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.
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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 provider will place an instrument (called a speculum) into your vagina. This allows your provider 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 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 provider if this is OK, 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 be more uncomfortable than a regular Pap test.
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 provider 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 or HPV test. It may also be recommended if you have bleeding after sexual intercourse.
Colposcopy may also be done when your 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.
A smooth, pink surface of the cervix is normal.
If the colposcopy or biopsy does not show why the Pap smear was abnormal, your 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 to 2 weeks. A normal result means there is no cancer and no abnormal changes were seen.
What Abnormal Results Mean
Your provider 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 to 3 days.
A colposcopy and biopsy will not make it more difficult for you to become pregnant, or cause problems during pregnancy.
Call your provider if:
American College of Obstetricians and Gynecologists. Practice bulletin no. 140: management of abnormal cervical cancer screening test results and cervical cancer precursors. Obstet Gynecol. 2013;122(6):1338-1367. PMID: 24264713 www.ncbi.nlm.nih.gov/pubmed/24264713.
Beard JM, Osborn J. Common office procedures. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine. 9th ed. Philadelphia, PA: Elsevier; 2016:chap 28.
Salcedo MP, Baker ES, Schmeler KM. Intraepithelial neoplasia of the lower genital tract (cervix, vagina, vulva): etiology, screening, diagnosis, management. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 28.
Smith RP. Carcinoma in situ (cervix). In: Smith RP, ed. Netter's Obstetrics & Gynecology. 3rd ed. Philadelphia, PA: Elsevier; 2018:chap 115.
Review Date: 1/14/2018
Reviewed By: John D. Jacobson, MD, Professor of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda Center for Fertility, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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