Colposcopy

Why this test may be ordered

• You had abnormal results on a Pap smear
• You have been diagnosed with HPV
• You have abnormal areas on your cervix seen during a pelvic exam
• You have bleeding after sex
• To check for genital warts, polyps, irritation, or inflammation of the cervix

Preparation and collection

Do not douche, use tampons or vaginal medicines, or have any kind of vaginal penetration for 48 hours before the test. Schedule the colposcopy when you are not having your menstrual period. Your provider may recommend taking an over-the-counter pain reliever before your appointment. Tell your provider if you are pregnant or think you may be pregnant.

During the procedure, you lie on an exam table with your feet in stirrups. A speculum is inserted into your vagina to spread the vaginal walls. The colposcope is placed outside your vagina, and a light is shone inside. Your cervix and vagina are swabbed with a vinegar or iodine solution to make abnormal tissues easier to see. If abnormal tissue is found, a biopsy may be taken using a small tool. An endocervical curettage (ECC) may also be done to sample tissue from inside the opening of the cervix.

There is very little risk to having a colposcopy. You may have some discomfort when the speculum is inserted, and the vinegar or iodine solution may sting, tingle, or burn. A biopsy is also safe; you may feel a pinch or pain when the tissue is taken, and afterward you may have cramping, slight bleeding, and discharge for up to a week. Serious complications are rare, but call your provider if you have heavy bleeding, abdominal pain, or signs of infection such as fever, chills, or bad-smelling vaginal discharge.

Understanding results

During your colposcopy, your provider may see certain conditions. If a biopsy was taken, the results will show whether abnormal cells are present. Your provider will discuss what your findings mean and recommend next steps.

• Normal biopsy results: No abnormal or precancerous cells were found in the cervix, vagina, or vulva. It is unlikely that you have cells at risk for turning into cancer. Limitation: Cell changes can develop over time, so normal results do not guarantee future health. Next step: Your provider may want to monitor you with more frequent Pap smears and/or additional colposcopies.
• Abnormal tissue seen during colposcopy (with or without biopsy): Abnormal cells, precancerous cells, or cancer may be present. The biopsy will confirm the diagnosis. Limitation: The colposcopy alone cannot diagnose cancer; a biopsy is needed for confirmation. Next step: If precancerous cells are found, you may need a procedure to remove them. If cancer is found, you may be referred to a gynecologic oncologist.
• Genital warts, polyps, or inflammation seen: These findings may indicate an HPV infection, noncancerous growths, or irritation of the cervix. Limitation: These findings are not diagnostic of cancer; further testing may be needed. Next step: Your provider will discuss treatment or monitoring based on the specific finding.

• A colposcopy is a procedure, not a laboratory test; it provides a magnified view but cannot diagnose cancer without a biopsy.
• The vinegar or iodine solution may cause temporary stinging or burning.
• Biopsy results may take time to process, and false negatives are possible if abnormal areas are missed.
• Pregnancy increases the risk of bleeding after a biopsy.
• After a biopsy, you should not douche, use tampons, or have sex for a week or as advised by your provider.

What to do next

If your results show precancerous cells, you may need a procedure to remove them to prevent cancer. If cancer is found, you may be referred to a gynecologic oncologist. If results are normal, your provider may recommend more frequent Pap smears or follow-up colposcopies. Always discuss your specific results and next steps with your healthcare provider.

• What did you see during the colposcopy?
• Was a biopsy taken, and if so, when will I get the results?
• What do my results mean for my risk of cancer?
• Do I need any follow-up tests or procedures?
• Are there any activity restrictions after the procedure?

Evidence source

U.S. National Library of Medicine: Colposcopy