What is colposcopy?

Colposcopy is a procedure used to detect abnormal cells and tissues of the cervix, vagina, and vulva. It is done with a colposcope — an instrument that looks like binoculars on a tripod. The colposcope has a magnifying glass that lets the clinician examine the surface cells.

Why do women have colposcopies?

Colposcopy is used to determine whether more tests or treatments are needed when abnormalities are observed.

It can be used

• after abnormal Pap or HPV (human papilloma virus) test results
• if the cervix looks abnormal during a pelvic exam
• to find out the cause of unexplained bleeding

It is impossible to diagnose conditions of the cervix and vagina with the naked eye. With magnification, a clinician can better tell whether more tests are needed, or if there is no need for concern.

Why is it important to diagnose and treat abnormal cervical cells?

Most of the time, abnormal cervical cells heal without treatment. But sometimes, abnormal cells can develop into cancer. Treatments for precancerous abnormal cells are highly effective at preventing cervical cancer. That is why it is so important to have regular Pap tests and to follow up on any abnormal results.

What is a biopsy?

A biopsy is the removal of a small piece of tissue. The tissue is sent to a lab to be examined under a microscope. Biopsy is often done during colposcopy.

How do colposcopy and biopsy work?

Colposcopy is a simple procedure. It does not require an anesthetic, and can be done in a clinician's office.

• A woman lies down on an exam table in the same position used to have a Pap test.
• A speculum — a metal or plastic instrument — is inserted into the vagina to separate the walls.
• The clinician swabs the walls of the vagina and the cervix with a vinegar-like solution. The solution removes mucus and also turns abnormal cells white — making them more visible. The clinician may also apply iodine to make the abnormal cells easier to see.
• The clinician looks at the magnified cervix and vagina through the colposcope from outside the vagina — the instrument never enters the body.
• Biopsies are taken from any areas that appear to have abnormal cells. This is done in two ways:
  • by scraping away cells with a small brush or a small metal loop called a curette
  • by taking a plug of tissue about the size of half a grain of rice with an instrument similar to a paper punch. This is known as a punch biopsy
• Collected tissue is sent to a lab for examination.

How long does it take?

Colposcopy and biopsy usually take about 10 minutes.

Are colposcopy and biopsy painful?

Colposcopy is nearly pain-free — the cervix does not have many nerve endings. Some women feel mild stinging or burning when the solution is applied.

If a biopsy is necessary, you may have some discomfort — most women describe it as feeling like a sharp pinch. To others it feels like a menstrual cramp.

What should I do to prepare for colposcopy?

• Schedule your colposcopy for when you will not have your period.
• You may want to take an over-the-counter pain reliever about an hour before the exam to reduce the chance of discomfort. Ask your clinician in advance to recommend a pain reliever.
• Do not douche, use tampons, put medications in your vagina, or have vaginal intercourse for at least 24 hours before the test.

What can I expect after the procedure?

Your vagina may feel slightly sore for a couple of days. You may also spot or have a dark-colored vaginal discharge — use a maxi pad or panty liner. Ask your clinician whether it is safe for you to use tampons.

You may shower or bathe as soon as you want after the procedure.

DES and Abnormal Cervical Cells

Women whose mothers took DES (diethylstilbestrol) — a drug widely prescribed between 1941 and 1971 to prevent miscarriage — are more likely than other women to develop abnormal cervical cells. If you were exposed to DES before you were born, your clinician may recommend colposcopy even if you have not had an abnormal Pap or HPV test or pelvic exam.

Are there any risks?

Complications are rare, but may require medical attention. Call your clinician if you have

• fever or chills
• heavy bleeding at a time when you are not having your period
• heavy, yellow-colored, or bad smelling discharge from your vagina
• severe pain in the lower abdomen

Will it affect my ability to have a child in the future?

Colposcopy and biopsy should not affect fertility.

When can I have sex again?

If a biopsy is not taken, you can resume sexual activity as soon as you like.

If a biopsy is taken, you should wait one week before having vaginal intercourse. This allows the cervix time to heal. You can enjoy other sex play that does not involve inserting anything into your vagina.

Can I continue using contraception and other medications?

Yes. Continue taking your medications as usual — including the birth control pill. You can also continue to use any other method of birth control.

Can I have colposcopy and biopsy during pregnancy?

Colposcopy is safe during pregnancy. The risk of biopsy during pregnancy is small, but your clinician may delay performing a biopsy if possible. Pregnant women may have more bleeding after biopsies than women who are not pregnant. This is because the cervix has an increased blood supply during pregnancy.

What happens if I have abnormal results?

Your need for treatment depends on the severity of cell abnormality.

• Your clinician may recommend waiting to see if the abnormal cells heal themselves. In this case, you will have a repeat Pap test and possibly other tests to monitor the cells.
• Sometimes, the biopsy is also the treatment. The clinician may be able to remove all of the abnormal cells during the colposcopy procedure. If so, no further treatment is needed.
• Another procedure may be prescribed if further treatment is needed. The following procedures are very effective at removing the abnormal areas and preventing cervical cancer:
  • Cryotherapy — abnormal tissue is frozen off
  • LEEP — abnormal tissue is removed using a thin wire loop that carries an electrical current
  • Laser — abnormal tissue is destroyed with a laser beam
  • Cone Biopsy — a cone-shaped wedge is cut out of the cervix

Pap Tests after Treatment

It is important to continue to get regular pelvic exams and Pap tests after you have been treated for abnormal cells. Even though cryotherapy, LEEP, laser, and cone biopsy are very effective, sometimes abnormal cells reappear or develop after treatment.

Very rarely, a hysterectomy — removal of the uterus — is used to treat abnormal cells. Talk with your clinician about your options if you would like to become pregnant in the future.