Many women receive a routine Pap test. But if your doctor calls and asks you to come back in for some further testing, it likely means there was something abnormal in your test. Your doctor may want to perform what's called a colposcopy to better examine your cervix (the opening of your uterus) and your vagina for disease.

A colposcopy is essentially a pelvic exam that makes use of a colposcope, a microscope-like instrument that allows doctors to view the vagina and cervix under magnification. The device is used to help physicians detect precancerous and cancerous tissue. If, during the colposcopy, your provider sees any tissue that looks abnormal, he or she will perform a biopsy. This means they will take a small sample to send to a laboratory for further investigation.

“A cervical biopsy, while typically small, provides detailed information about the tissue and any potential abnormalities,” explains Sangini S. Sheth, MD, MPH, a Yale Medicine Ob/Gyn who, with her colleagues, routinely performs this diagnostic procedure. She wants women to know that colposcopies are safe, not very uncomfortable, and a vital way to follow up on abnormal Pap screening tests. 

A Pap test or “smear” is done to screen for cervical cancer by looking for abnormal cells that are sometimes called “precancerous.” These cells may be the first signs of cervical cancer, which can develop years later, and therefore should be closely monitored. For certain women, depending on age and prior medical history, doctors may recommend human papillomavirus (HPV) testing as part of cervical cancer screening. This is because persistent infection from high-risk, potentially cancer-causing strains of HPV lead to the vast majority of cervical cancers.

If Pap and/or HPV tests indicate certain abnormalities, the doctor may want to do a colposcopy to get a closer look and take a more targeted tissue sample. With the magnification provided by a colposcope, the doctor can see abnormal blood vessels, tissue structure, color, and patterns. Using the same instrument, a physician can take a biopsy from the vagina or the cervix and, sometimes, the vulva, for further study.

An Ob/Gyn may also use colposcopy if he or she discovers abnormal lesions during a routine gynecologic exam, or one performed in response to abnormal bleeding.

A colposcopy can be done as an outpatient procedure in an Ob/Gyn’s office. During the procedure, the Ob/Gyn will insert a speculum into the vagina in order to expose the cervix. He or she will then place the colposcope just outside the opening of the vagina and will apply a mild solution to the cervix, which highlights differences between normal and abnormal tissues. The doctor looks through the colposcope to examine tissues of the cervix and vagina. If any tissues look abnormal, the doctor will collect small tissue samples that will later be analyzed under a microscope in a laboratory.

Some women experience mild cramps during the procedure, and a biopsy may cause a slight pinching sensation. In all, the test should take 10 to 15 minutes and does not require anesthesia.

If a biopsy is taken, some women experience mild cramping or spotting for a few days. Women should not douche, use tampons, or have sexual intercourse for at least a few days following the procedure. Over-the-counter painkillers can be used to relieve discomfort.

Biopsy results are typically available in seven to 10 days. Abnormal results may indicate an increased risk of developing cervical cancer in the future. In these cases, a doctor will discuss the findings as well as options for monitoring and treatment. If there are no abnormalities found, or only mild ones, the doctor will discuss the appropriate time interval for future follow up.

Colposcopy is a safe and common procedure with few risks. However, possible complications of a biopsy may include discomfort, infection, and bleeding.

At Yale Medicine, we provide expert care for women who have abnormal cervical cancer screening results. Our gynecologists perform colposcopy with the most current, evidence-based guidelines, and with a high quality of care. We perform a large volume of colposcopies, and we are training the next generation of gynecologists to perform colposcopy in the same skilled fashion.

“With the ability to capture digital colposcopy images and store them within the patient’s medical record, we can monitor abnormalities more accurately over time. In addition, we aim to have a patient-centered approach in performing colposcopy and in determining subsequent care,” Dr. Sheth says.