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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.

Alternative Names

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 examines 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:

  • Do not douche
  • Do not place any products into the vagina
  • Do not have sex for 24 hours before the exam
  • Tell your doctor or nurse if you are pregnant or could be pregnant

This test should not be done during a heavy period, unless it is abnormal. Keep your appointment if you are:

  • At the very end or beginning of your regular period
  • Having abnormal bleeding

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 feel a slight sting from the cleansing solution.
  • You may feel a pinch or cramp each time a tissue sample is taken.
  • You may have some cramping or slight bleeding after the biopsy.
  • Heavy bleeding is unusual; if you have bleeding that soaks a pad in an hour, call your doctor.
  • Do not use tampons or put anything in the vagina for several days after a biopsy.

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.

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:

  • Any abnormal growth on the cervix, or elsewhere in the vagina
  • Genital warts or HPV
  • Irritation or inflammation of the cervix (cervicitis )

The colposcopy may be used to keep track of HPV, and to look for abnormal changes that can come back after treatment.

Normal Values

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.

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 patterns in the blood vessels
  • Areas that are swollen, worn away, or wasted away (atrophic)
  • Cervical polyps
  • Genital warts
  • Whitish patches on the cervix

Abnormal biopsy results may be due to changes that can lead to cervical cancer. These changes are called dysplasia, or cervical intraepithelial neoplasia (CIN).

  • CIN I is mild
  • CIN II is moderate
  • CIN II is severe dysplasia or very early cervical cancer called carcinoma in situ

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.

What the risks are

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:

  • Bleeding is very heavy or lasts for longer than 2 weeks.
  • You have pain in your belly or in the pelvic area.
  • You notice any signs of infection (fever, foul odor, or discharge).

Special considerations

You may have some bleeding after the biopsy for up to 1 week.

You should not douche, place tampons or creams into the vagina, or have sex for up to a week afterward. Ask your doctor or nurse how long you should wait. You can use sanitary pads.

If the colposcopy or biopsy does not show why the Pap smear was abnormal, your health care provider may suggest that you have a more extensive biopsy.

See also: Cold knife cone biopsy

References

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.

Cervical cancer in adolescents: screening, evaluation, andmanagement. Committee Opinion No. 463. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2010;116:1492-1509.

Updated: 2/26/2012

Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.


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