Colposcopy

What is a colposcopy?

A colposcopy is a procedure to examine your cervix, vagina, and vulva:

• The vagina connects your womb (uterus) and cervix to the outside of your body.
• The cervix is the lower part of your uterus (the uterus is the place where a baby grows during pregnancy).
• The vulva includes your genital parts that are outside your body.

During the procedure, your health care provider will be looking for abnormal cells, which could be cancer or precancer. Precancer means that the cells could turn into cancer over time.

To do the procedure, your provider will use a lighted, magnifying device called a colposcope. They will place the device at the opening of your vagina. The device magnifies the normal view, allowing your provider to see problems that can't be seen by the eyes alone.

If your provider sees a problem, they may take a tissue sample for testing (biopsy). The sample is most often taken from the cervix. This procedure is known as a cervical biopsy. Biopsies may also be taken from the vagina or vulva. The results of the biopsy will show if you have cells that are cancer or precancer.

Other names: colposcopy with directed biopsy

What is it used for?

A colposcopy is most often used to find abnormal cells in the cervix, vagina, or vulva. It may also be used to:

• Check for genital warts, which may be a sign of an HPV (human papillomavirus) infection. Having HPV may put you at higher risk for developing cervical, vaginal, or vulvar cancer.
• Look for noncancerous growths called polyps.
• Check for irritation or inflammation of the cervix.
• Check for the cause of abnormal vaginal bleeding or vulvar itching.

If you've already been diagnosed and treated for HPV, the test may be used to monitor cell changes in the cervix. Sometimes, abnormal cells return after treatment.

Why do I need a colposcopy?

You may need this test if you had abnormal results on a Pap smear. A Pap smear is a test that involves collecting a sample of cells from the cervix. It can show if there are abnormal cells but can't provide a diagnosis. A colposcopy provides a more detailed look at the cells. It may help your provider confirm a diagnosis and/or find other potential problems. It could allow your provider to find precancer cells early enough that they can be treated and might not turn into cancer.

You may also need this test if you have:

• Been diagnosed with HPV
• Abnormal areas on your cervix (which were seen during a routine pelvic exam)
• Bleeding after sex

What happens during a colposcopy?

A colposcopy may be done by your primary care provider or a gynecologist, a doctor who specializes in diagnosing and treating diseases of the female reproductive system. The test is usually done in the provider's office and takes 10 to 20 minutes. If the provider finds abnormal tissue, you may also get a biopsy. which may take about 10 minutes longer.

During a colposcopy:

• You will remove your clothing and put on a hospital gown.
• You will lie on your back on an exam table with your feet in stirrups.
• Your provider will insert an instrument called a speculum into your vagina. A speculum is the same instrument used in a Pap smear. It is used to spread open your vaginal walls so that your cervix is visible.
• Your provider will place the colposcope outside your vagina.
• Your provider will shine a light into your vagina and look through the colposcope, which provides a magnified view of the cervix, vagina, and vulva.
• Your provider will gently swab your cervix and vagina with a vinegar or iodine solution. The solution makes abnormal tissues easier to see.
• If any areas of tissue look abnormal, your provider may perform a cervical, vaginal, or vulvar biopsy.

During a biopsy:

• A vaginal biopsy may cause mild to moderate pain, and your provider may recommend you take an over-the-counter pain reliever before the procedure or give you medicine to numb the area.
• Once the area is numb, your provider will use a small tool to remove a tissue sample for testing. Sometimes, many samples are taken.
• Your provider may also do a procedure called an endocervical curettage (ECC). This procedure involves taking a tissue sample from the inside of the opening of the cervix. This area can't be seen during a colposcopy. An ECC is done with a special tool called a curette. You may feel a pinch or cramp as the tissue is removed.
• Your provider may apply a topical medicine to the biopsy site to treat any bleeding you may have.

After a biopsy, you should not douche, use tampons, or have sex for a week after your procedure or for as long as your provider advises.

Will I need to do anything to prepare for the test?

Do not douche, use tampons or vaginal medicines, or have any kind of vaginal penetration for 48 hours before the test. Also, it's best to schedule your colposcopy when you are not having your menstrual period. Your provider may recommend taking an over-the-counter pain reliever before your appointment.

Tell your provider if you are pregnant or think you may be pregnant. Colposcopy is generally safe during pregnancy, but being pregnant raises your risk of bleeding after a biopsy.

Are there any risks to the test?

There is very little risk to having a colposcopy. You may have some discomfort when the speculum is inserted into the vagina, and the vinegar or iodine solution may sting, tingle, or burn.

A biopsy is also a safe procedure. You may feel a pinch or some pain when the tissue sample is taken. After the procedure, you may be sore for a day or two. You may have some cramping and slight bleeding. It's normal to have a little bleeding and discharge for up to a week after the biopsy.

Serious complications from a biopsy are rare, but call your provider if you have any of the following symptoms:

• Heavy bleeding
• Abdominal (belly) pain
• Signs of infection, such as fever, chills, and/or bad smelling vaginal discharge

What do the results mean?

During your colposcopy, your provider may find one or more of the following conditions:

• Genital warts
• Polyps
• Swelling or irritation of the cervix
• Abnormal tissue

If your provider also performed a biopsy, your results may show you have:

• Precancerous cells in the cervix, vagina, or vulva
• An HPV infection
• Cancer of the cervix, vagina, or vulva

If your biopsy results were normal, it's unlikely that you have cells in your cervix, vagina, or vulva that are at risk for turning into cancer. But that can change. So, your provider may want to monitor you for cell changes with more frequent Pap smears and/or additional colposcopies.

If you have questions about your results, talk to your provider.

Is there anything else I need to know about a colposcopy?

If your results show that you have precancerous cells, you may need to have a procedure to remove them. This may prevent them from developing into cancer.

If your results show that you have cancer, you may be referred to a gynecologic oncologist. This is a provider who specializes in treating cancers of the female reproductive system.