What Is Cervical Biopsy?

What to expect when undergoing this test

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

A cervical biopsy is a diagnostic procedure during which a sample of tissue is taken from a woman's cervix for microscopic evaluation. You may need a cervical biopsy if you had an abnormal Pap smear result or if you are at high risk of cervical cancer.

Purpose of Procedure

The cervix, often referred to as the birth canal, is the area that connects the vagina to the uterus. You would need a cervical biopsy if there is a concern that you have early-stage cervical cancer.

The biopsy provides a sample of tissue that can be evaluated by a pathologist to determine if you have cervical cancer or precancerous changes.

Indications for the diagnostic procedure include:

  • Pap smear results: A Pap smear is a screening test that is recommended every three years for women between the ages of 21 to 65, or every five years if accompanied by a human papillomavirus (HPV) test. If your Pap smear shows cervical dysplasia, which indicates abnormal, precancerous cells in the cervix, you may need a biopsy.
  • Cervical examination: If your doctor notices abnormalities during your cervical examination, you may need a biopsy to evaluate these abnormalities in greater detail.
  • Imaging: If you have the appearance of cervical cancer on an imaging test, such as a computed tomography (CT) scan, magnetic resonance imaging (MRI), or ultrasound, you may need a biopsy to characterize the type of cells in your cervix.
  • Symptoms: Vaginal bleeding after sexual intercourse, irregular or heavy menstrual bleeding, pelvic pain, and vaginal discharge are all possible symptoms of cervical cancer. When these symptoms are considered along with your medical history, you may need a cervical biopsy to identify whether cervical cancer is the cause.
  • Risk factors: You may have an increased risk of cervical cancer if you have a family history of cervical cancer, diethylstilbestrol (DES) exposure, or a history of HPV infection. Depending on your symptoms and other diagnostic tests, a cervical biopsy may be needed.

Risks and Contraindications

A cervical biopsy is an invasive procedure, and it can cause bleeding or an infection. In rare instances, it can cause long-term complications such as decreased fertility or an incompetent cervix.

It is generally not recommended if you are pregnant, but your doctor will discuss the risks and benefits with you if you need to have a cervical biopsy during pregnancy.

Before the Procedure

A cervical biopsy is generally considered a relatively low-risk procedure, and cervical cancer is a serious potential diagnosis. Your doctor will discuss your previous test results along with any symptoms or risk factors you have as you plan your cervical biopsy.

If you are taking blood thinners, you may be asked to stop taking them for a day or two before your procedure. Do not stop taking blood thinners unless you discuss this with your doctor first.

Timing

A cervical biopsy typically takes about 10 to 30 minutes. If you experience some bleeding, your doctor may want to wait until the bleeding has slowed down before you leave.

Location

A cervical biopsy can be done in your doctor's exam room or in a procedure suite. In rare instances, it may be done in an operating room if surgery is anticipated.

What to Wear

You can wear whatever is comfortable for you, as you will be asked to undress from the waist down and wear a gown for your procedure.

Food and Drink

You do not need to make any special changes regarding food or drink before a cervical biopsy.

Cost and Health Insurance

Generally, most health insurance plans cover the cost of a cervical biopsy, but you may want to check whether that is indeed the case under your plan and if you have a co-pay. If you are paying for your procedure out of pocket, you should expect the cost to range from $2,500 to $5,000, but there is variability based on geographic location and the type of biopsy.

Other Considerations

It is recommended that women not have sex or douche for 24 to 48 hours before a cervical biopsy, as this can interfere with the biopsy result.

During the Procedure

A cervical biopsy is normally performed during an in-office procedure called a colposcopy. Your gynecologist may do your cervical biopsy, or you will be referred to a gynecologist for the procedure.

Pre-Procedure

You will be asked to fill out paperwork consenting to your procedure and agreeing to payment. You will meet a nurse, who may check your blood pressure and pulse, and take you into the procedure room.

Throughout the Procedure

You will be asked to undress from the waist down and wear an examination gown. Right before your procedure is about to start, you lie down and put your legs in stirrups.

A cervical biopsy begins in a way that is very similar to a Pap smear. However, with a cervical biopsy, more tissue is removed, and the tissue sample is often taken from a specific area of concern.

Your doctor will begin by visualizing your cervix with a colposcope, which is a magnifying instrument used to visualize the cervix. Your doctor will gently insert a speculum into your vagina, and a solution will be placed on your cervix to make it easier to identify abnormal areas. Your doctor will position the colposcope about 30 centimeters from your vagina to get a better view of your cervix.

You may need a local anesthetic, but this is not always necessary with small biopsies.

Once your doctor identifies an abnormal area of your cervix, which usually appears white in color, the biopsy will be taken, typically from the whitest area or areas, and sent to a lab for analysis. 

There are several types of cervical biopsies:

  • Punch biopsy: Your doctor removes a small amount of tissue with a device that resembles a paper hole puncher.
  • Endocervical curettage (ECC): An ECC removes tissue using a small scoop-like device.
  • Cone biopsy: A cone-shaped area is removed from the cervix with a laser or scalpel.

Most women experience little to no discomfort during a cervical biopsy. Your doctor may ask you to cough just as the sample is being taken to alleviate any immediate discomfort.

Your doctor will stop the bleeding after the biopsy is taken by placing an absorptive material or a suture.

Post Procedure

Once your doctor removes the speculum, you should feel minimal, if any, discomfort. Your doctor or nurse will provide you with towels to wipe any discharge or blood, and you may need to use the toilet. You may be provided with a sanitary pad in case you have any discharge or bleeding.

After the Procedure

You may experience light bleeding and/or mild cramping up to a week after a cervical biopsy. Most doctors recommend avoiding sex or tampons for up to two weeks afterward.

Typically, you should not need to take any pain medication for post cervical biopsy discomfort. However, you should let your doctor know if you have any heavy bleeding, discharge, foul-smell, fever, or severe pain.

Interpreting Results

Results from a cervical biopsy are typically ready within two weeks. The pathologist will send your doctor a report describing whether the cells are normal or abnormal, and detailing their appearance.

If you have normal results, this is highly suggestive that you do not have cervical cancer, because your biopsy was typically taken from the most concerning area or areas of your cervix.

Abnormal results from a cervical biopsy can indicate low-grade dysplasia (mild), high-grade dysplasia (moderate to severe), or cervical cancer. Cervical dysplasia means that there are precancerous changes to the cervix.

Follow-Up

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

If you have abnormalities, your doctor may monitor your condition and see whether it persists or worsens, because it can take many years for cervical cancer to develop. Depending on how extensive or advanced the dysplasia is, your doctor may decide that you need surgical resection of the dysplasia before it develops into cancer.

A Word From Verywell

Cervical dysplasia usually does not cause any symptoms, so that's why it's important to get regular screenings from your doctor. Cervical dysplasia is a risk factor for the development of cervical cancer. When cervical cancer is caught in its earliest stage, the survival rate is 93 percent.

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