What Is a Cervical Biopsy?

What to expect when undergoing this procedure

A cervical biopsy is a minor surgical procedure in which a sample of tissue is taken from the cervix, the cylinder-shaped structure connecting the vagina and the uterus. A cervical biopsy may be needed if you had an abnormal Pap smear, if your healthcare provider noted an abnormality during a routine pelvic exam, or if you are at high risk of cervical cancer.

This article will review the use of cervical biopsy, why it's needed, how it is performed, and what happens with the results.

Cervical Pap smear showing abnormal cells
Spike Walker / The Image Bank / Getty Images

Purpose of Procedure

A cervical biopsy is important for the detection of cancer or precancerous cells. Indications for a cervical biopsy include:

  • Abnormal Pap smear
  • A positive test for high-risk strains of human papillomavirus (HPV)
  • Abnormalities detected during a pelvic examination
  • Abnormal imaging test results that suggest cervical cancer, such as a computed tomography (CT) scan, magnetic resonance imaging (MRI), or ultrasound
  • Symptoms of cervical cancer, such as vaginal bleeding after sexual intercourse, irregular or heavy menstrual bleeding, pelvic pain, or vaginal discharge

In addition, a cervical biopsy sometimes is done to diagnose genital warts or cervical polyps. A healthcare provider also may choose to do a cervical biopsy on a woman whose mother took diethylstilbestrol (DES) while pregnant.

DES was prescribed from 1938 until 1971 to prevent miscarriage, premature labor, and related complications. The drug was discontinued in the U.S. in 1971 when researchers discovered it increased the risk of reproductive cancers in the daughters of women who took it during pregnancy.

Once a cervical biopsy has been ordered, it is important to know which type you will have. There are a few different types of biopsies including:

  • Punch biopsy, in which a small amount of tissue is removed with a device that resembles a hole punch
  • Endocervical curettage (ECC), which involves removing a sample with a scoop-like instrument
  • Cone biopsy, a more involved procedure in which a laser or scalpel is used to remove a cone-shaped tissue sample

Risks

A cervical biopsy is usually safe for most women. The most common complication associated with the procedure is light bleeding. More serious complications include:

  • Infection
  • Incompetent cervix (see pregnancy risks below)
  • Pelvic pain

A cone biopsy, in particular, can result in heavy bleeding and (though rare) infection, injury to tissue, vaginal tears, perforation of the uterus requiring surgical repair, or impaired menstrual flow (cervical stenosis due to scarring).

Pregnancy-Related Risks

Some cervical biopsy procedures may be associated with an increased risk of premature birth due to an incompetent cervix. This is primarily a concern when more than 1 centimeter (roughly 1/2 inch) of tissue is cut out and is more common if a woman gives birth within one year of the procedure.

Incompetent Cervix

If you have a procedure that may raise your risk of preterm labor, your healthcare provider will monitor you closely during pregnancy. In some cases, your healthcare provider may recommend a cervical cerclage where the cervix is sewn closed. This procedure can help prevent preterm labor.

Contraindications

Women who have acute pelvic inflammatory disease or inflammation of the cervix will usually need to wait until their condition has subsided before having a cervical biopsy.

A cervical biopsy is generally safe during early pregnancy, although bleeding may occur. The benefits versus risks need to be carefully weighed for each person by reviewing Pap smear results, any history of abnormal Pap smears, and history of HPV infections.

Before the Procedure

Tell your healthcare provider if you're allergic or sensitive to any medications or to latex. it's also important to tell your healthcare provider what medications you're taking, as some can increase the risk of bleeding. These medications include:

  • Aspirin
  • Advil (ibuprofen)
  • Aleve (naproxen)
  • Blood thinners like Coumadin (warfarin)

Your healthcare provider will tell you if you should stop taking these medications before your cervical biopsy and how soon to do so.

Don't use tampons, vaginal creams or medicines, or douche for 24 hours before the procedure, and refrain from sexual intercourse for 24 hours before a cervical biopsy.

Location

The place a cervical biopsy is performed may vary, depending on your condition and your healthcare provider's practices. Usually it is done in the practitioner's exam room or in an outpatient facility. In rare instances, a biopsy may be scheduled in an operating room if surgery is anticipated due to any further complications.

What to Wear

You will need to remove your clothing from the waist down and put on a hospital gown for your biopsy, so choose a skirt or trousers with a comfortable top rather than a dress or other one-piece garment.

Exam rooms can be chilly, so it's advisable to wear or bring socks to keep your feet warm during the procedure.

Food and Drink

You do not have to make any special changes regarding food or drink before a cervical biopsy. However, if you will be having a cone biopsy, in which general anesthesia is necessary, you likely will be instructed to not eat or drink for at least eight hours before your procedure.

Cost and Health Insurance

Most health insurance plans cover the cost of a cervical biopsy. Confirm that this is the case with your insurance company, and find out if you will need to bring a copay with you to your appointment.

What To Bring

You may experience light bleeding after the procedure. The healthcare provider's office or clinic will likely have sanitary napkins, but you may want to bring your own just in case.

During the Procedure

When you arrive for your cervical biopsy, you will check in at the front desk. If you're having a cone biopsy, your healthcare provider may come out to greet you.

Pre-Procedure

In the waiting room, you will be asked to fill out paperwork consenting to the biopsy and agreeing to pay, if you haven't done so already. When it's time for your procedure, a nurse will have you empty your bladder and then escort you to the room where it will take place. They will give you a gown and leave the room to give you privacy after instructing you to undress from the waist down. They may check your blood pressure, pulse, and temperature before or after you change.

Your healthcare provider may prescribe a pain reliever 30 minutes before the procedure.

Throughout the Procedure

Here are the steps you will most likely go through for a cervical biopsy:

  • A cervical biopsy begins much like a Pap smear. You will lie down and put your feet in stirrups.
  • You may be given a local anesthetic, but this is not always necessary with small biopsies. 
  • The healthcare provider will insert a speculum into your vagina to hold it open and provide access to your cervix. They also may use a colposcope, an instrument with a special lens like a microscope, to get a close look at your cervical tissue.
  • Before taking the sample, the healthcare provider will clean the cervix. If you have any sensation, this may burn a bit but should not be painful.
  • Next, your cervix will be swabbed with iodine for what is called Schiller’s test. The iodine will turn abnormal tissue a different color so that it's easy to see. It is from the whitest areas that samples will be taken.
  • The amount of tissue removed and where it is removed from depends on the type of biopsy you have. When this is done, you may feel a slight pinch or cramp.
  • If you have a cone biopsy, your healthcare provider may use a loop electrosurgical excision procedure (LEEP) or the cold knife cone biopsy procedure. With the cold knife cone biopsy, a laser or a surgical scalpel may be used to remove tissue.

Bleeding from the biopsy site may be treated with medication, and if necessary, they may also use a probe (electrocauterization) or stitches to stop the bleeding.

After the Procedure

After the speculum is removed, the healthcare provider or a nurse will provide you with towels to wipe any discharge or blood, and you may need to use the toilet. You may also need a sanitary napkin if you have discharge or bleeding.

Recovery will depend on the type of biopsy done and if you had anesthesia.

You will be taken to the recovery room and monitored with general anesthesia until you're fully awake and no longer groggy. Once your blood pressure, pulse, and breathing are stable, you will be taken to a hospital room or discharged. If you had the procedure done at an outpatient facility, you should arrange for someone to pick you up.

After a simple biopsy, you may rest for a few minutes before going home.

Recovery

It's normal to have mild cramping, spotting, and dark or black-colored discharge for several days after a cervical biopsy. The dark discharge is from the medicine applied to your cervix to control bleeding.

If necessary, take a pain reliever for cramping, as recommended by your healthcare provider.

Most healthcare providers recommend avoiding sex or using tampons for up to two weeks after a cervical biopsy. Certain activities may also be restricted. Full recovery from a cone biopsy may take several weeks.

Managing Side Effects

Typically, you should not need to take any pain medication for post-cervical biopsy discomfort. Call your healthcare provider if you experience any of the following signs of infection:

  • Pain
  • Fever
  • Heavy bleeding
  • A foul-smelling vaginal discharge

Interpreting Results

Your healthcare provider will send your cervical sample to a pathology lab immediately after the procedure, and it can take a few weeks to result. The pathologist will send a report describing whether the cells are normal or abnormal and detailing their appearance. The healthcare provider will then call you to share the results.

If they're normal, it most likely means you do not have cervical cancer. Abnormal results can indicate low-grade dysplasia (mild), high-grade dysplasia (moderate to severe), or cervical cancer. Cervical dysplasia means there are precancerous changes to the cervix.

  • CIN1 (low-grade intraepithelial lesion/LSIL) indicates mild changes, often due to a persistent HPV infection. Many of these changes go away on their own.
  • CIN2 shows cells that appear more abnormal than CIN1. For roughly 50% of women, these changes also go away on their own.
  • CIN3 will often progress to cervical cancer if untreated.

Adenocarcinoma in situ (AIS) means that cancer cells are present but may still be localized to the area where they originated (pre-invasive). Though the cells appear cancerous, they do not yet have the potential to spread.

The terminology and treatment approaches for cervical dysplasia can be very confusing. Make sure to talk to your healthcare provider about any questions you may have.

Follow-Up

Untreated cervical dysplasia may lead to cervical cancer in some cases. However, having cervical dysplasia does not mean you have cancer or will develop the disease.

It can take years for cervical cancer to develop. Depending on how extensive or advanced the dysplasia is, your healthcare provider may decide that you need surgical resection of the dysplasia before it develops into cancer. Treatment options may include cryotherapy, laser therapy, loop electrosurgical procedure (LEEP), or conization.

Recommendations for follow-up and treatment will depend not only on your biopsy results but on your history of Pap smears, HPV testing, your age, and biopsies in the past.

For example, suppose you have a biopsy that suggests CIN2, and you have a history of a high-grade intraepithelial lesion (HSIL) in the past. In that case, recommendations may differ from those for someone who has a CIN2 biopsy with no history of Pap smear abnormalities in the past.

Remember, there are many factors that healthcare providers consider when recommending treatment. Two biopsies that look the same under the microscope may be treated very differently depending on age, history of Pap smears, pregnancy, and more.

Summary

Your healthcare provider may recommend a cervical biopsy if your Pap smear results are abnormal. A biopsy can be done in a few different ways to remove abnormal cells and have them tested for the presence of cancer.

This procedure is often done in a healthcare provider's office, with results available in a few weeks after the pathologist reviews the sample.

The results will help your healthcare provider determine the best treatment options if needed.

A Word From Verywell

Having a biopsy and waiting for the results can be very anxiety-producing. But the procedure may be the best way to stave off cancer or illness before it becomes a severe and full-blown disease. That's why it's important to get regular screenings and, if necessary, a biopsy. When cervical cancer is caught in its earliest stage, there is a 93% five-year survival rate.

Frequently Asked Questions

  • What causes abnormal cervical cells besides HPV?

    There are other causes of abnormal cells including:

    • yeast infection
    • inflammation
    • hormonal changes
  • How long after a cervical biopsy can you have intercourse?

    The exact length of time to abstain from intercourse will vary based on the type of biopsy, and will be told to you by the healthcare provider.

Originally written by Lisa Fayed
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8 Sources
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