What not to do before colposcopy?

Colposcopy

A colposcopy is a procedure that allows a health care provider to closely examine a woman’s cervix, vagina, and vulva. It uses a lighted, magnifying device called a colposcope. The device is placed at the opening of the vagina. It magnifies the normal view, allowing your provider to see problems that can’t be seen by the eyes alone.

If your provider sees a problem, he or she may take a sample of tissue for testing (biopsy). The sample is most often taken from the cervix. This procedure is known as a cervical biopsy. Biopsies may also be taken from the vagina or vulva. A cervical, vaginal, or vulvar biopsy can show if you have cells that are at risk for becoming cancer. These are called precancerous cells. Finding and treating precancerous cells may prevent cancer from forming.

Other names: colposcopy with directed biopsy

What is it used for?

A colposcopy is most often used to find abnormal cells in the cervix, vagina, or vulva. It may also be used to:

• Check for genital warts, which may be a sign of an HPV (human papillomavirus) infection. Having HPV may put you at higher risk for developing cervical, vaginal, or vulvar cancer.
• Look for noncancerous growths called polyps
• Check for irritation or inflammation of the cervix

If you’ve already been diagnosed and treated for HPV, the test may be used to monitor cell changes in the cervix. Sometimes abnormal cells return after treatment.

Why do I need a colposcopy?

You may need this test if you had abnormal results on your Pap smear. A Pap smear is a test that involves getting a sample of cells from the cervix. It can show if there are abnormal cells, but it can’t provide a diagnosis. A colposcopy provides a more detailed look at the cells, which may help your provider confirm a diagnosis and/or find other potential problems.

You may also need this test if:

• You have been diagnosed with HPV
• Your provider sees abnormal areas on your cervix during a routine pelvic exam
• You have bleeding after sex

What happens during a colposcopy?

A colposcopy may be done by your primary care provider or by a gynecologist, a doctor who specializes in diagnosing and treating diseases of the female reproductive system. The test is usually done in the provider’s office. If abnormal tissue is found, you may also get a biopsy.

During a colposcopy:

• You will remove your clothing and put on a hospital gown.
• You will lie on your back on an exam table with your feet in stirrups.
• Your provider will insert a tool called a speculum into your vagina. It is used to spread open your vaginal walls.
• Your provider will gently swab your cervix and vagina with a vinegar or iodine solution. This makes abnormal tissues easier to see.
• Your provider will place the colposcope near your vagina. But the device will not touch your body.
• Your provider will look through the colposcope, which provides a magnified view of the cervix, vagina, and vulva. If any areas of tissue look abnormal, your provider may perform a cervical, vaginal, or vulvar biopsy.

During a biopsy:

• A vaginal biopsy can be painful, so your provider may first give you a medicine to numb the area.
• Once the area is numb, your provider will use a small tool to remove a sample of tissue for testing. Sometimes many samples are taken.
• Your provider may also do a procedure called an endocervical curettage (ECC) to take a sample from the inside of the opening of the cervix. This area can’t be seen during a colposcopy. An ECC is done with a special tool called a curette. You may feel a slight pinch or cramp as the tissue is removed.
• Your provider may apply a topical medicine to the biopsy site to treat any bleeding you may have.

After a biopsy, you should not douche, use tampons, or have sex for a week after your procedure, or for as long as your health care provider advises.

Will I need to do anything to prepare for the test?

Do not douche, use tampons or vaginal medicines, or have sex for at least 24 hours before the test. Also, it’s best to schedule your colposcopy when you are not having your menstrual period. And be sure to tell your provider if you are pregnant or think you may be pregnant. Colposcopy is generally safe during pregnancy, but if a biopsy is needed, it can cause extra bleeding.

Are there any risks to the test?

There is very little risk to having a colposcopy. You may have some discomfort when the speculum is inserted into the vagina, and the vinegar or iodine solution may sting.

A biopsy is also a safe procedure. You may feel a pinch when the tissue sample is taken. After the procedure, your vagina may be sore for a day or two. You may have some cramping and slight bleeding. It’s normal to have a little bleeding and discharge for up to a week after the biopsy.

Serious complications from a biopsy are rare, but call your provider if you have any of the following symptoms:

• Heavy bleeding
• Abdominal pain
• Signs of infection, such as fever, chills and/or bad smelling vaginal discharge

What do the results mean?

During your colposcopy, your provider may find one or more of the following conditions:

• Genital warts
• Polyps
• Swelling or irritation of the cervix
• Abnormal tissue

If your provider also performed a biopsy, your results may show you have:

• Precancerous cells in the cervix, vagina, or vulva
• An HPV infection
• Cancer of the cervix, vagina, or vulva

If your biopsy results were normal, it’s unlikely that you have cells in your cervix, vagina, or vulva that are at risk for turning into cancer. But that can change. So your provider may want to monitor you for cell changes with more frequent Pap smears and/or additional colposcopies.

If you have questions about your results, talk to your health care provider.

Is there anything else I need to know about a colposcopy?

If your results showed you have precancerous cells, your provider may schedule another procedure to remove them. This may prevent cancer from developing. If cancer was found, you may be referred to a gynecologic oncologist, a provider who specializes in treating cancers of the female reproductive system.

References

1. ACOG: Women’s Healthcare Physicians [Internet]. Washington D.C.: American College of Obstetricians and Gynecologists; c2020. Colposcopy; [cited 2020 Jun 22]; [about 3 screens]. Available from: https://www.acog.org/patient-resources/faqs/special-procedures/colposcopy
2. Cancer.Net [Internet]. Alexandria (VA): American Society of Clinical Oncology; 2005–2020. Colposcopy: How to Prepare and What to Know; 2019 Jun 13 [cited 2020 Jun 22]; [about 3 screens]. Available from: https://www.cancer.net/blog/2019-06/colposcopy-how-prepare-and-what-know
3. Cancer.Net [Internet]. Alexandria (VA): American Society of Clinical Oncology; 2005-2020. Pap Test; 2018 Jun [cited 2020 Jun 22]; [about 3 screens]. Available from: https://www.cancer.net/navigating-cancer-care/diagnosing-cancer/tests-and-procedures/pap-test
4. Cleveland Clinic [Internet]. Cleveland (OH): Cleveland Clinic; c2020. Colposcopy: Results and Follow-Up; [cited 2020 Jun 22]; [about 5 screens]. Available from: https://my.clevelandclinic.org/health/diagnostics/4044-colposcopy/results-and-follow-up
5. Mayo Clinic [Internet]. Mayo Foundation for Medical Education and Research; c1998–2020. Colposcopy Overview; 2020 Apr 4 [cited 2020 Jun 22]; [about 3 screens]. Available from: https://www.mayoclinic.org/tests-procedures/colposcopy/about/pac-20385036
6. National Cancer Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; NCI Dictionary of Cancer Terms: colposcopy; [cited 2020 Jun 22]; [about 3 screens]. Available from: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/colposcopy
7. National Cancer Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; NCI Dictionary of Cancer Terms: gynecologic oncologist; [cited 2020 Jun 22]; [about 3 screens]. Available from: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/gynecologic-oncologist
8. UF Health: University of Florida Health [Internet]. Gainesville (FL): University of Florida Health; c2020. Colposcopy – directed biopsy: Overview; [updated 2020 Jun 22; cited 2020 Jun 2]; [about 2 screens]. Available from: https://ufhealth.org/colposcopy-directed-biopsy
9. University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; c2020. Health Encyclopedia: Colposcopy; [cited 2020 Jun 22]; [about 2 screens]. Available from: https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=92&ContentID=p07770
10. UW Health [Internet]. Madison (WI): University of Wisconsin Hospitals and Clinics Authority; c2021. Healthwise Knowledgebase: Colposcopy; [cited 2021 Aug 28]; [about 2 screens]. Available from: https://patient.uwhealth.org/healthwise/article/hw4205

Colposcopy

A colposcopy is a test to have a look at the cervix in detail. A colposcope is a large magnifying glass that a doctor or specialist nurse (colposcopist) uses to closely look at the skin-like covering of the cervix. By looking through it, the colposcopist can see changes that may be too small to see with the naked eye. They can take samples (biopsies) of any abnormal areas on the cervix.

You usually have a colposcopy in the hospital outpatient clinic.

• About cervical screening

Why you might have a colposcopy

You have a colposcopy if you’ve had an abnormal result after a cervical screening test, or if you have symptoms that could be caused by cervical cancer.

• Symptoms of cervical cancer

How you have the test

To have the colposcopy, you need to undress from the waist down. Your nurse will give you a sheet to cover yourself.

You lie on your back on the couch with your feet drawn up and your knees apart. If you can’t get into that position for any reason, the colposcopist may be able to do the examination with you lying on your side with your knees drawn up. Your nurse will help you to get in a comfortable position.

The colposcopist gently puts in a speculum to open up your vagina. Then they look through the colposcope at the surface of your cervix. They can take biopsies of any abnormal areas. They send these to the laboratory to be looked at. The examination takes up to 20 minutes.

The biopsy is usually painless. But some women have crampy pain for a few minutes.

If your doctor or specialist nurse finds an area of abnormal cells, you might have treatment there and then. They call this see and treat. Or they may wait until they have the biopsy results.

• Find out about treatment for abnormal cells

After your test

You can go home as soon as the colposcopy is over.

Getting your results

Before you leave hospital make sure you know how you will be given the results. You may be asked to go back to the hospital for an outpatient appointment to get the results. Or the results may be sent in the post.

If you have abnormal cells on your cervix, you’ll have an appointment to go back to the colposcopy clinic to have them treated.

Possible risks

Colposcopy is a very safe procedure but your nurse will tell you who to contact if you have any problems after your test. Your doctors make sure the benefits of having a colposcopy outweigh any possible risks.

Bleeding

You might have some light bleeding for up to 5 days after having a biopsy. This is normal. But see your GP or contact the colposcopy unit for advice if the bleeding is heavier than your usual period, or you are still bleeding after a week.

Infection

There is a small risk of infection. You should avoid having sex and using tampons until any bleeding stops — about 5 days after a biopsy. This allows the area on the cervix to heal and reduces the risk of infection. Your GP will give you antibiotics if you develop an infection.

If you are pregnant

You can have a colposcopy if you’re pregnant. It is perfectly safe for you and your baby, and will not affect the delivery. It won’t affect your ability to get pregnant in future either.

If you have any questions about colposcopy you can contact the Cancer Research UK information nurses on freephone 0808 800 4040. The lines are open from 9am to 5pm, Monday to Friday.

References

• NHS Cervical Screening Programme. Colposcopy and Programme Management, 3rd edition
  Public Health England, March 2016 (updated Feb 2020).

Colposcopy

A colposcopy is a procedure to check your cervix, the wall of your vagina and your vulva for signs of cancerous or pre-cancerous tissue. If you’ve had an abnormal Pap test or a positive HPV test, your provider may recommend colposcopy to get closer to a diagnosis.

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Overview

What is colposcopy?

Colposcopy is a diagnostic procedure that allows your provider to check your cervix (lower part of your uterus) and the wall of your vagina for abnormal tissue. During the procedure, a special lighted microscope called a colposcope magnifies the tissue that lines your cervix and vagina. If your provider sees any abnormalities, they can take tissue samples (biopsies) that can be tested in a lab for cancerous or precancerous cells.

What does colposcopy test for?

Colposcopies primarily check for cancer cells or cells that could become cancer if not treated (also called cervical dysplasia). Your provider will look for these cells in your cervix, vagina and external genitals (vulva). Colposcopies can also test for genital warts and noncancerous growths called polyps.

Sometimes, your provider might recommend a colposcopy to evaluate other symptoms like abnormal vaginal bleeding or vulvar itching.

Why would a woman need a colposcopy?

People designated female at birth (DFAB), including cisgender women, transgender men and nonbinary people with vaginas, may need colposcopy to investigate test results that may indicate abnormalities. Your provider may recommend a colposcopy if you:

• Had abnormal Pap test, or Pap smear, results.
• Had abnormal results during a pelvic exam.
• Had a positive HPV test (human papillomavirus).

Should I be worried if I need a colposcopy?

You shouldn’t worry. The chances are good that you don’t have cancer. And if you do have precancerous cells, they’re not likely to become cancerous while you’re waiting for your appointment. A colposcopy can allow your provider to identify and treat precancer cells early so that you don’t have to worry over a cancer diagnosis.

Who performs a colposcopy?

Your primary care provider or gynecologist can perform a colposcopy. Sometimes, trained specialists called colposcopists perform the procedure. Research suggests that having an experienced medical specialist perform the procedure increases the likelihood that precancerous cells will be caught early.

Test Details

Is colposcopy considered surgery?

Colposcopy isn’t surgery, but biopsies are considered minor surgical procedures. Biopsies sometimes happen as part of colposcopy. If your provider finds any abnormalities during your colposcopy, they can remove a sample of the suspicious tissue. It’s a painless procedure that takes less than 30 minutes and doesn’t require a hospital stay.

How do I prepare for a colposcopy?

• Share your pregnancy status with your healthcare provider. You can have a colposcopy during pregnancy, but you may be at greater risk for bleeding if your provider performs a biopsy during the procedure. Discuss these concerns with your provider.
• Schedule your colposcopy for a time when you’re not menstruating. You can have the procedure during your period. Still, your provider will have an easier time viewing your cervix if you’re not bleeding.
• Avoid any kind of vaginal penetration for 48 hours before your colposcopy. Avoid intercourse and penetration with fingers or sex toys. Don’t use tampons or vaginal medications, like creams or suppositories. All these things can alter the results of your colposcopy.
• Take a pain reliever on the day of the procedure. Medications containing acetaminophen (Tylenol©) or ibuprofen (Advil©, Motrin©) can make you more comfortable during the procedure.

What to expect during colposcopy?

Colposcopy can take place in a medical office or clinic. The procedure usually lasts from 10 to 20 minutes. You should be able to go home the same day of your procedure.

What is it like to have colposcopy?

A colposcopy is usually no more uncomfortable than having a Pap test. You won’t need any anesthesia or pain medicine. Here’s what to expect:

1. You’ll lie on an examining table with your feet in stirrups.
2. Your provider will insert an instrument called a speculum that will widen your vagina so that your cervix is visible.
3. Your provider will look through the colposcope to take a closer look at your vagina and cervix. The colposcope has a built-in light and binocular-like lenses that make it easy for your provider to view your cervix while remaining seated at your feet. The colposcope will remain outside your vagina the whole time.
4. Your provider will use a cotton swab to apply an acetic acid solution (vinegar solution) to your cervix. You may notice a slight burning sensation. The solution helps highlight any suspicious areas.

If your colposcopy shows one or more areas of abnormal tissue, your provider can do a biopsy to remove the tissue for testing.

What is it like to have a biopsy?

Unlike a Pap test, where tissue from your entire cervix gets scraped, colposcopy allows your provider to take tissue samples by scraping cells from select areas. Small pieces of tissue will be removed and sent to a laboratory to see if cancer or precancer cells are present. You may feel mild pressure or a pinch when your provider removes the abnormal tissue.

How painful is a colposcopy?

A colposcopy is relatively painless. You may feel slight pressure when the speculum enters your vagina. You may feel a slight burning or stinging when the solution comes into contact with your cervix. If you need a biopsy, you may feel a sharp pinch or a sensation like a period cramp when the tissue sample is excised. Taking over-the-counter pain relievers before the exam can help with the pain.

What happens after the colposcopy?

You should be able to resume normal activities immediately following your appointment. If you didn’t have a biopsy, you might notice some spotting for the next two days.

If you had a biopsy, you might experience:

• Light vaginal bleeding that lasts a few days.
• Slight 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. In the meantime, avoid inserting anything into your vaginal. Allow your cervix time to heal by avoiding penetrative sex, tampons or douching. Ask your provider about how long you should avoid these activities to ensure adequate recovery time.

Results and Follow-Up

What do the results of my colposcopy mean?

The results of your colposcopy and biopsy will determine if you need any treatment. About 40% of people receive results that report no sign of abnormal cells. About 60% need treatment of some kind to address an abnormality. Examples of abnormalities include masses on the cervix, vagina or vulva.

What happens if a colposcopy is abnormal?

Suppose the colposcopy biopsy results reveal early cases of abnormality, like mild cervical dysplasia. In that case, 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 precancer cells include:

• Loop electrosurgical incision procedure (LEEP). An electricity-powered wire loop destroys any abnormal cells.
• Cone biopsy. A cone-shaped sample of tissue that includes the abnormal cells is removed from your cervix.
• Cryotherapy.Cold chemicals, like liquid nitrogen, destroy any abnormal cells.
• Laser surgery. A heated laser beam destroys any abnormal cells.

In more serious cases, you may need surgery to remove your entire uterus. Ask your provider about any follow-up testing that is needed after surgery.

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 key findings will be communicated with you.

When should I call my healthcare provider?

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 experience during your period).
• Symptoms of an infection, like a foul-smelling vaginal discharge that’s thicker than usual, fever and chills.

A note from Cleveland Clinic

Learning that you’ll need follow-up testing because you’ve had abnormal test results is scary. Colposcopy is a simple, relatively painless procedure that can give you peace of mind from worry. Colposcopy can help your healthcare provider identify any cancer or precancerous cells early so that you get the treatment you need. Cervical cancer that’s diagnosed and treated early can be cured. Coloscopy can rule out cancer, too. Discuss your concerns about cancer risk and potential outcomes with your provider as you prepare for the day of your exam.

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Last reviewed by a Cleveland Clinic medical professional on 05/19/2022.

References

• American Society for Colposcopy and Cervical Pathology. Recommendations on new standards of colposcopy practice. (https://www.asccp.org/colposcopy-standards) Accessed 5/19/2022.
• Hoffman BL, Schorge JO, Schaffer JI, et al. Chapter 30. Cervical Cancer. Williams Gynecology. 2nd ed. New York: McGraw-Hill; 2012. Accessed 5/19/2022.
• Lili E, Chatzistamatiou K, Kalpaktsidou-Vakiani A, et al. Low recurrence rate of high-grade cervical intraepithelial neoplasia after successful excision and routine colposcopy during follow-up. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5794389/) Medicine (Baltimore). 2018;97(4):e9719. Accessed 5/19/2022.
• Pierce JG Jr, Bright S. Performance of a colposcopic examination, a loop electrosurgical procedure, and cryotherapy of the cervix. (https://pubmed.ncbi.nlm.nih.gov/24286998/) Obstet Gynecol Clin North Am. 2013;40(4):731-757. Accessed 5/19/2022.
• Wentzensen N, Massad LS, Mayeaux EJ Jr, et al. Evidence-based consensus recommendations for colposcopy practice for cervical cancer prevention in the United States. (https://pubmed.ncbi.nlm.nih.gov/28953109/) J Low Genit Tract Dis. 2017;21(4):216-222. Accessed 5/19/2022.

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