Colposcopy and cervical biopsy

What is the test?

Colposcopy is a procedure in which a magnifying lens is used to closely examine a woman's cervix, the entrance to the uterus located at the inner end of the vagina. The colposcope is basically a pair of special binoculars on a rolling stand. By looking through the colposcope, a doctor can identify abnormal-appearing areas of the cervix, which can then be biopsied. A pathologist examines the biopsy specimen under a microscope to determine if a precancerous condition (or, rarely, cancer) is present.

Colposcopy is done to evaluate an abnormal Pap smear. It is appropriate to have colposcopy if your pap reveals abnormal cells, particularly if you have human papillomavirus (HPV) found in the pap sample. It is also appropriate to have colposcopy if you have HPV found in repeated pap samples. This is true even if the cells appear normal.

How do I prepare for the test?

If you think you might be pregnant, tell your doctor; it may be necessary to defer="defer" the procedure. Try to schedule the test for a day when you are not likely to be menstruating. For a day before the test, avoid having sexual intercourse and using any creams inside the vagina.

Be sure to tell your doctor about all of the medications that you take, especially if you take any anticoagulants or anti-platelet drugs.

What happens when the test is performed?

The test begins with a pelvic exam and another Pap smear, as well as testing for the HPV virus if this has not yet been done. The doctor then uses a cotton swab to dab a solution containing acetic acid (similar to white vinegar) onto your cervix. This makes any abnormal areas temporarily turn white. The solution might burn slightly. The magnifying lens in the colposcope makes the white areas easier for the doctor to see.

If there are abnormal areas on your cervix, your doctor might do a cervical biopsy using small clippers. You will feel some pinching or cramping during the biopsy, and there might be some bleeding. If there is bleeding, the bleeding can usually be stopped with a chemical solution that is dabbed on with a cotton swab, but you might also need a stitch.

What risks are there from the test?

The colposcopy examination itself (without biopsy) has no risks. With biopsy, there is a very small risk of bleeding and infection, which might require additional treatment. If a biopsy was done, you might have some cramping and discharge or light bleeding from the vagina for a few days. The discharge will be grainy and black (or sometimes gray) if a chemical solution was used to stop bleeding.

Must I do anything special after the test is over?

You can return to work or normal activities right away. If you're bleeding, use sanitary pads, not tampons, for the first day after your procedure. If you had a biopsy, your doctor might also advise you to wait a day or two before having intercourse because it can cause some extra bleeding. Call your doctor if you have bleeding with clots, unusual vaginal odor, fever, or pelvic pain.

How long is it before the result of the test is known?

Your doctor can tell you right away if abnormal areas appear on the cervix. If a biopsy is done, it can take three days to a week to get the results.

When your doctor receives the report, he or she may recommend additional testing (including additional Pap smears) or treatment, depending on the results of the test.

Your doctor will probably have you come back after the cervix has had time to heal from the biopsy, usually in about two weeks or after the next menstrual cycle. Additional treatment might include removal of any abnormal areas of the cervix. This might involve:

• shaving off the abnormal cells with a special electrical wire loop (known as a LEEP procedure)
• freezing a part of the surface of the cervix (cryotherapy)
• removing a thin layer of the cervix all around the opening (cone biopsy or conization).