What Is Colposcopy?

What to expect when undergoing this test

A colposcopy is an in-office diagnostic procedure that a doctor uses to examine the inside of the vagina, vulva, and cervix for concerns such as cell changes, growths, and inflammation. An illuminated, magnifying instrument called a colposcope is used to access the areas and provide a clearer view. You may need a colposcopy for investigation of your symptoms or as a follow-up evaluation after an abnormal pelvic exam or Pap smear.

what to expect during a colposcopy
 Illustration by Emily Roberts, Verywell

Purpose of Test

A colposcopy allows your doctor to see the inside these areas so he or she can carefully look for and examine lesions or abnormalities with the aid of magnification. Several different solutions can be applied to help your doctor assess the cervical lining during this procedure. Your doctor might take a sample of tissue for biopsy examination during your colposcopy as well.

Symptoms that may prompt an evaluation with a colposcopy:

  • Pelvic discomfort, pain, and cramping
  • Irregular vaginal bleeding
  • Excessive vaginal bleeding
  • Vaginal or cervical pain, irritation or discharge

According to the American College of Obstetricians and Gynecologists (ACOG), a colposcopy is recommended if a pelvic examination showed:

  • Cancer or pre-cancer: These changes can be detected on a routine Pap smear and require further investigation and, perhaps, treatment.
  • Cervicitis: Inflammation of the cervix can be caused by illness, infection, irritation, or physical abrasion.
  • Polyps: Growths on the cervix are typically not cancerous and often need to be removed.
  • Genital warts: Warts, typically caused by HPV infection, can be present on the vagina or cervix and may cause serious problems, such as cancer.

Limitations

A colposcopy does not extend all the way to the uterus, and it does not provide a view of the outside of the cervix or the surrounding structures.

Risks and Contraindications

In general, this test is considered safe. If you are pregnant, a biopsy can cause cramping and may increase the risk of complications, such as premature labor or miscarriage. If you are prone to bleeding or take a blood thinner, you may experience heavy bleeding after a biopsy.

Before the Test

If you need to have a colposcopy, your doctor will schedule it for a time when you are not having your period, as this can change the appearance of the cervix and the bleeding may interfere with optimal visualization.

It's also important to not place anything into your vagina for at least one day prior to the procedure, so you will be instructed to abstain from sexual intercourse, using vaginal creams, douching, or using tampons. 

Tell your doctor if you are taking any blood-thinning medications like aspirin or warfarin, but do not stop taking them unless you are instructed to do so.

Timing

You might have your colposcopy in your doctor's office as part of your gynecologic examination. If this is the case, you should expect the procedure to last for about 10 to 20 minutes. If you have to come back for the colposcopy, you should anticipate a bit longer time commitment.

Location

A colposcopy is done in the doctor's examination room. Most of the time, you need to see a gynecologist to have your colposcopy done, but sometimes a primary care doctor can do it as well.

What to Wear

You will be asked to change into a hospital gown, so you can wear whatever is comfortable on your way to the test.

Food and Drink

You do not need to make any adjustments in your food or drink prior to having a colposcopy.

Cost and Health Insurance

If you are having a colposcopy, your insurance may require a pre-authorization, which your doctor's office should take care of. You may also need to pay a co-pay, and your insurance company and doctor's office will be able to tell you the amount. If you are paying for the test out of pocket, you should expect the cost to be between $200 and $500; the amount will be on the higher end if you are having a biopsy.

What to Bring

You should be sure to bring your test order form, your health insurance card, a form of identification, and a method of payment for the co-pay or the test if you need it.

During the Test

Your test will be done by your gynecologist or primary care doctor, and an assistant or nurse may be present as well.

Pre-Test

You will need to fill out some paperwork, including a consent form for the procedure, authorization for payment, and patient privacy forms.

You will be asked to change into a gown, and your nurse may ask you if you need to empty your bladder so that the test will be more comfortable. Once on the examination table, you will be asked to lie down and place your feet in footrests.

Throughout the Test

Your doctor will place a speculum into your vagina to provide a better view of the cervix. Once the device is in position, he or she will gently cleanse your cervix with saline, either using a spray bottle or a cotton swab. Typically, your doctor will also place a 3% to 5% dilute acetic acid solution on your cervix to better visualize the area and distinguish between normal and abnormal areas.

Next, the colposcope will be positioned close to your vaginal opening, so the light is shining on the vagina and cervix. Your doctor will then take careful note of what he or she can see. 

Blood vessel enlargement, bleeding, or irregularities are often visible through the colposcope. Often, white areas on the cervix signal abnormal cervical changes.

Your doctor may insert Lugol's solution, which is composed of iodine and potassium iodide. Normal cervical tissue appears brown when it comes in contact with Lugol's solution, and pre-cancerous cells appear yellow.

Finally, your doctor may take a tissue sample or biopsy, if necessary, from the abnormal areas. You may feel mild discomfort or cramping during the biopsy, but this should only last a few minutes. Be sure to tell your doctor if you experience severe pain, as this can be a sign of inflammation or infection.

Post-Test

Once your doctor removes the speculum, you may need a few minutes to rest. If a sample was collected, it will be prepared to be sent to a lab.

Your doctor might discuss some of the test results with you right away or a couple of weeks later. You can empty your bladder if you need to, and your nurse may give you a sanitary pad if you have any bleeding. Normally, you can be discharged to go home at that time.

After the Test

If you have a colposcopy without a biopsy, you may have very mild spotting. If you had a colposcopy with a biopsy, you are likely to experience some vaginal bleeding and mild cramping for 24 to 48 hours after the procedure. In addition to some light vaginal bleeding, you may notice a dark discharge from any solution used to help your doctor visualize your cervix. 

You should use a sanitary pad and not a tampon for the bleeding and discharge. The pain is typically treatable with over-the-counter pain medications such as Tylenol (acetaminophen) or Motrin (ibuprofen). 

After your procedure, your doctor may recommend that you refrain from putting anything into your vagina or 24 hours. This includes abstaining from sexual intercourse.

Managing Side Effects

You should contact your doctor for follow-up advice if your symptoms are worse than expected. 

Call your doctor if:

  • Your bleeding or discharge lasts for longer than two to three days or soaks more than one sanitary pad per hour
  • Your pain does not improve with over-the-counter medication
  • You experience severe lower abdominal pain, fever, or chills

Interpreting Results

Your colposcopy results are based on your doctor's observations during the procedure as well as the results of the biopsy, if you had one. Your doctor may discuss some preliminary results during or immediately after the procedure or may schedule an appointment at a later time after your biopsy results return, which is usually within one to two weeks.

A colposcopy may identify:

  • Areas of injury of the cervical lining
  • Cervical warts
  • Inflammatory conditions
  • Infections
  • Blood vessel irregularities or fragile blood vessels
  • Precancerous lesions
  • Endometriosis

Follow-Up

If you have a medical condition diagnosed by colposcopy, your next step is either treatment or further evaluation. For example, if you have an infection, you may need to be treated with an antibiotic. If you have cervical bleeding, your doctor may prescribe hormone therapy. A pre-cancerous lesion may prompt the need for imaging studies, surgery, chemotherapy, or radiation therapy.

In general, it is not typical to have routine follow-up colposcopy at regular intervals, but you may need to have another one if you have recurrent or unexplained symptoms that require another colposcopy.

A Word From Verywell

A colposcopy is a diagnostic test that can provide your doctor with some results while you are having the test. It should be easy for you to tolerate with few, if any side effects. However, you may be anxious or worried about the results if the symptoms that you are being evaluated for are particularly distressing, or if you have a risk of cervical cancer. In general, most medical conditions diagnosed by colposcopy are treatable. Cervical cancer, in fact, has a good prognosis when it is diagnosed early and treated promptly.

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