Colposcopy - directed biopsy
A colposcopy is a special way of looking at the cervix. It uses a light and a low-powered microscope to make the cervix appear much larger. This helps your health care provider find and then biopsy abnormal areas in your cervix.
Biopsy - colposcopy - directed; Biopsy - cervix - colposcopy; Endocervical curettage; ECC; Cervical punch biopsy; Biopsy - cervical punch; Cervical biopsy
How the Test is Performed
You will lie on a table and place your feet in stirrups, just like you would do for a pelvic exam. The health care provider will place an instrument (called a speculum) into your vagina. This allows your doctor or nurse to better see the cervix.
The cervix and vagina are gently swabbed with a vinegar or iodine solution. This removes the mucus that covers the surface and highlights abnormal areas.
The health care provider will place the colposcope at the opening of the vagina and examine the area. Photographs may be taken. The colposcope does not touch you.
If any areas look abnormal, a small sample of the tissue will be removed using small biopsy tools. Many samples may be taken. Sometimes a tissue sample from inside the cervix is removed. This is called endocervical curettage (ECC).
How to Prepare for the Test
There is no special preparation. You may be more comfortable if you empty your bladder and bowel before the procedure.
Before the exam:
This test should not be done during a heavy period, unless it is abnormal. Keep your appointment if you are:
You may be able to take ibuprofen or acetaminophen (Tylenol) before the colposcopy. Ask your doctor or nurse if this is okay, and when and how much you should take.
How the Test will Feel
You may have some discomfort when the speculum is placed inside the vagina. It may more uncomfortable than a regular Pap smear.
Some women may hold their breath during pelvic procedures because they expect pain. Slow, regular breathing will help you relax and relieve pain. Ask your doctor or nurse about bringing a support person with you if that will help.
You may have some bleeding after the biopsy, for up to 1 week.
Why the Test is Performed
Colposcopy is done to detect cervical cancer and changes that may lead to cervical cancer.
It is most often done when you have had an abnormal Pap smear. It may also be recommended if you have bleeding after sexual intercourse.
Colposcopy may also be done when your health care provider sees abnormal areas on your cervix during a pelvic exam. These may include:
The colposcopy may be used to keep track of HPV, and to look for abnormal changes that can come back after treatment.
Your doctor should be able to tell you if anything abnormal was seen during this test. A smooth, pink surface of the cervix is normal.
If the colposcopy or biopsy does not show why the Pap smear was abnormal, your health care provider may suggest that you have a cold knife cone biopsy.
A specialist called a pathologist will examine the tissue sample from the cervical biopsy and send a report to your doctor. Biopsy results most often take 1 - 2 weeks. A normal result means there is no cancer and no abnormal changes were seen.
What Abnormal Results Mean
Your doctor should be able to tell you if anything abnormal was seen during the test, including:
Abnormal biopsy results may be due to changes that can lead to cervical cancer. These changes are called dysplasia, or cervical intraepithelial neoplasia (CIN).
Abnormal biopsy results may be due to:
If the biopsy does not determine the cause of abnormal results, you may need a procedure called a cold knife cone biopsy.
After the biopsy, you may have some bleeding for up to a week. You may have mild cramping, your vagina may feel sore, and you may have a dark discharge for 1 - 3 days.
A colposcopy and biopsy will not make it more difficult for you to become pregnant, or cause problems during pregnancy.
Call your health care provider if:
American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 99: management of abnormal cervical cytology and histology. Obstet Gynecol. 2008;112:1419-1444.
Apgar BS, Kittendorf AL, Bettcher CM, Wong J, Kaufman AJ. Update on ASCCP consensus guidelines for abnormal cervical screening: tests and cervical histology. Am Fam Physician. 2009;80:147-155.
Noller KL. Intraepithelial neoplasia of the lower genital tract (cervix, vulva): Etiology, screening, diagnostic techniques, management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, PA: Mosby Elsevier; 2007:chap 28.
Beard JM, Osborn J. Common office procedures. In: Rakel RE, ed. Textbook of Family Medicine. 8th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 28.
Review Date: 3/11/2014
Reviewed By: Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, WA; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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