Colposcopy is a special visual examination of the cervix, vagina, and sometimes the outer lips or

vulvar area. If you have an abnormal Pap smear, you may require a colposcopy. This requires

your healthcare provider to look through an instrument called a “colposcope” which is a type of

microscope mounted on a pole. The colposcope helps your healthcare provider check for

problems, which are often very small, on the cervix and vagina and may not be seen during your

regular exam. If abnormalities are seen, a small sample of tissue, called a biopsy, is usually done.

The biopsy gives your healthcare provider important information to decide if treatment would be

necessary. Biopsies may cause mild cramping. The colposcopy exam takes about 10 to 20

minutes.

Colposcopy is most often advised for women who have had an abnormal Pap smear. An

abnormal Pap smear may be a sign of a precancerous condition that can then be successfully

treated before turning into cancer. Occasionally, a patient may be referred for colposcopy because

of some abnormal appearance of their cervix, noted during a pelvic examination.

The colposcope used in colposcopy is instrument that looks like a pair of binoculars mounted on a

pole. A speculum is placed in the vagina to hold the vaginal walls open, just as if you were

having a Pap smear done, and remains in place until the exam is finished. The colposcope is

placed a few inches in front of the vagina, but does not touch you. A repeat Pap smear may also

be done at this time, in the same way it is collected during your prior exam. Your health care

provider may place vinegar, and sometimes an iodine solution (notify your healthcare provider if

you are allergic to iodine), directly onto the cervix and vagina to identify any abnormal areas.

You may have some mild burning or tingling, but most patients do not experience this. The

provider might also adjust the colposcope by changing the magnification or looking through

different colored filters. This helps in finding suspicious areas. Sometime photographs of your

cervix, vagina, or vulva are taken during your exam and become part of your medical record.

Abnormal cells that cause cervical disease may extend up toward the lining of the uterus or womb

through an opening called the endocervical canal. This is the same birth canal that dilates when

women have vaginal childbirth. Sampling the endocervical canal may cause cramping or, rarely,

light-headedness. If abnormal areas are seen on the cervix, they often require a biopsy to make a

correct diagnosis. The biopsy takes a very small piece of tissue from the abnormal areas. If more

than one area is abnormal, several different biopsies may be performed. Any bleeding from the

biopsy sites can be stopped using silver nitrate or an iron-containing compound called Monsel’s

solution. A pathologist, who will tell your healthcare provider the final diagnosis, then sends the

biopsy specimens that are collected to the lab for processing and examination. This may take

several days or even a few weeks.

For about three to five days following a colposcopy with biopsies you may experience some

spotting or a brown crumbly discharge, like coffee grounds, which may require you to use a

mini-pad. There are few restrictions after the procedure and you may usually go about your daily

routine. If biopsies are performed you may be restricted from certain activities until the spotting

has stopped and your cervix has time to heal. These include:

•Sexual activity (vaginal intercourse)

•Putting tampons into your vagina

•Washing or douching inside your vagina

You should call your healthcare provider if you have:

•Fever

•Bright red, heavy bleeding which is more than what you have with your period

•Bad cramps or pain that do not improve with over-the-counter medications, such as ibuprofen

The treatment following a colposcopy depends on the degree of abnormality reported on the

biopsy. For minor or low-grade abnormalities, no treatment may be necessary and only a follow

up Pap smear or HPV testing would be required. If there are greater or more severe

abnormalities, other treatment may be required including destroying surface cells of the cervix

with laser or freezing therapies. Another option includes a larger biopsy of the cervix called a

“Loop” or loop electro excision procedure (LEEP), which may be performed in the healthcare

provider’s office. A surgical conization in the operating room is needed occasionally. Your

healthcare provider will discuss these treatments with you, if any is needed. You may also wish

to read the ASCCP patient education pamphlet on LEEP.

As with non-pregnant women any abnormal Pap smear in pregnancy needs further examination.

Looking through the colposcope is completely safe and biopsies may be performed in pregnancy

if suspicious areas are identified. Sampling from the birth canal, such as by an endocervical

curettage, should not be performed in pregnancy. Most of the treatment methods which are used

on nonpregnant patients are not recommended during pregnancy. These treatments can usually

wait until after the pregnancy is finished. Often a repeat exam is done after the pregnancy to

determine if treatment is still necessary.

There are no serious risks to colposcopy, which is performed routinely in the healthcare

provider’s clinic. The most likely side effect is mild discomfort from the solutions used and

cramping or pinching from the endocervical curettage or biopsies. There may be a small amount

of spotting for a few days, but heavy bleeding is rare. The Monsel’s solution or silver nitrate used

to help stop bleeding may also cause a brown crumbly discharge for two to three days.

If your abnormal Pap test was done by another healthcare provider, it is useful to have a copy of

the report at the time of your referral for a colposcopy. Undergoing colposcopy does not require

any special preparation. You may take over-the-counter medications like ibuprofen or

acetaminophen before the procedure to help reduce the cramping. To avoid obscuring the

abnormal cells, it is best to avoid anything in the vagina for two days prior to the procedure such

as sexual activity, intravaginal medications, tampons, or douching. Try to avoid having

colposcopy during your period, but if the bleeding is light, the exam may still be satisfactory.

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