Colposcopy: What to Expect

There is usually very little preparation needed before a colposcopy, and you can eat and drink normally before your appointment.

A few things to keep in mind:

• Try to avoid scheduling during your period when possible. Light spotting is usually okay, but heavier bleeding can make it difficult to see the cervix clearly. If your period starts before your appointment and you are having more than light bleeding, please call our office so we can determine whether your procedure should be rescheduled.

• We will usually ask you to provide a urine sample for a pregnancy test before the procedure. Please let us know if you are pregnant or think you could be pregnant. Colposcopy can still be performed during pregnancy when needed, but the procedure is approached somewhat differently.

• You may take ibuprofen (Motrin/Advil) or acetaminophen (Tylenol) before your appointment if you normally take these medications safely. Taking a dose about 30–60 minutes beforehand may help with cramping from cervical biopsies.

• You are welcome to bring a support person with you if that would make you more comfortable.

• You will typically be able to drive yourself home and return to normal activities after the procedure.

A colposcopy is performed in the office and usually takes about 10–15 minutes. Here's what you can expect:

1. Getting positioned
You'll lie on the exam table just as you would for a routine pelvic exam. A speculum is placed in the vagina so that we can see your cervix.

2. Looking closely at the cervix
A colposcope is a special magnifying instrument that allows us to examine the cervix in much greater detail. The colposcope stays outside of your body throughout the procedure. We pay particular attention to the transformation zone, where most HPV-related cervical cell changes develop.

3. Applying solutions to highlight abnormal areas
We apply a dilute vinegar (acetic acid) solution to the cervix. This temporarily causes certain abnormal cells to appear white, making areas of concern easier to see. We may also use other solutions, such as Lugol's iodine, to help distinguish normal from potentially abnormal tissue.

4. Taking biopsies, if needed
If an area looks abnormal, we may take one or more small biopsies from the surface of the cervix. I typically use a lidocaine numbing spray first to help make this more comfortable. You may still feel a brief pinch or cramp when a biopsy is taken.

5. Sampling the cervical canal, if needed
Sometimes we also collect a small sample from just inside the opening of the cervix. This is called an endocervical curettage (ECC) and allows us to evaluate cells from an area that can't be seen as easily during the exam. An ECC can cause a brief menstrual-like cramp.

6. Controlling any bleeding
After biopsies are completed, we make sure there is no significant bleeding. Silver nitrate is commonly applied to the biopsy sites, and sometimes Monsel's solution is used instead. Monsel's can cause dark brown, black, or coffee-ground-like vaginal discharge afterward, which is normal.

If biopsies are taken during your colposcopy, the tissue is sent to a pathologist for evaluation under a microscope. The biopsy provides more specific information than what we can see during the colposcopy itself and helps determine whether you need routine follow-up, closer monitoring, or treatment.

Biopsy results may include:

• Normal / No dysplasia: No precancerous changes were identified. Your recommended follow-up will depend on the Pap and HPV results that led to your colposcopy.

• CIN 1 (low-grade dysplasia): Mild cell changes, usually related to HPV. CIN 1 often resolves as the immune system controls the HPV infection and can usually be monitored without treatment.

• CIN 2 (high-grade dysplasia): More significant abnormal cell changes. Depending on your age, pregnancy plans, previous results, and other factors, treatment may be recommended, although careful monitoring may be appropriate in some situations.

• CIN 3 (high-grade dysplasia): More significant precancerous changes with a greater risk of progressing over time. Treatment is generally recommended.

• Cervical cancer: Cancer is uncommon following colposcopy for an abnormal screening test, but if cancer is identified, additional evaluation and treatment will be arranged.

CIN stands for cervical intraepithelial neoplasia. CIN is not cervical cancer. It describes precancerous changes in the cells of the cervix that can be monitored or treated to prevent cervical cancer from developing.

If your biopsy shows higher-grade cervical dysplasia, treatment may be recommended to remove the abnormal cells and prevent them from progressing over time. The most common treatment is a LEEP, although a cold knife cone biopsy (CKC) may be recommended in some situations.

Learn more: 

→ LEEP 

→ Cold Knife Cone Biopsy

Results are typically available within 3–5 days. We will review your pathology results along with your previous Pap and HPV testing and let you know what follow-up is recommended.

Most patients are able to return to their usual activities immediately after a colposcopy. If biopsies were taken, it is normal to have some mild symptoms afterward.

You may notice:

• Mild cramping for several hours after the procedure. Ibuprofen (Motrin/Advil) or acetaminophen (Tylenol) can be used if needed.

• Light spotting or bleeding for a few days.

• Dark brown, black, or coffee-ground-like discharge if medication was applied to the cervix to control bleeding. This is normal and may continue for several days.

• Mild vaginal discharge as the biopsy sites heal.

If a biopsy was taken, avoid intercourse, tampons, and anything else inside the vagina for 1-2 days to allow the cervix to heal. Pads or panty liners can be used for any spotting or discharge.

You can otherwise shower, exercise, work, and continue your normal daily activities as you feel comfortable.

Biopsy results are typically available within 3–5 days. We will review your results and let you know whether any additional testing, monitoring, or treatment is recommended.