Colposcopy: What to Expect
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Basic female reproductive system. LouisBB / Svenskbygderna, Public domain, via Wikimedia Commons
A colposcopy is a test to take a closer look at your cervix. If your cervical screening (smear test) has shown some cell changes, a colposcopy can help determine the extent of these changes and whether you need treatment. Understanding what this procedure involves can help ease anxiety and prepare you for what to expect.
What is a colposcopy?
A colposcopy is a detailed examination of the cervix (the opening to your womb from your vagina) using a special microscope called a colposcope. The colposcope stays outside your body and provides a magnified view of the cervix, allowing the doctor to examine any abnormal areas in detail.
The procedure is usually performed by a specially trained doctor or nurse and typically takes about 15-20 minutes. It is usually done in an outpatient clinic, which means you will not need to stay overnight in hospital.
A colposcopy is often done if cervical screening finds changes to your cells that are caused by certain types of human papillomavirus (HPV). These changed cells can sometimes develop into cervical cancer if left untreated. The colposcopy allows healthcare professionals to assess these changes and decide if treatment is needed.
Why it is done
A colposcopy may be recommended for several reasons:
- You have had an abnormal cervical screening result showing cell changes (dyskaryosis)
- You have tested positive for high-risk human papillomavirus (HPV)
- Your cervix looks unusual during a routine examination
- You have had bleeding after sex or between periods that requires investigation
- To monitor previously identified cell changes
- To check the effectiveness of treatment for cervical abnormalities
It is important to remember that an abnormal screening result does not mean you have cancer. In fact, most women who have a colposcopy do not have cancer. The procedure is primarily a preventative measure to identify any pre-cancerous changes that can be treated before they develop into cancer.
Understanding HPV: Human papillomavirus (HPV) is a common virus that most people will have at some point in their lives. There are many types of HPV, and most are harmless. However, some high-risk types can cause cell changes that may lead to cancer if left untreated. HPV infection is the main cause of cervical cancer, but it usually takes many years for cancer to develop after HPV infection.
Getting ready
Preparing for a colposcopy involves a few simple steps:
- Try to schedule your appointment when you are not having your period, as blood can make it difficult to get a clear view of your cervix
- Avoid using vaginal medications, creams, or lubricants for at least 24 hours before your appointment
- Avoid sexual intercourse for 24-48 hours before the procedure
- You may wish to take a mild pain reliever about an hour before your appointment to reduce any discomfort
- Wear comfortable, loose-fitting clothes to your appointment
- You do not need to fast before a colposcopy; eating and drinking normally is fine
- If you are pregnant or think you might be, inform your healthcare provider before the procedure
It is also helpful to bring someone with you to the appointment for support, especially if you are feeling anxious. Some women find it reassuring to have a friend or partner with them, though this is entirely your choice.
What happens on the day
Understanding what happens during a colposcopy can help reduce anxiety about the procedure:
- You will be asked to undress from the waist down (a gown or sheet will be provided for privacy) and lie on an examination table with your feet in supports, similar to having a cervical screening
- A smooth, tube-shaped tool (a speculum) is gently placed into your vagina to hold it open so the cervix can be seen clearly
- The colposcope (which looks like a pair of binoculars on a stand) is positioned outside your body, about 30 cm from your vulva, giving the doctor a magnified view of your cervix
- The doctor will apply a solution to your cervix using a cotton swab - this may feel slightly cold or tingling but is not painful. This solution helps highlight any abnormal areas
- If abnormal areas are identified, a small sample of tissue (biopsy) may be taken for further testing. This involves removing a tiny piece of tissue (about the size of a pinhead) from the cervix
- Taking a biopsy may cause mild cramping or pinching sensations, and some women experience brief discomfort similar to menstrual cramps
- If larger areas of abnormal cells are found, treatment might be recommended right away or at a later appointment
The entire procedure typically takes 15-20 minutes. Some women experience mild discomfort during a colposcopy, similar to period cramps, while others report little or no discomfort. If you feel pain or significant discomfort during the procedure, let your doctor know right away.
Treatment during colposcopy: Sometimes, if the abnormal area is small and clearly defined, your doctor might suggest treating it during the same appointment. This is known as "see and treat" approach. The most common treatment is LLETZ (Large Loop Excision of the Transformation Zone), which uses a thin wire loop with an electrical current to remove the abnormal cells. Your doctor will discuss whether this is appropriate for you and explain the procedure fully before proceeding.
Results
What happens after your colposcopy depends on the findings:
- If no abnormal cells are found, you may simply be advised to return to routine cervical screening
- If a biopsy was taken, you will usually get the results within 2-4 weeks
- Your results will typically be classified as:
- Normal - no abnormal cells found
- CIN 1 - mild changes that often clear up on their own without treatment
- CIN 2 or CIN 3 - moderate to severe changes that usually require treatment
- CGIN - abnormal glandular cells that usually require treatment
- If treatment is needed, this might be done during a future appointment or, in some cases, may have been done during your colposcopy
- After treatment, you will need follow-up appointments to ensure the abnormal cells have been completely removed
It is important to remember that even if abnormal cells are found, this does not mean you have cancer. CIN (Cervical Intraepithelial Neoplasia) describes abnormal changes in the cells of the cervix that, if left untreated, could potentially develop into cervical cancer over time. Treatment at this pre-cancerous stage is very effective.
After your colposcopy
After your colposcopy, you should be able to resume most normal activities right away, but there are a few things to keep in mind:
- If you had a biopsy, you may experience mild cramping or spotting for a day or two
- You may notice a dark discharge for a few days, which is normal and is due to the solution used during the procedure
- Avoid using tampons, having sex, or swimming for at least a week if you had a biopsy or treatment
- Take over-the-counter pain relievers if you experience discomfort
- Contact your healthcare provider if you experience heavy bleeding (heavier than a period), severe pain, fever, or foul-smelling discharge
Frequently asked questions
A colposcopy is a diagnostic procedure where a specialist uses a colposcope, a large, standing microscope positioned outside your body, to examine your cervix in high magnification. It is recommended if a routine cervical screening shows cell changes or high-risk HPV, if you have unexplained bleeding after sex or between periods, or if the cervix looked unusual during a routine examination. An abnormal screening result does not mean you have cancer. A colposcopy is primarily a preventative tool to find and treat pre-cancerous cells before they can develop further.
Schedule your appointment for a time when you are not on your period, as this ensures the clearest view of the cervix. Avoid sex and vaginal creams or medications for 24–48 hours before the test. You may take a mild over-the-counter pain reliever about an hour beforehand to help minimise any cramping during the procedure.
The procedure takes about 15–20 minutes in an outpatient clinic. You lie on an examination table with your feet in supports, similar to a smear test. A speculum is inserted and the colposcope is positioned about 30cm away. A liquid such as dilute vinegar or iodine is applied to the cervix. This may tingle slightly but highlights abnormal cells by turning them a different colour. If an abnormal area is found, a tiny tissue sample the size of a pinhead may be taken for laboratory testing, causing a brief pinching sensation. In some cases, abnormal cells may be removed immediately using a thin wire loop (LLETZ).
If a biopsy was taken, results typically arrive within 2–4 weeks. A normal result means no abnormal cells were found and you return to routine screening. CIN 1 (mild changes) is often monitored as these frequently clear on their own. CIN 2 or CIN 3 (moderate to severe changes) usually requires treatment to remove the affected cells. CGIN, which involves abnormal glandular cells, also generally requires treatment. Your consultant will explain your results and discuss the most appropriate next steps.
Most women feel fine immediately afterwards. Some cramping and light spotting is common for one to two days, particularly if a biopsy was taken. You may also notice a dark, coffee-ground-like discharge for a few days. This is the solution used to stop bleeding and is entirely normal. Avoid tampons, swimming, and sexual intercourse for at least one week to allow the cervix to heal. Contact your healthcare provider if you experience heavy bleeding, severe abdominal pain, fever, or a foul-smelling discharge.
Final thoughts
A colposcopy is a valuable diagnostic tool that helps detect and prevent cervical cancer by identifying abnormal cells at an early stage when treatment is most effective. While the procedure might cause some anxiety, understanding what to expect can help you feel more prepared and comfortable.
Remember that having a colposcopy does not mean you have cancer - it is primarily a preventative measure. The vast majority of women who undergo colposcopy and any subsequent treatment go on to have normal cervical screening results in the future.
If you have any concerns or questions about your colposcopy, do not hesitate to discuss these with your healthcare provider. They can provide you with personalised information and support throughout the process.