Colposcopy and Cervical Biopsy
Colposcopy is a way for your doctor to use a special magnifying device to look at your vulva, vagina, and cervix. If the doctor sees a problem, he or she can take a small sample of tissue (biopsy) from the cervix or from inside the opening of the cervix. The sample is looked at under a microscope.
This test is most often done when the result of a Pap test is abnormal. Most abnormal Pap tests are caused by viral infections. Examples are HPV infection and other types of infection, such as those caused by bacteria, fungi (yeast), or protozoa ( Trichomonas). Natural cervical cell changes (atrophic vaginitis) linked to menopause can also cause an abnormal Pap test. In some cases, untreated cervical cell changes that cause abnormal Pap tests may become precancerous or cancerous changes.
During the test, your doctor uses a lighted magnifying device that looks like a pair of binoculars. This device is called a colposcope. It allows your doctor to see problems that would be missed by the naked eye. A camera can be attached to the colposcope to take pictures or videos of the vagina and cervix.
Your doctor may put vinegar (acetic acid) and sometimes iodine on the vagina and cervix with a cotton swab or cotton balls. It allows the doctor to see problem areas more clearly.
Why It Is Done
Colposcopy is done to:
- Look at the cervix for problem areas when a Pap test was abnormal. If an area of abnormal tissue is found, a biopsy is often done.
- Check a sore or other problem (such as genital warts) found on or around the vagina and cervix.
- Follow up on abnormal areas seen on a previous colposcopy. It can also be done to see if treatment for a problem worked.
- Look at the cervix for problem areas if an HPV test shows a high-risk type of HPV.
How To Prepare
Tell your doctor if you:
- Are or might be pregnant. A blood or urine test may be done before the test to see if you are pregnant. Colposcopy is safe during pregnancy. If a cervical biopsy is needed during the test, the chance of any harm to the pregnancy (such as miscarriage) is very small. But you may have more bleeding from the biopsy. A colposcopy may be repeated about 6 weeks after your baby is born.
- Take any medicines.
- Are allergic to any medicines.
- Take a blood thinner, or if you have had bleeding problems.
- Have been treated for a vaginal, cervical, or pelvic infection.
Do not have sex or put anything into your vagina for 24 hours before the test. This includes douches, tampons, and vaginal medicines. You will empty your bladder just before the test.
You may want to take a pain reliever, such as ibuprofen (Advil or Motrin). It is best to take it 30 to 60 minutes before the test, especially if a biopsy may be done. This can help decrease any cramping pain that you may have.
Schedule your colposcopy for when you are not having your period. Heavy bleeding makes it harder for your doctor to see your cervix. The best time to have this test is during the early part of your menstrual cycle. This is usually 8 to 12 days after the start of your last menstrual period.
You will be asked to sign a consent form that says you understand the risks of the test and agree to have it done.
Talk to your doctor about any concerns you have regarding the need for the test. Ask about its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form .
How It Is Done
Colposcopy is usually done by a gynecologist, a family medicine physician, or a nurse practitioner who has been trained to do the test. If a biopsy is done, the sample will be looked at by a pathologist. This test can be done in your doctor's office.
You will need to take off your clothes below the waist. You will be given a covering to drape around your waist. You will then lie on your back on an exam table. Your feet will be raised and put in foot rests (stirrups).
The colposcope is moved near your vagina. Your doctor looks through it at the vagina and cervix. Vinegar (acetic acid) or iodine may be used on your cervix to make abnormal areas easier to see. Photos or videos of the vagina and cervix may be taken.
If areas of abnormal tissue are found on the cervix, your doctor will take a small sample of the tissue. This is called a cervical biopsy. Usually several samples are taken. The samples are looked at under a microscope for changes in the cells that may mean cancer may be present or is likely to develop. If bleeding occurs, a special liquid (Monsel's) or silver nitrate swab may be used on the area to stop the bleeding.
If a sample of tissue is needed from inside the opening of the cervix, a test called endocervical curettage (ECC) will be done. This area can't be seen by the colposcope. So a small sharp-edged tool called a curette is gently put into the area to take a sample. ECC takes less than a minute to do. It may cause mild cramping. An ECC is not done during pregnancy.
Colposcopy and a cervical biopsy usually take about 15 minutes.
How It Feels
You may feel some discomfort when the speculum is put in. You may feel a pinch and have some cramping if a tissue sample is taken.
In rare cases, a cervical biopsy can cause an infection or bleeding. Bleeding can usually be stopped by using a special liquid or swab on the area.
After the test
If you have a biopsy, your vagina may feel sore for a day or two. Some vaginal bleeding or discharge is normal for up to a week after the biopsy. The discharge may be dark-colored. You can use a sanitary pad for the bleeding. Do not douche, have sex, or use tampons for 1 week. This will allow time for your cervix to heal. Do not exercise for 1 day after your colposcopy.
Follow any instructions your doctor gave you. Call your doctor if you have:
- Heavy vaginal bleeding. (This means more than a normal menstrual period).
- A fever.
- Belly pain.
- Bad-smelling vaginal discharge.
Your doctor will talk to you about what he or she sees at the time of the test. Lab results from a biopsy may take several days or more.
The vinegar or iodine does not show any areas of abnormal tissue. The vagina and cervix look normal.
A biopsy sample does not show any abnormal cells.
The vinegar or iodine shows areas of abnormal tissue. Sores or other problems, such as genital warts or an infection, are found in or around the vagina or cervix.
A biopsy sample shows abnormal cells. This may mean cervical cancer is present or likely to develop.
What Affects the Test
You may not be able to have the test, or the results may not be helpful, if:
- You have sex up to 24 hours before the test.
- You use douches, tampons, or vaginal creams or medicines up to 24 hours before the test.
- You are having a menstrual period at the time of the test.
- You have a vaginal or cervical infection.
- You have gone through menopause. Hormonal changes may make it hard to see the cervical canal clearly.
What To Think About
- A colposcopy gives you and your doctor more information if you have an abnormal result from a Pap test.
- If a colposcopy and cervical biopsy are normal, it is not likely that you have cell changes that can lead to cervical cancer. But your doctor may still want you to have testing more often for a period of time.
- Another biopsy may be needed if a Pap test, colposcopy, and cervical biopsy show different results.
- Women with HIV have a higher chance of getting cervical cancer. A colposcopy is usually advised for women with HIV and an abnormal Pap test.
Other Works Consulted
- Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.
- Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.
- Pagana KD, Pagana TJ (2010). Mosby's Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby.
Current as of: August 21, 2019
Author: Healthwise Staff
Medical Review: Sarah Marshall MD - Family Medicine
Martin J. Gabica MD - Family Medicine
E. Gregory Thompson MD - Internal Medicine
Kathleen Romito MD - Family Medicine
Kevin C. Kiley MD - Obstetrics and Gynecology