What's a colposcopy?

Dear Alice,

I was just wondering what a colposcopy is? Something irregular turned up on my pap smear. My gynecologist gave me sulfa-based creams, but the irregularity on the cells from my cervix was still there on my next exam. Now, I have to have a colposcopy, and I was wondering what that entails. My doctor said that it was just to see if further action needed to be taken. Could you tell me, if at all possible, what purpose colposcopies serve and what is wrong with the cells? In other words, do you have any idea, from a vague description, what could be wrong? Thanks.

Dear Reader, 

Finding out that you need further testing or examination can be nerve-racking in any medical scenario, especially if you haven’t been told what might be wrong or what to expect. While it’s completely understandable to be nervous, getting a colposcopy doesn't necessarily mean bad news is forthcoming. A colposcopy is a procedure done to examine the cervix, vagina, and vulva using an instrument called a colposcope. While only your health care provider can make an accurate assessment and provide a diagnosis, there are couple of possibilities for why they could be requesting that you get a colposcopy. The most common of these reasons being that your pap smear showed either inconclusive, abnormal, or irregular results (more on this in a bit). Colposcopies may be done to help diagnose genital warts, cervicitis, and any precancerous changes in the cervical and vaginal tissues and vulva. The colposcopy process is very similar to a Pap test—read on for more information. 

You mentioned that your pap smear—known medically as a Papanicolaou test—results were irregular. Pap smears are conducted to examine cervical cells and identify if any irregularities or abnormalities exist. The portion of the cervix exposed inside the vaginal canal is a very active site for cell growth. This makes it the ideal spot to discover any precancerous cells as well as test for cervical cancer and Human Papillomavirus (HPV). There are a variety of things that can influence the results of a pap smear and while one ultimately hopes to hear that everything in the cervix and vagina is all good, it can be helpful to highlight all the possibilities for results that someone–including yourself–may receive: 

  • Normal or Negative: no abnormal cells in the cervix 
  • Unclear or Inconclusive: cervical cells could be abnormal 
  • Abnormal or Irregular: cell changes were found 
  • Unsatisfactory: not enough cells in sample to test accurately 

One reason for an abnormal pap smear could be because of "atypical" cells, which simply means that some of the cells in the cervix aren’t growing as expected. This could indicate a non-cancerous strain of HPV, also known as low-risk HPV. Another potential reason for abnormal or irregular results is a condition called cervical intraepithelial neoplasia, also known as dysplasia. There are a few things you can do to prepare for your colposcopy. First, keep in mind that there is very little risk involved with this procedure. If you experience menstrual cycles, it’s recommended that you schedule your appointment immediately following menstruation and halt the use of tampons, vaginal medications, and refrain from engaging in vaginal intercourse for two days prior to the procedure. Some people describe a colposcopy as feeling similar to a gynecological exam, though some people experience discomfort or cramping from the procedure. If you’re concerned about the pain during the exam, you might consider discussing over-the-counter pain relief medication, such as ibuprofen or acetaminophen, with your health care provider prior to the appointment. You may also want to write down any questions or concerns you have and relay them to your health care provider prior to the procedure. It can also be helpful to continue communicating with your health care provider throughout the exam, especially if you begin experiencing any pain or discomfort. Consider asking your health care provider for any additional information that they would recommend reviewing about colposcopies to help you feel more prepared for the appointment. 

A colposcopy usually takes between 10 to 20 minutes and can be done in your provider's office without anesthesia. For the duration of the exam, you may be lying on your back with your feet in supports, much like the position you were likely in during your pap test. Your health care provider will use a speculum to keep your vagina open, then place the colposcope a few inches away from your vulva and shine a bright light onto the area. They will then proceed to swab the area to remove mucus, at which point they may use a staining solution to make it easier to distinguish between the normal cells and the abnormal cells. If abnormal cells are found during the colposcopy, the provider may use a sharp biopsy tool to remove some tissue. They may also apply a solution to control the bleeding if you spot a little. You may experience some vaginal spotting or light bleeding two to three days following the colposcopy exam. If a biopsy sample is retrieved, you may also experience vaginal pain or dark discharge for a few days afterwards. Your health care provider will inform you when to expect the test results. Depending on the results, more testing may be required. 

It can be understandably scary to go through this process, but assuming the worst may increase your stress levels unnecessarily. Regardless of the results, you may consider talking to a mental health professional to navigate any emotions that you may have as you go through this process. They can also help unpack how you’re feeling after everything is said and done—having a support system can provide reassurance and hope. 

Last updated Jun 28, 2023
Originally published Oct 18, 1996

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