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Colposcopy - Directed Biopsy

Definition

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 to position your pelvis for examination. The health care provider will insert an instrument (speculum) into your vagina to open the vaginal walls and examine the cervix.

The cervix and vagina are gently swabbed with dilute vinegar (acetic acid). This removes the mucus that covers the surface and highlights abnormal areas. Sometime an iodine-based solution (Lugol's) similar to solutions used for cleaning skin may also be swabbed on the cervix and vagina.

The health care provider will place the colposcope at the opening of the vagina and examine 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 (biopsy) using small biopsy forceps. Many samples may be taken, depending on the size and location of the area. 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.

You should not douche, place any products into the vagina, or have sexual intercourse for 24 hours before the exam. You should not be menstruating heavily. However, if you are at the very end or beginning of your regular period or you are having abnormal bleeding, you should still keep your appointment.

You may be able to take ibuprofen or acetaminophen (Tylenol) before the colposcopy. Ask your doctor if this is okay, and when and how much you should take.

Tell your doctor before the test if you are pregnant or could be pregnant.

How the Test Will Feel

The placement of the instrument (speculum) to better see the cervix may be more uncomfortable than for a regular Pap smear.

Some women feel a slight sting from the vinegar or Lugol's solution.

The biopsy or curettage may feel like 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.

It is typical for women to hold their breath during pelvic procedures because they expect pain. Concentrating on 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 either cancer of the cervix or changes that may lead to cancer at an early stage.

This procedure 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 Results

Your doctor should be able to tell you about anything abnormal that was seen during a colposcopy. A smooth, pink surface of the cervix is normal.

A specialist called a pathologist will examine the tissue sample from the cervical biopsy and will report to your doctor whether the cells appear normal or abnormal. Results of a biopsy most often take 1 - 2 weeks. If the biopsy results are normal, it means that no cancer or precancerous changes were seen in the cells.

What Abnormal Results Mean

Abnormal findings that may be seen during the colposcopy include:

  • 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 include:

  • Cancer of the cervix
  • Cervical intraepithelial neoplasia (precancerous tissue changes that are also called cervical dysplasia)
  • Cervical warts (infection with human papilloma virus, or HPV)

Risks

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).

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.

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.