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Many women receive a routine Pap test. But if your obstetrician-gynecologist (Ob/Gyn) 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, and possibly obtain a biopsy.

The procedure is essentially a pelvic exam that relies on an instrument called a colposcope, which has a magnifying lens and light, and is placed just outside your vaginal opening. If, during the colposcopy, your provider sees any tissue that looks abnormal (which could indicate precancerous changes), he or she will perform a biopsy, taking a small sample to send to a laboratory for further examination.

“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. 

Why might I need a colposcopy?

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 if not watched closely.

For certain women, depending on age and prior history, human papillomavirus (HPV) testing may also be performed as part of cervical cancer screening. This is because persistent infection from high-risk (cancer-causing) strains of HPV cause the vast majority of cervical cancers.

If your Pap or HPV test indicates certain abnormalities, your doctor may want to do a colposcopy to get a closer look and take a more targeted tissue sample. This request would come based on a pathology report from your Pap that indicated abnormalities. With a colposcope, your doctor can see abnormal blood vessels, tissue structure, color, and patterns. With the help of the same instrument, your physician can take a biopsy from the vagina or the cervix (and, sometimes, the vulva) for further study.

Your 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.

What does a colposcopy entail?

A colposcopy can be done in your Ob/Gyn’s office. Your doctor will review your medical history and discuss the benefits and risks of the procedure. You will then empty your bladder, undress from the waist down, put on a hospital gown, and lie on an exam table, just as you would for a pelvic exam. Your provider will insert a speculum into your vagina to expose the cervix and then place the colposcope just outside the opening of your vagina.

Your doctor will apply a mild solution of iodine or vinegar to your cervix, which will highlight the differences between any abnormal and normal tissue. Various patterns, colors, and abnormal vessels may indicate abnormalities on the cervix. Looking through the colposcope, which can also take pictures with a tiny camera, your doctor will perform biopsies if he or she sees tissue that looks unusual. The samples are sent to a lab.

You may experience mild cramps during the procedure and feel a slight pinch if a biopsy is done. The test should take 20 to 30 minutes and does not require anesthesia.

What is recovery from a colposcopy like?

If a biopsy is taken, you may have some mild cramping or spotting for a few days. You should not douche, use tampons, or have sex for one week after the procedure. You may take over-the-counter painkillers for any discomfort.

Biopsy results are typically available in seven to 10 days. If abnormal tissue is present that might increase your risk of developing cervical cancer in the future, your doctor will discuss these risks and the options for close monitoring or treatment. If there are no abnormalities found, or only mild ones, your doctor will discuss with you the appropriate time interval for future follow up.

What are the risks of colposcopy?

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

What stands out about Yale Medicine’s approach to colposcopy?

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.