Patient education: Colposcopy (Beyond the Basics)

COLPOSCOPY OVERVIEW — Screening for cervical cancer (either by Pap test and/or human papillomavirus [HPV] testing) is an important part of staying healthy and avoiding cervical cancer. If the results of your screening test are abnormal, further testing is needed to confirm the result and determine the severity of the abnormality. Colposcopy is the test that is usually recommended in this case. It allows your health care provider to look at your cervix using magnification. Biopsies may also be done at the time of the colposcopy. The colposcopy (ie, the visualization of the cervix) and the biopsies (removing small tissue at the time of the colposcopy for examination in a laboratory) may or may not be done at the same time. (See "Patient education: Cervical cancer screening (Beyond the Basics)".)

Not all people with an abnormal cervical screening test will need treatment. Colposcopy with or without biopsy can help to determine if and when treatment of the abnormality is needed.

More detailed information about colposcopy is available by subscription. (See 'Professional level information' below.)

WHY DO I NEED COLPOSCOPY? — Colposcopy is used to follow up abnormal cervical cancer screening tests (eg, Pap smear, human papillomavirus [HPV] testing) or abnormal areas seen on the cervix, vagina, or vulva. Your Pap smear may be abnormal if you have cervical precancer or cancer, often caused by HPV infection of the cervix. HPV is explained in detail separately. (See "Patient education: Cervical cancer screening (Beyond the Basics)".)

The colposcope magnifies the appearance of the cervix (figure 1). Acetic acid or vinegar is placed on the cervix and vagina to stain the cells and to allow the clinician to better see where the abnormal cells are located and the size of any abnormal areas. The size, type, and location of abnormal cells help to determine which area or areas may need to be biopsied. This information will further determine how severe the abnormality is and also help to determine what treatment, if any, is needed. When monitored and treated early, precancerous areas usually do not develop into cervical cancer.

PREPARING FOR COLPOSCOPY — Before your colposcopy appointment, you should not put anything in the vagina (eg, creams).

Colposcopy can be done at any time during your menstrual cycle, but if you have heavy vaginal bleeding on the day of your appointment, call your health care provider to ask if you should reschedule.

If you take any medication to prevent blood clots (aspirin, warfarin, heparin, clopidogrel), notify your health care provider in advance. These medications can increase bleeding if you have a biopsy during the colposcopy.

If you know or think you could be pregnant, let your health care provider know. Colposcopy is safe during pregnancy, although health care providers usually do not perform biopsies of the cervix when you are pregnant.

To help minimize discomfort, you can take ibuprofen (400 to 600 mg) one hour before your appointment, but this is not necessary.

COLPOSCOPY PROCEDURE — Colposcopy can be performed by a physician, nurse practitioner, or physician assistant who has had specialized training. Colposcopy takes approximately 5 to 10 minutes, can be performed during an office visit, and causes minimal discomfort.

Colposcopy is performed similar to a routine pelvic examination while you lie on an exam table. The health care provider will use an instrument called a speculum to open your vagina and look at your cervix (figure 1). The provider may repeat a Pap smear and then will look at your cervix using the colposcope. The colposcope is like a microscope on a stand, and it does not touch you.

The provider will apply a solution called acetic acid (vinegar) to your cervix. This solution helps to highlight any abnormal areas, making them easier to see with the colposcope. When this solution is used, you may feel a cold or slight burning sensation, but it does not hurt.

During colposcopy, your health care provider may remove a small piece of abnormal tissue (a biopsy) from the cervix or vagina. Having a biopsy does not mean that you have precancerous cells. Anesthesia (numbing medicine) is not usually used before the biopsy because the biopsy causes only mild discomfort or cramping. The tissue sample will be sent to a laboratory and examined with a microscope by pathologists.

Some people also need to have a biopsy of the inner cervix during colposcopy; this is called endocervical curettage (ECC). Pregnant people should not have ECC because it may disturb the pregnancy. The ECC may cause crampy pain, although this resolves quickly in most people.

If you have a biopsy, your provider may apply a yellow-brown solution to your cervix. This acts as a liquid bandage.

AFTER COLPOSCOPY — Some people feel a little dizzy or nauseated right after the colposcopy. If you feel this way, tell your provider and lie down until the feeling goes away. Sometimes a cold compress applied to your forehead may help you feel better. If you have a history of fainting or feeling lightheaded after other procedures, be sure to tell your provider and wait a few minutes after the colposcopy before sitting up.

If you have a biopsy of your cervix, you may have some vaginal bleeding after the colposcopy. If your provider used the liquid bandage solution, you may have brown or black vaginal discharge that looks like coffee grounds. This should resolve within a few days.

Most people can return to work or school immediately after having a colposcopy. Some people have mild pain or cramping, but this usually goes away within one to two hours.

Do not put anything in the vagina (creams, douches, tampons) and do not have sex for 48 hours after having a biopsy.

If you have a biopsy, ask your health care provider when your results will be available (usually within 7 to 14 days). In most cases, further testing and treatment will depend on the results of the biopsy. (See "Patient education: Follow-up of low-grade abnormal Pap tests (Beyond the Basics)" and "Patient education: Follow-up of high-grade or glandular cell abnormal Pap tests (Beyond the Basics)" and "Patient education: Management of a cervical biopsy with precancerous cells (Beyond the Basics)".)

Do not assume that the biopsy results are normal if you do not hear from your health care provider: Call and inquire about the results. Most people will need a follow-up test (repeat cervical cancer screening [Pap smear] and/or colposcopy) within six months.

When to seek help after colposcopy — Call your health care provider if you have any of the following after colposcopy:

●Heavy vaginal bleeding (soaking through a large menstrual pad in an hour for two hours)

●Vaginal bleeding for more than seven days

●Foul smelling vaginal discharge; remember that the brown/black, coffee-ground discharge is normal for the first few days

●Pelvic pain or cramps that do not improve with ibuprofen (Advil, Motrin)

●Temperature greater than 100.4°F or 38°C

WHERE TO GET MORE INFORMATION — Your health care provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for health care professionals, are also available. Some of the most relevant are listed below.

Patient level information — UpToDate offers two types of patient education materials.

The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Patient education: Cervical cancer (The Basics)
Patient education: Cervical cancer screening tests (The Basics)
Patient education: Vaginal cancer (The Basics)

Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.

Patient education: Cervical cancer screening (Beyond the Basics)
Patient education: Follow-up of low-grade abnormal Pap tests (Beyond the Basics)
Patient education: Follow-up of high-grade or glandular cell abnormal Pap tests (Beyond the Basics)
Patient education: Management of a cervical biopsy with precancerous cells (Beyond the Basics)

Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Cervical adenocarcinoma in situ
Cervical cancer in pregnancy
Cervical cancer screening tests: Techniques for cervical cytology and human papillomavirus testing
Cervical cancer screening: Risk assessment, evaluation, and management after screening
Cervical cytology: Evaluation of atypical and malignant glandular cells
Cervical intraepithelial neoplasia: Ablative therapies
Cervical intraepithelial neoplasia: Terminology, incidence, pathogenesis, and prevention
Cervical intraepithelial neoplasia: Management
Cervical intraepithelial neoplasia: Diagnostic excisional procedures
Colposcopy

The following organizations also provide reliable health information.

●National Library of Medicine

     (www.nlm.nih.gov/medlineplus/ency/article/003913.htm, available in Spanish)

●American College of Obstetricians and Gynecologists

     (www.acog.org/Patients)

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