What Is a Colposcopy Biopsy?

A colposcopy biopsy—sometimes just called colposcopy—is a procedure that takes a closer look at your cervix, vagina, and vulva using a magnifying device called a colposcope. A gynecologist (a medical doctor who specializes in diagnosing and treating conditions of the female reproductive system) usually performs a colposcopy biopsy when you have an abnormal Pap smear result. 

During a colposcopy, your healthcare provider may see an area of tissue in your cervix or vagina that looks concerning. When this happens, your provider will use a biopsy (a procedure that removes cells from a part of your body) to test the sample for abnormal cells and screen for certain types of gynecological cancers. 

Purpose 

The purpose of colposcopy is to diagnose cancer or precancer of the cervix, vagina, or vulva. Your healthcare provider may also use colposcopy to diagnose human papillomavirus (HPV), noncancerous growths called polyps, or inflammation. 

Providers usually recommend colposcopy after an abnormal screening test such as a Pap smear. A Pap smear takes a sample of your cells from the cervix to examine them under a microscope. If the cells appear abnormal, your provider may order a colposcopy. Other reasons to order a colposcopy include an abnormal pelvic exam, bleeding after sex, or concern of an HPV infection. 

Types of Colposcopies

A colposcopy helps your gynecologist take a better look at the overall health of your cervix, vagina, and vulva. Depending on what your healthcare provider observes during the exam, they may recommend a biopsy as well. 

The two types of colonoscopies include:

• Colposcopy: Your provider views the cervix, vagina, and vulva with a magnifying tool called a colposcope
• Colposcopy with biopsy: If test results after a colposcopy are abnormal or unclear, your provider will use a special tool to take a sample of cells or tissue that they can send to a lab to be examined under a microscope

How Does It Work?

A colposcopy is a procedure that your healthcare provider uses to examine your cervix, vagina, and vulva—all of which are essential structures that make up the female reproductive system. The vagina is the thin, hollow tube that goes from the bottom of the uterus (cervix) to the outer genitals (vulva).

A gynecologist usually performs a colposcopy but a primary care provider can be trained in this procedure as well. When a healthcare provider sees abnormal cells during a colposcopy, they will likely recommend taking a tissue sample with a biopsy for further testing. 

Before the Test

When you are preparing for a colposcopy, there are a few things to keep in mind before your appointment. Do not insert anything into your vagina for 24 hours before the test. Healthcare providers recommend avoiding douching, tampons, vaginal medications, and sex before the procedure. 

Your healthcare provider will perform the colposcopy in an outpatient clinic, meaning you don't have to stay the night at a hospital after the test is over. When arriving for your appointment, you will likely need to fill out health questionnaires. If the forms were sent to you ahead of time, be sure to bring them with you. At the time of your appointment, you will need to change into a hospital gown so your provider can access your genital area with ease.

There will be an exam table with footrests (stirrups) for you to lie down on once. You will likely not receive any anesthesia or sedation for a colposcopy. If your provider determines that you need a biopsy, they will administer a local anesthetic at that time. 

During the Test

To begin the exam, your healthcare provider will insert a speculum into your vagina. A speculum is a tool that opens to spread the walls of the vaginal walls. Providers also use speculums during pelvic exams. 

Once your provider inserts and opens the speculum, they will use a cotton ball or cotton swab to apply a vinegar or iodine solution to the vaginal walls. This solution makes it easier to see abnormal cells. It may sting or burn at first—but, this is common. 

Your provider will then use the colposcope to examine the cervix, vagina, and vulva. The colposcope will not touch your body. If your provider sees cells that appear abnormal, they will recommend performing a biopsy at that time. 

Once you consent to a biopsy, your provider will administer a local anesthetic because a biopsy would be painful without numbing medication. It is still normal to feel some type of pinching or cramping with a biopsy. Your comfort and safety always come first, so let your provider know if the pain seems extreme or unbearable.

To take a biopsy of your cervix, your provider will use a tool called a curette to remove a sample of your cervical cells. Keep in mind: your provider may take one or several tissue samples during this part of the test. If you experience bleeding at the biopsy site, your provider will apply a topical medication to stop the bleeding. 

After the Test  

Once the colposcopy and biopsy are complete, your provider will make sure there is no bleeding and then remove the speculum from your cervix and vagina. Most people can drive themselves home after the colposcopy. 

It is normal to feel soreness, spotting, or cramping for a few days after colposcopy. If your provider took a biopsy sample, you may experience some vaginal bleeding and dark discharge for a few days. Plan to wear a sanitary pad until the discharge or bleeding goes away. Your provider may recommend limiting your physical activity for a few days after a biopsy to limit excess bleeding or pain.

After a colposcopy, do not douche, use tampons or vaginal medication, or have sex for at least one week. While this is not common, your provider will tell you if you need to wait longer than a week to continue these activities. This is also a good time to ask if there are any rules you need to follow after the procedure is done.

Risks and Precautions

A colposcopy biopsy is safe for most people. If you are pregnant or could be pregnant, tell your healthcare provider. A colposcopy is likely still safe during pregnancy but could lead to more bleeding than is usually expected. 

Like every test, there are some risks and side effects that come with a colposcopy. It's common to experience some discomfort with a colposcopy. The speculum can be uncomfortable, and the solution your provider uses may sting. You will likely also feel pinching if a biopsy is taken. To manage any pain or discomfort during your procedure, focus on taking slow, deep breaths rather than holding your breath. 

However, more serious side effects are a sign to reach out to your healthcare provider. If you experience any of the following, call your provider as soon as you can: 

• Heavy bleeding: Soaking a sanitary pad in an hour or less
• Abdominal pain: Lower abdominal pain or intense cramping 
• Infection: Fever, chills, or foul-smelling vaginal discharge 
  

How to Prepare for a Colposcopy

Going in for a colposcopy can feel scary. Knowing what to expect may help. Consider the following details when planning for a colposcopy biopsy:

• Location: Most gynecologists or primary care providers perform colposcopies in their outpatient clinics. This is true for colposcopies with biopsies as well. 
• Attire: Before your colposcopy, your provider will ask you to change into a hospital gown. Plan to wear loose, comfortable clothing that you can change back into after the procedure. 
• Food and drink: Most people can eat and drink normally before and after colposcopy. Ask your provider if there are any temporary dietary changes you need to make. 
• Medications: Your provider will let you know if there are any medications you need to stop before your colposcopy appointment. It may be helpful to take an over-the-counter (OTC) pain medication such as Advil (ibuprofen) or Tylenol (acetaminophen) before the appointment to minimize discomfort. But, always ask your provider before taking an OTC medication. 
• Items to bring: When going to your colposcopy appointment, plan to bring your driver’s license or identification card, insurance information, and any forms that were mailed to you. Consider also bringing a sanitary pad to put on your underwear after the test. It's OK if you forget to bring one as most gynecologists usually have extra supplies in their offices.
• Emotional support: If you would like to bring a loved one with you to your appointment, ask your care team where they can wait during the procedure. 
• Cost and insurance: Before your colposcopy, plan to call both your insurance company and hospital billing department to ask about coverage and copays.

Results

If your provider took a biopsy sample during your colposcopy, the results may take one to two weeks to come back. A pathologist (a medical doctor who specializes in diagnosing diseases and conditions) will examine your tissue sample under a microscope to look for abnormal cells. Once their report is ready, they will send it to your healthcare provider. Your provider will then contact you via phone, email, or online medical record. 

Interpreting Your Results  

Your healthcare provider may detect any of the following signs of disease with a colposcopy examination:

• Abnormal patterns of blood vessels
• Swollen areas
• Areas where the tissue has wasted away (atrophy)
• Patches of white color 
• Cervical polyps
• Genital warts

If your provider took a biopsy sample, the results may come back as one of the following:

• Normal result: The cervix, vagina, and vulva tissue appears healthy, and there are no abnormal cells
• Abnormal result: There are abnormal cells in the cervix, vagina, or vulva, which may be cancerous, precancerous, or caused by an infection

A colposcopy biopsy can also detect cancer cells, genital warts, and physical changes to the cervix known as dysplasia. Dysplasia can lead to cervical cancer over time. This condition is sometimes also known as cervical intraepithelial neoplasia (CIN) and is classified into the following stages:

• CIN I: Mild physical changes in the cervix 
• CIN II: Moderate physical changes in the cervix 
• CIN III: Severe physical changes that may be signs of an early-stage cancer called carcinoma in situ 

Fortunately, many types of precancer can be successfully treated before they turn into cancer. If your results show that you have cervical, vaginal, or vulvar cancer, your provider will refer you to a gynecological oncologist, which is a medical doctor who specializes in diagnosing and treating cancers of the female reproductive system. 

A Quick Review

A colposcopy is a common procedure that your gynecologist can use to examine the cells inside your cervix, vagina, and vulva. Normally, this test happens when you receive abnormal results from a Pap smear. If your provider suspects any abnormal cells in your cervix or vagina, they might also perform a biopsy to remove a sample of your cells and send them in for testing. This procedure also helps detect and screen for cancers and infections.

Going in for a colposcopy can be scary and sometimes uncomfortable. Talk with your healthcare provider about how to prepare for the test, manage discomfort during the procedure, and take care of yourself once the test is over. Results from a colposcopy biopsy are usually available within one to two weeks. If you don't hear back from your provider in a timely manner, reach out to them to ask when you can expect to have your results.