A colposcopy is a procedure that allows a physician to examine a woman’s vulva, vagina and cervix. This is achieved through the use of a colposcope, an instrument that shines a light on the cervix and magnifies the tissue being inspected. Colposcopy is usually performed as a follow-up test to a screening Pap smear, in which the classification suggests the need to rule out possible abnormal or potentially cancerous cells.

During the procedure, a vinegar solution (acetic acid) is applied to the cervix or area to be evaluated with a cotton swab. This solution will react with the abnormal cells – abnormal tissue will appear white – allowing it to be identified through the colposcope. A physician can magnify the image many times its normal size, making it easier to see abnormal cells. This white area also has certain changes seen with the colposcope affecting the surface appearance, texture and vessels in the abnormal area that will allow a directed biopsy sample to be taken. 

Colposcopies usually produce only minimal discomfort for the patient. If a colposcopy reveals abnormal cells or any suspicious changes to the surrounding tissues, a follow-up procedure such as tissue removal (biopsy) will be performed. Biopsies are necessary to determine if cells are abnormal, precancerous or cancerous. In some cases, a biopsy can be performed at the same time as the colposcopy. A patient should inform her physician if she is or might be pregnant because special precautions may be taken if a cervical biopsy needs to be performed during pregnancy.

A colposcopy is a procedure to closely examine the cervix, the lower, narrow end of the uterus, or the surrounding tissues. It is usually performed as a follow-up test after a Pap smear reveals the presence of abnormal cells that may indicate a cancerous, precancerous or infected condition in the cervix.

During this procedure, a specially lighted microscope called a colposcope is used to examine a woman’s genital area, including the cervix, vagina and vulva (vaginal opening). A specialist known as a colposcopist performs the test, which magnifies the area of examination by many times its normal size.

The colposcopist uses these enhanced images to identify abnormal cell growth that cannot be seen with the naked eye. If abnormalities are detected, a biopsy will be performed to remove a tissue sample that will be sent to a laboratory for analysis by a pathologist.

A patient should reveal if she is or might be pregnant because:

• Special precautions may be taken to reduce the increased risk of bleeding when cervical biopsy is performed during pregnancy.
  
  
• Biopsy may be postponed.
  
  
• The patient may be referred to a colposcopist experienced in examining pregnant women.

Colposcopy should not be confused with culdoscopy, which involves inspection of a woman’s pelvic cavity with a lighted tube.

Patients should follow all preparatory steps recommended by their physician. Patients should inform their physician if they are or may be pregnant. The test should be scheduled during a time other than a woman’s menstrual period. Women should avoid intercourse for 24 hours prior to the test. Also, patients should avoid douching or using any vaginal medicines or spermicidal foams, creams or jellies for 24 hours prior to the colposcopy. These agents may wash away or obscure abnormal cells.

Patients may feel more comfortable if they empty their bladder and bowel beforehand. Taking an over-the-counter pain reliever an hour prior to the exam may help alleviate discomfort during the ensuing exam. However, patients should not take any medication without first consulting their physician.

During the colposcopy, the patient lies down on an exam table with her knees bent and to the sides, and heels resting in supports called stirrups. A sheet covers the woman’s legs and stomach. The physician examines the external genitals before gently inserting an instrument called a speculum into the woman’s vagina to widen it. This allows the physician to more clearly examine the cervix.

The physician or an assistant positions the colposcope so that a clear view of the vagina is obtained. The colposcope, which resembles a lighted microscope or binoculars, does not enter the vagina. A saline solution is used to clean the cervix before a vinegar solution (acetic acid) is applied to the cervix with a cotton ball or swab. This solution makes abnormal tissue appear white and be visible through the colposcope.

If none of the tissue turns white, a second solution known as Lugol’s solution, containing iodine, will be applied to the cervix. This solution stains normal cervical tissues, but leaves abnormal tissues unstained.

The colposcope can be adjusted to increase the magnification of abnormal tissues. This will reveal features such as the course of blood vessels in the tissue, changes in the texture or arrangement of the cells. Some of the colposcopes may allow a photograph to be taken that will document the suspicious areas for future reference. The physician may also perform a biopsy of some of the suspect tissue. This can be sent to a pathologist for examination.

For the most part, a colposcopy is painless. Patients may experience discomfort when the speculum is inserted, and the application of acetic acid may cause a stinging sensation.  A pinching feeling or cramps may be experienced as the tissue is removed. If a biopsy is performed, a numbing gel may be applied.

Some women may experience mild cramping or discomfort for several hours after the colposcopy. If a biopsy was completed in addition to the colposcopy, the symptoms may be more severe. Typically, an over-the-counter pain medication can reduce the discomfort.

In some cases, women experience minor bleeding or other vaginal discharge for a few days after the test, especially if a biopsy has been performed. After a biopsy, a thick, brownish-yellow paste (Monsel’s solution) is applied to the area to stop any bleeding. As a result, dark-colored vaginal discharge is normal as the paste and fluids used during the colposcopy are expelled from the body. Sanitary pads can be used during this time, but tampons should not be used.

Patients should refrain from inserting anything into their vagina for a week, or until a physician approves. As a result, patients should refrain from:

• Sexual intercourse
• Using tampons
• Douching
• Applying vaginal medications

In some cases, bleeding will be heavy enough that a physician will approve the use of tampons instead of a sanitary pad. In such cases, the tampon should be changed every four hours or as needed.

Results from the colposcopy are usually available within one to two weeks. A follow-up exam should be scheduled no later than a week after the procedure to discuss the results and any necessary tests or treatments.

A colposcopy carries a slight risk of infection or significant bleeding. Patients should contact a physician if they experience the following:

• Signs and symptoms of an infection. These include fever of 100.4 degrees Fahrenheit (38 Celsius) or higher, foul-smelling vaginal odor or thick, yellowish vaginal discharge.
  
  
• Excessive vaginal bleeding. This is indicated if a sanitary pad is soaked within an hour over a period of four or more hours.
  
  
• Severe pelvic or abdominal pain. Although this symptom is rare, patients who experience it should seek immediate emergency care.
  
  
• Allergic reaction to iodine, latex or other materials used during the colposcopy.

If a colposcopy reveals the presence of abnormal cells, additional procedures may be performed to confirm the type of abnormality. These include:

• Biopsy. A sample of tissue or several samples may be removed to be sent to a laboratory for analysis by a pathologist.
  
  
• Endocervical curettage. A procedure in which the mucous membrane of the cervical canal is scraped using a spoon-shaped instrument called a curette. A sample of cells is obtained and sent to a laboratory for analysis. Endocervical curettage is a valuable way to examine parts of the cervix that cannot be visualized.
  
  
• Cone biopsy. Often used if either a standard biopsy or endocervical curettage indicates a problem that requires further investigation. In this procedure, a conical section of tissue is removed from the area around the opening of the cervical canal. A cone biopsy can also be used to remove suspect tissue.
  
  
• Loop electrosurgical excision procedure (LEEP). The suspicious tissue is removed with an instrument called a loop device. The remaining tissue is then cauterized. The sample that has been removed is sent to a laboratory for analysis.

Researchers are evaluating the use of electronic probes to evaluate cervical tissue. These probes are placed directly on the cervix and gather data about the amount of light the tissue absorbs and reflects. Physicians can compare this data against data from tissues known to be healthy as a means of identifying diseased tissue that should be biopsied.