Colposcopy and Cervical Biopsy

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 (What is a PDF document?).

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 doctor will insert a lubricated tool called a speculum into your vagina. It gently spreads apart the vaginal walls so your doctor can see inside the vagina and the cervix.

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.

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

• Colposcopy is not usually used as a screening test for women at high risk for cervical cancer. A Pap test is done for that purpose. But 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 Pap tests 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.