery may include some vaginal bleeding and mild cramping for 24 to 48 hours after the procedure.
In addition to some light vaginal bleeding, you may notice a dark discharge from the solution that your healthcare provider used to help visualize your cervix.
You should use a sanitary pad and not a tampon for the bleeding and discharge. Pain is typically treatable with over-the-counter pain medications such as Tylenol (acetaminophen) or Motrin (ibuprofen).
After your procedure, your healthcare provider may recommend that you refrain from putting anything into your vagina for about 48 hours. This includes abstaining from sexual intercourse.
Managing Colposcopy Side Effects
You should contact your healthcare provider if your symptoms are worse than expected or you develop any symptoms of infection. Both are uncommon but can occur.
Interpreting Results
Your colposcopy results are based on your healthcare provider’s observations during the procedure as well as the results of the biopsy, if you had one.
Heavy vaginal bleeding or bleeding that soaks more than one sanitary pad per hour for two hoursSevere or worsening pelvic painHigh fever with chillsPus-like vaginal discharge with a bad odor
Your healthcare provider may discuss some preliminary results during or immediately after the procedure or may schedule an appointment at a later time after your biopsy results return, which is usually within one to two weeks.
A colposcopy may help identify:
Areas of injury of the cervical lining Blood vessel irregularities or disruption Cervical hyperplasia (abnormal cervical tissues) Cervical infections Cervical warts Cervicitis Endometriosis
If you haven’t heard any news from your healthcare provider after two weeks, call the office to check on the results.
Some busy gynecological practices only call if the biopsy is positive. In addition, many doctor’s offices post online to a patient portal where you can view test results. A negative result means no cancer was detected.
Follow-Up
If you have a medical condition diagnosed by colposcopy, your next step is either treatment or further evaluation. For example, if you have an infection, you may need to be treated with an antibiotic.
A pre-cancerous lesion may prompt the need for further evaluation such as a repeat biopsy, a larger biopsy, or close monitoring with more frequent Pap smears or colposcopies. A cancer diagnosis will require further tests and treatments.
In general, it is not typical to have a routine follow-up colposcopy at regular intervals, but you may need to have another colposcopy if you have an abnormal Pap smear in the future or other concerning findings.
A Word From Verywell
A colposcopy is a diagnostic test that can provide your healthcare provider with some results while you are having the test. It is generally easy to tolerate with few side effects.
However, you may be anxious or worried about the results if your symptoms are unusual or severe, or if you are at risk of cervical cancer. In general, most medical conditions diagnosed by colposcopy are treatable. Even cervical cancer, in fact, has a good prognosis when it is diagnosed early and treated promptly.
