Pain after colposcopy biopsy

You know the drill when it comes to Pap smears: Don the paper gown, slide to the edge of the table, etc. But what if, after an abnormal Pap smear, your doctor says they need to do a cervical biopsy? Freak out a bit? I did.

I’ve been moderately sexually active, kept up to date on Pap smears, and received the HPV vaccine. Nevertheless, I was diagnosed with HPV a few years ago, when a Pap smear turned up abnormal cervical cell changes—even though I had no noticeable signs or symptoms—and the doctors recommended a cervical biopsy. I was terrified at first (Biopsy? Cervical cancer?), but the procedure was quick and mostly painless. So if you’re going through a similar situation—or just want to know what to expect in case you ever do—here’s what you should know.

First of all, there’s a difference between a Pap smear (also called a Pap test) and a biopsy. A Pap smear screens for any changes in cervical cells that could be precancerous or cancerous, according to the Mayo Clinic. (And, contrary to popular belief, a Pap smear doesn’t test for STIs, though your doctor may give you an STI test at the same time.) During the Pap smear, the speculum is inserted into the vagina so that your doctor can gently scrape away cells from your cervix, which is located at the opening of the uterus. The cells are then examined for any abnormalities.

Pap smears can be uncomfortable, but in general they’re quick and relatively painless. According to the U.S. Preventative Task Force (USPSTF), women aged 21 to 65 should get Pap tests on a regular basis (every three years). As an alternative, women aged 30 to 65 can have a combination Pap smear/HPV test every five years. That said, your personal screening recommendation may depend on your risk factors and medical history, so check with your doctor to find out what’s recommended.

Here’s what it means to get an abnormal Pap smear result.

If your Pap smear results come back showing any abnormal cells, that doesn’t necessarily mean they found cancerous or precancerous cells. Eduardo Franco, M.D., an epidemiologist at McGill University’s division of cancer epidemiology, tells SELF that an abnormal Pap result “contains cells that have abnormalities in architecture, shape, and ability.” These cervical cell changes are referred to as cervical dysplasia, which can range in severity. Dysplasia can be low-grade, meaning changes will often go away on their own and treatment isn’t required, Dr. Franco says, whereas high-grade dysplasia can progress to cancer over time.

Low-grade cervical changes may just signal an HPV infection, says Dr. Franco. HPV is incredibly common, and in most cases it will go away on its own, while in some cases it can lead to genital warts or cervical cancer (HPV actually is responsible for nearly all cases of cervical cancer). An estimated 79 million Americans currently have some form of HPV, and 14 million new infections occur each year, according to the CDC. While the HPV vaccine protects against several strains of the virus, many of which can cause cervical cancer, it’s still possible to get HPV and cervical cancer even if you’ve been vaccinated.

If your Pap smear shows any cervical dysplasia, your doctor may want you to come back for a colposcopy, which is a lot less terrifying than it sounds.

A colposcopy is when your doctor examines your cervix through a microscope, at which point they may also take that cervical biopsy. “The decision to refer a woman for colposcopy is based on the Pap smear grade primarily,” Dr. Franco says. For patients 35 or older with high-grade cells, a biopsy will be referred immediately. “Doctors may be more likely to wait and see with young patients in their 20s ,” he says, because those cells typically regress over time. Still, it ultimately comes down to what you and your doctor deem best for you.

Cervical cancer

The cervix forms the neck of your uterus (or womb) and sits at the top of your vagina. This cancer is not very common.

Less than two in 100 Australian women who have cancer have cervical cancer. Each year there are about 900 new cases of cervical cancer found in Australian women.

Most women with early cancer of the cervix will be cured. Even if the disease is not discovered until after it has advanced, treatment is still possible but the likelihood of a long-term cure is less likely.

Cervical cancer is almost always caused by the human papillomavirus (HPV). HPV is very common and 80 per cent of women will have it at some point in their lives. Almost always – 95 per cent of the time – your immune system clears it naturally. But if your body doesn’t clear it, some types of HPV can lead to cervical cancer. Because HPV has no symptoms, you won’t know you have it unless you have regular Cervical Screening Tests (every five years from age 25).

Causes

It is not usually possible to say what causes cancer in a particular woman but known risk factors are:

  • you have had the higher risk genital human papilloma virus (HPV)
  • you have been a regular smoker
  • you do not have regular cervical tests (these can find pre-cancerous abnormalities)
  • you are over 35
  • you have used the contraceptive pill (the Pill) for more than five years (a small increase in risk)
  • you have had cervical cancer in the past
  • a family history of cervical cancer (a first degree relative such as a sister or mother)
  • you have had five or more children
  • your mother was given the synthetic hormone diethylstilbestrol (DES), when she was pregnant with you (it was used in the 1950s to prevent miscarriage).

Symptoms

Usually there are no symptoms or signs when the cancer begins to grow because it is often very small.

Symptoms can include:

  • bleeding from your vagina when you have already been through menopause
  • pain during sex and bleeding from your vagina afterwards
  • bleeding from your vagina in between your periods
  • unusual discharge from your vagina
  • your period is heavier or lasts longer than usual.

Advanced cervical cancer is very uncommon but symptoms are:

  • excessive tiredness
  • leg pain or swelling
  • lower back pain.

See your doctor if you have any of these symptoms and they persist and/or they are unusual for you.

Diagnosis

If you have symptoms that might be linked to cervical cancer you should talk to a doctor, nurse or gynaecologist. You should tell them about any changes to your body that you have noticed. You should tell them if you have ever had HPV.

If you have symptoms that might be linked to cervical cancer your doctor will most likely:

  • ask you questions about the history of the health of you and your family
  • do a Cervical Screening Test
  • look at your cervix using a magnifying machine called a colposcopy that sits close to your body
  • take a sample of any areas that do not look normal and send them away to be tested (known as a biopsy). This is sometimes done at the same time as a colposcopy and sometimes as part of an examination under anaesthetic
  • you may have a blood test
  • you may also have a minor operation (where a cone-shaped piece of your cervical tissue is removed for testing), a chest x-ray, MRI, CT or PET scan.

Treatment

The type of treatment you have will depend upon:

  • the size of the cancer and where it is in your body (this is known as the stage of cancer)
  • how quickly it is growing and how different it looks to normal cells (the grade of cancer)
  • the specific type of cancer (the cell of origin)
  • your age, health and medical history.

Your doctors will discuss these things with you and help choose the best possible treatment for your particular cancer, lifestyle and wishes.

Treatment options

  • Surgery to remove your cervix, uterus and fallopian tubes (known as a total hysterectomy and bilateral salpingectomy) and usually nearby pelvic tissue (known as a radical hysterectomy). Some of the nearby lymph nodes (which filter and trap disease) may also need to be removed. Less often your ovaries may need to be removed (known as a bilateral oophorectomy).
  • Radiotherapy aims to control or kill the cancer. If you have external radiation you will lie or sit near a machine that directs radiation beams at your cancer. If you have internal radiotherapy (known as brachytherapy), a small radioactive device will be put inside your cervix and uterus through your vagina.
  • Chemotherapy is medicine that aims to control or kill the cancer. Usually this involves being connected to an IV or drip for a few hours so the drugs can be released slowly into your body.

Questions to ask

  • How big is my cancer and where exactly is it?
  • Is my daughter more likely to have cervical cancer if I have it?
  • What if I want to become pregnant?
  • Is there a risk that any children I have after being treated will get cancer?
  • Will I still be able to have sex?
  • What are the side effects of the treatment you are recommending?
  • Why is the treatment you are recommending best for me?
  • Will I have all my treatments at this hospital?
  • How often will I need to have checkups?
  • Will treatment stop my periods and start menopause?
  • Can you write down what you have told me so that I can read it again later?

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Disclaimer

The Women’s does not accept any liability to any person for the information or advice (or use of such information or advice) which is provided on the Website or incorporated into it by reference. The Women’s provide this information on the understanding that all persons accessing it take responsibility for assessing its relevance and accuracy. Women are encouraged to discuss their health needs with a health practitioner. If you have concerns about your health, you should seek advice from your health care provider or if you require urgent care you should go to the nearest Emergency Dept.

Abnormal cervical biopsy results

After a biopsy, the tissue sample is examined under a microscope to look for changes or abnormalities such as cancer. If there are no abnormal cells, the result is reported as normal. An abnormal cervical biopsy means that there have been some changes to the cells in the cervix.

Abnormal cervical biopsy results are reported similar to abnormal Pap test results.

Describing abnormal cells in the cervix

Abnormal cells in the cervix may be described in different ways using different terms. Most often abnormal cell changes in the cervix are described using the Bethesda reporting system, which gives information about how different the cells look from normal cells. The Bethesda reporting system includes the terms low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL) and adenocarcinoma in situ (AIS). Other reporting systems refer to cervical intraepithelial neoplasia (CIN) and cervical dysplasia.

Abnormal squamous cells

This diagram shows how the different terms for describing abnormal cells in the cervix are related.

Squamous intraepithelial lesion (SIL) is the newest way of describing abnormal changes to the squamous cells in the cervix. SIL is described as low grade or high grade.

  • Low-grade SIL (LSIL) compares to CIN 1 and mild dysplasia. LSIL affects a lower part of the cervical lining.
  • High-grade SIL (HSIL) compares to CIN 2 and CIN 3 and moderate and severe dysplasia. HSIL affects most of the cervical lining.

Cervical intraepithelial neoplasia (CIN) is another way to describe abnormal changes to squamous cells in the cervix. Neoplasia means an abnormal and uncontrolled growth of cells.

CIN is graded on a scale of 1 to 3 based on how abnormal the cervical tissue looks under a microscope:

  • CIN 1 is the least severe and compares to mild dysplasia.
  • CIN 2 is moderately severe and compares to moderate dysplasia.
  • CIN 3 is the most severe. It describes both severe dysplasia and carcinoma in situ (a very early stage of cancer in which tumour cells have not yet invaded surrounding tissues).

Dysplasia is another way to describe abnormal cell changes in the cervix. It means that the cells are different from normal cells in size, shape and organization within tissue. Dysplasia almost always refers to a precancerous condition.

The type of dysplasia is based on how much the abnormal cells look like normal cells:

  • Mild dysplasia means the cells look slightly different from normal cells.
  • Moderate dysplasia means the cells look quite different from normal cells.
  • Severe dysplasia means the cells look very different from normal cells.

Abnormal glandular cells

Adenocarcinoma in situ (AIS) describes cancer cells found in the glandular tissue of the endocervix. The cancer hasn’t spread into the deeper tissues of the cervix or surrounding tissue.

Follow-up and treatment for abnormal results

Follow-up and treatment options for an abnormal cervical biopsy can vary. Depending on how severe they are, some changes or abnormalities may not need to be treated. Some abnormal cells change back to normal on their own. Other abnormal cells or precancerous changes to cells may develop into cancer if they aren’t treated.

Women with abnormal cervical biopsy results may have one or more of the following procedures for follow-up or treatment:

  • A Pap test removes a small sample of cells from the cervix. Doctors examine the tissue under a microscope to see if they look normal or abnormal. Find out more about a Pap test.
  • A human papillomavirus (HPV) test is used to test the cervical cells to see if they have the DNA of certain types of HPV. These high-risk types of HPV are more likely to cause cells to become cancerous. Find out more about an HPV test.
  • A colposcopy uses a colposcope (a lighted magnifying instrument) to examine the vulva, vagina and cervix. During a colposcopy, the doctor may also remove cells or tissue so they can be examined under a microscope (called a biopsy).
  • A biopsy removes tissues or cells from the body so they can be examined under a microscope to check for cancer. A biopsy can be done during a colposcopy. Find out more about a biopsy.
  • An endocervical curettage is a type of biopsy. It uses a special tool, called a curette, to remove cells from the endocervical canal. It can be used to collect cells so they can be examined under a microscope to check for cancer. An endocervical curettage can be done during a colposcopy.
  • Cryosurgery uses extreme cold (usually liquid nitrogen or carbon dioxide) to freeze and destroy abnormal cells or tissues. Find out more about cryosurgery.
  • Laser surgery uses a laser, which is a high-intensity beam of light, to remove tissue. Find out more about laser surgery.
  • A cone biopsy removes a cone-shaped piece of tissue from the cervix. It can be done using a surgical scalpel, loop electrosurgical excision procedure (LEEP) or laser surgery. The doctor sends the removed tissue to a lab to be examined under a microscope. Find out more about a cone biopsy.
  • Loop electrosurgical excision procedure (LEEP) is a type of cone biopsy. It uses a thin wire heated by an electrical current to remove tissue from the cervix. Find out more about a LEEP.

Pregnant women with abnormal cervical biopsy results

A woman who is diagnosed with LSIL when she is pregnant usually doesn’t need a repeat colposcopy or treatment until after she has her baby.

If a pregnant woman is diagnosed with HSIL, she will usually have a repeat colposcopy or treatment 8 to 12 weeks after she has her baby. Some women with HSIL will need to have more tests such as a colposcopy, a Pap test or another biopsy during pregnancy. A cone biopsy is not usually done during pregnancy because there is a small risk of bleeding.

What Is a Colposcopy?

Colposcopies are used to help diagnose cervical cancer.

A colposcopy is a diagnostic procedure to examine a woman’s cervix, vagina, and vulva.

It provides an illuminated, magnified view of these areas, allowing doctors to better identify problematic tissues and diseases, particularly cervical cancer.

Physicians typically conduct colposcopies if cervical cancer screening tests (Pap smears) reveal abnormal cervical cells.

The test may also be used to examine:

  • Pain and bleeding
  • Inflamed cervix
  • Noncancerous growths
  • Genital warts or human papillomavirus (HPV)
  • Cancer of the vulva or vagina

Colposcopy Procedure

For at least 24 hours before the examination, which shouldn’t take place during a heavy period, you should not:

  • Douche
  • Use tampons or any other products inserted into the vagina
  • Have vaginal sex
  • Use vaginal medications

You may be advised to take an over-the-counter pain reliever just prior to your colposcopy appointment (such as acetaminophen or ibuprofen).

Just like with a standard pelvic exam, a colposcopy begins with you lying on a table and placing your feet in stirrups.

A speculum (dilating instrument) will be inserted into your vagina, allowing for a better view of the cervix.

Next, your cervix and vagina will be gently swabbed with iodine or a weak vinegar-like solution (acetic acid), which removes mucus from the surface of these areas and helps highlight suspicious tissues.

Then a special magnifying instrument called a colposcope will be placed near the opening of your vagina, allowing your physician to shine a bright light into it, and look through lenses.

If abnormal tissue is found, small pieces of tissue may be taken from your vagina and/or cervix using biopsy tools.

A larger sample of cells from the cervical canal may also be taken using a small, scoop-shaped instrument called a curet.

Your doctor might apply a solution to the biopsy area to prevent bleeding.

Colposcopy Discomfort

A colposcopy generally doesn’t cause any more discomfort than a pelvic exam or Pap smear.

Some women, however, experience a sting from the acetic acid solution.

Cervical biopsies can cause some issues, including:

  • A slight pinch when each tissue sample is taken
  • Discomfort, cramping, and pain, which may last for 1 or 2 days
  • Slight vaginal bleeding and a dark-colored vaginal discharge that could last for up to one week

Colposcopy Recovery

Unless you have a biopsy, there is no recovery time for colposcopy — you can go on with your normal daily activities right away.

If you have a biopsy during your colposcopy, you may need to limit your activity while your cervix heals.

Do not insert anything into your vagina for at least several days — do not have vaginal sex, douche, or use tampons.

For a day or two after the colposcopy, you will probably notice:

  • Light vaginal bleeding and/or a dark vaginal discharge
  • Mild vaginal or cervical pain or very light cramping

Contact your doctor immediately if you experience any of the following after your examination:

  • Heavy vaginal bleeding
  • Severe pain in the lower abdomen
  • Fever or chills

You probably won’t have any problems after your colposcopy and biopsy. If your results show any problems, your doctor might suggest more tests or treatment.

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What do I need to do after my colposcopy procedure?

After you have a colposcopy, your vagina may feel a little sore for a couple of days. If you had a biopsy, you may also have spotting or dark-colored vaginal discharge. Use a pad, panty-liner, or tampon — unless your doctor or nurse tells you not to use tampons.

Here are some other things to keep in mind after your colposcopy and biopsy:

  • You can shower or bathe as soon as you want.

  • If you didn’t have a biopsy, you can have vaginal sex whenever you want.

  • If you did have a biopsy, wait about 3 days to have vaginal sex. This lets your cervix heal.

  • If you take any medications, continue taking them as usual — including your birth control.

What are the risks of a colposcopy and biopsy?

It isn’t common to have problems after a colposcopy and biopsy. Rare risks include bleeding or an infection that needs treatment.

Call your doctor or nurse if you have:

  • bleeding that’s heavier than spotting — unless you think it’s your period

  • fever or chills

  • heavy, yellow-colored, or bad-smelling discharge from your vagina

  • severe pain in the lower part of your belly

If You’re Pregnant

It’s safe to get a colposcopy procedure while you’re pregnant. Getting a biopsy while you’re pregnant is pretty low-risk, but your doctor may want to delay it until after you have your baby. Pregnant people may have more bleeding after a biopsy than people who aren’t pregnant. This is because the cervix has an increased blood supply during pregnancy.

And don’t worry: getting a colposcopy and a biopsy won’t affect your ability to have children in the future.

What if my colposcopy results aren’t normal?

If your doctor or nurse finds abnormal cells, you might not need to do anything right away. Sometimes, you’ll need more tests or treatments. It depends on how abnormal your cervical cells are.

Your doctor or nurse may recommend waiting to see if the cells heal themselves. In this case, you’ll have another Pap test and maybe other tests to watch the cells.

Sometimes, your biopsy is also your treatment. That’s because your doctor may be able to remove all of your abnormal cells during the biopsy. If so, you won’t need any more treatment. You’ll go back to having regular pelvic exams, Pap tests, and/or HPV tests. Your doctor or nurse will tell you how often you need to have these.

Or you might also need further treatment. There are 4 procedures that are very good at removing the abnormal cells and preventing cervical cancer.

  • Cryotherapy: abnormal cells are frozen off

  • LEEP: abnormal cells are removed using a thin wire loop that carries an electrical current

  • Laser: abnormal cells are removed using a laser

  • Cone biopsy: a cone-shaped wedge is cut out of your cervix to remove the abnormal cells

No matter what treatment you get, it’s important to continue getting regular pelvic exams after you’ve been treated for abnormal cells. Even though these procedures are very effective, sometimes abnormal cells come back.

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Cervical Biopsy

What is a cervical biopsy?

A cervical biopsy is a procedure to remove tissue from the cervix to test for abnormal or precancerous conditions, or cervical cancer.

The cervix is the lower, narrow part of the uterus. It forms a canal that opens into the vagina.

Cervical biopsies can be done in several ways. The biopsy can remove a sample of tissue for testing. It can also be used to completely take out abnormal tissue. It can also treat cells that may turn into cancer.

Types of cervical biopsies include:

  • Punch biopsy. This procedure uses a circular blade, like a paper hole puncher, to remove a tissue sample. One or more punch biopsies may be done on different areas of the cervix.

  • Cone biopsy. This procedure uses a laser or scalpel to remove a large cone-shaped piece of tissue from the cervix.

  • Endocervical curettage (ECC). This procedure uses a narrow instrument called a curette to scrape the lining of the endocervical canal. This is an area that can’t be seen from the outside of the cervix.

Why might I need a cervical biopsy?

A cervical biopsy may be done when abnormalities are found during a pelvic exam. It may also be done if abnormal cells are found during a Pap test. A positive test for human papillomavirus (HPV) may also call for cervical biopsy. HPV is a type of sexually transmitted infection. Certain types of HPV can cause cervical cancer and other less common types of genital cancers. A cervical biopsy is often done as part of a colposcopy. This is also called a colposcopy-guided cervical biopsy. A colposcopy uses an instrument with a special lens to look at the cervical tissues.

A cervical biopsy may be done to find cancer or precancer cells on the cervix. Cells that appear to be abnormal, but are not yet cancerous, are called precancerous. These abnormal cells may be the first sign of cancer that may develop years later.

A cervical biopsy may also be used to diagnose and help treat these conditions:

  • Noncancerous growth (polyps) on the cervix

  • Genital warts. These may mean that you have an infection with HPV. HPV is a risk factor for cervical cancer.

  • Diethylstilbestrol (DES) exposure if your mother took DES during pregnancy. DES raises the risk for cancer of the reproductive system.

Your healthcare provider may have other reasons to recommend a cervical biopsy.

What are the risks for a cervical biopsy?

Some possible complications may include:

  • Infection

  • Bleeding

In addition, cone biopsies may increase the risk for infertility and miscarriage. This is because of the changes and scarring in the cervix that may happen from the procedure.

Tell your healthcare provider if:

  • You are allergic to or sensitive to medicines, iodine, or latex.

  • You are pregnant or think you could be pregnant. Some types of cervical biopsies can be done during pregnancy, but others cannot.

If possible, a cervical biopsy will be scheduled about 1 week after your period.

You may have risks depending on your specific health condition. Be sure to talk with your provider about any concerns you have before the procedure.

Certain things can make a cervical biopsy less accurate. These include:

  • Menstruation

  • Acute pelvic inflammatory disease

  • Acute inflammation of the cervix

How do I get ready for a cervical biopsy?

  • Your healthcare provider will explain the procedure and you can ask questions.

  • You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.

  • You usually do not need to stop eating or drinking before a simple cervical biopsy. If your biopsy needs anesthesia, you may need to fast for a certain number of hours before the procedure. This is usually after midnight.

  • Tell your provider if you are pregnant or think you may be pregnant.

  • Tell your provider if you are sensitive to or are allergic to any medicines, latex, tape, or anesthetic medicines (local and general).

  • Tell your provider about all medicines you are taking. This includes prescriptions, over-the-counter medicines, and herbal supplements.

  • Tell your provider if you have had a bleeding disorder. Also tell your provider if you are taking any blood-thinning medicines (anticoagulants), aspirin, or other medicines that affect blood clotting. You may need to stop taking these medicines before the test.

  • You should not use tampons, vaginal creams or medicines, or douche for 24 hours before the procedure.

  • You should not have sex for 24 hours before the procedure.

  • Your healthcare provider may tell you to take a pain reliever 30 minutes before the procedure. Or you may be given medicine to help you relax before the anesthesia is started. You will need someone to drive you home afterward.

  • You may want to bring a sanitary pad to wear home after the procedure.

  • Follow any other instructions your provider gives you to get ready.

What happens during a cervical biopsy?

You may have a cervical biopsy in a healthcare provider’s office, as an outpatient, or during a hospital stay. Some biopsy procedures only need local anesthesia. Other need regional or general anesthesia. The way the test is done may vary depending on your condition and your healthcare provider’s practices.

Generally, a cervical biopsy follows this process:

  1. You will need to undress completely or from the waist down and put on a hospital gown.

  2. You will be told to empty your bladder before the procedure.

  3. You will lie on an exam table, with your feet and legs supported as for a pelvic exam.

  4. Your healthcare provider will put an instrument called a speculum into your vagina. This will spread the walls of the vagina apart to reach the cervix.

  5. Often the healthcare provider will use a colposcope. This is an instrument with a special lens like a microscope to help see the cervical tissues. The provider will put colposcope at the opening of your vagina. It will not enter your vagina.

  6. Your healthcare provider will look through the colposcope to find any problem areas on the cervix or in the vagina.

  7. He or she may clean and soak the cervix with a vinegar solution (acetic acid solution). This solution helps make the abnormal tissues turn white so they are easier to see. You may feel a mild burning sensation. An iodine solution may be used to coat the cervix. This is called the Schiller test.

  8. The type of biopsy done will depend on the size and shape of the abnormal cells, as well as where they are.

  9. The healthcare provider may numb the area using a small needle to inject medicine.

  10. He or she may use forceps (tenaculum) to hold the cervix steady for the biopsy. You may feel some cramping when the tenaculum is put in place.

  11. The amount of tissue removed and where it is removed depend on the type of biopsy. For a simple cervical biopsy, one or more small samples of tissue will be removed using a special type of forceps. When this is done, you may feel a slight pinch or cramp. Cells from the inside of the cervical canal may be removed with a special tool called an endocervical curette or an endocervical brush. This may also cause some cramping.

  12. For a cone biopsy, the provider may use a loop electrosurgical excision procedure (LEEP) or the cold knife cone biopsy procedure. With the cold knife cone biopsy, a laser or a surgical scalpel may be used to remove tissue. This procedure needs regional or general anesthesia.

  13. Bleeding from the biopsy site may be treated with a paste-like topical medicine. The provider may also use a probe (electrocauterization) or stitches (sutures) to stop the bleeding.

  14. After a cone biopsy, the provider may pack the cervix with a pressure dressing. Your provider will tell you how to remove this packing.

  15. The provider will send the tissue to a lab for testing.

What happens after a cervical biopsy?

Your recovery will depend on the type of biopsy done and if you had anesthesia.

If you have regional or general anesthesia, you will be taken to the recovery room to be watched. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home. If you had the procedure done as an outpatient, you should plan to have someone drive you home.

After a simple biopsy, you may rest for a few minutes after the procedure before going home.

You may want to wear a sanitary pad for bleeding. It is normal to have some mild cramping, spotting, and dark or black-colored discharge for several days. The dark discharge is from the medicine put on your cervix to control bleeding.

Take a pain reliever for cramping as recommended by your healthcare provider. Aspirin or certain other pain medicines may increase the chance of bleeding. Be sure to take only recommended medicines.

You may be told not to douche, use tampons, or have sex for 1 week after a biopsy, or for a period advised by your healthcare provider.

After a cone biopsy, you should not put anything into your vagina until your cervix has healed. This may take several weeks. You may also have other limits on your activity, including no heavy lifting.

You may go back to your normal diet unless your healthcare provider tells you otherwise.

Your healthcare provider will tell you when to return for further treatment or care. Generally, women who have had a cervical biopsy will need more frequent Pap tests.

Tell your healthcare provider if you have any of the following:

  • Bleeding

  • Foul-smelling drainage from your vagina

  • Fever and/or chills

  • Severe lower abdominal pain

Your healthcare provider may give you other instructions after the procedure, depending on your situation.

Colposcopy is a way to get a close-up look at your cervix. It’s a quick and easy way to find cell changes in your cervix that may turn into cancer.

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What’s a colposcopy?

A colposcopy is a type of cervical cancer test. It lets your doctor or nurse get a close-up look at your cervix — the opening to your uterus. It’s used to find abnormal cells in your cervix.

What happens during a colposcopy and biopsy?

You’ll lie down on an exam table like you would for a pelvic exam. The doctor or nurse will put a speculum into your vagina and open it. This separates the walls of your vagina so they can get a really good look at your cervix.

They’ll wash your cervix with a vinegar-like solution. This makes it easier to see abnormal cells. Next they’ll look at your cervix through a colposcope — an instrument that looks like binoculars on a stand with a bright light. The colposcope doesn’t touch you or go inside you.

If your doctor or nurse sees something that doesn’t look normal, they’ll do a biopsy. This means they’ll take a tiny sample of tissue and send it to a lab.

There are 2 types of biopsies: One takes tissue from outside your cervix. The other takes tissue from inside the opening of your cervix. Sometimes you need more than one biopsy.

A colposcopy and biopsy only takes about 5-10 minutes.

Does it hurt?

A colposcopy is nearly pain-free. You might feel pressure when the speculum goes in. It might also sting or burn a little when they wash your cervix with the vinegar-like solution.

If you get a biopsy, you might have some discomfort. Most people describe it feeling like a sharp pinch or a period cramp. You might have a little spotting, bleeding, or dark discharge from your vagina for a few days after a biopsy.

What should I know before my appointment?

You don’t have to do much to prepare for a colposcopy. Here are 2 things you can do to make things easier:

  1. Schedule your colposcopy for when you won’t have your period. That makes it easier to see the cervix.

  2. Don’t douche, use tampons, put medicine in your vagina, or have vaginal sex for at least 24 hours before your appointment.

Where can I get a colposcopy?

You can get a colposcopy at your doctor or nurse’s office, some community health clinics, or your local Planned Parenthood health center.

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Your doctor may want to do a colposcopy to check for changes in the health of your cervix, vagina, and vulva. Here are a few things to know about this important examination before your appointment.

1. What’s a colposcopy and why do I need one?

A colposcopy is used to find cancerous cells or abnormal cells that can become cancerous in the cervix, vagina, or vulva. These abnormal cells are sometimes called “precancerous tissue.” A colposcopy also looks for other health conditions, such as genital warts or noncancerous growths called polyps. A special instrument called a colposcope gives your doctor a lighted, highly magnified view of the tissues that make up your cervix, vagina, and vulva. The colposcope is placed close to the body, but it does not enter the body.

2. How is a colposcopy different than a pap test?

A pap test, also called a pap smear, involves gathering a sample of cells from your cervix and testing them for early changes that can lead to cervical cancer. If your pap test showed some abnormal cells and you tested positive for HPV, a colposcopy can help confirm and diagnose potential problems. HPV, or human papillomavirus, is a virus that may raise your risk for certain types of cancer, including cervical, vaginal, and vulvar cancers. Your doctor may also recommend a colposcopy if you have symptoms or signs of cervical, vaginal, or vulvar cancer.

3. What happens during a colposcopy?

A colposcopy can be done in the office of your primary care doctor or your gynecologist. After lying down on the exam table, you’ll place your heels in the stirrups at the end of the table. An instrument called a speculum will be inserted inside your vagina to open it up and give your doctor a clearer view of your cervix. Your cervix, vagina, and vulva will be lightly wiped with a vinegar or iodine solution that helps your doctor better see abnormal areas. The colposcope is positioned between your legs as close to your vagina as possible, but it never goes inside your body.

4. What happens if my doctor sees an abnormal area during the colposcopy?

During the colposcopy, your doctor may perform a biopsy on areas that look unhealthy. A biopsy is the removal of a small amount of tissue for examination by a pathologist. A pathologist can identify abnormal cells by looking at the tissue sample under a microscope. While a colposcopy can suggest that you have cancer or precancerous tissue, only a biopsy can actually make a diagnosis. If an abnormal area is small, your doctor may be able to remove all of it during the biopsy.

The type of biopsy you’ll have will depend on the location of the tissue being biopsied. For example, 1 common biopsy method of cervical tissue uses an instrument to pinch off small pieces of suspicious areas. The doctor may also do an endocervical curettage biopsy to check an area inside the opening of the cervix that can’t be seen during a colposcopy. You may feel pinching or discomfort similar to menstrual cramps during some biopsy types. Sometimes a local anesthetic is used to numb the area before the biopsy. Ask your doctor about the different types of biopsies that could potentially be done during your colposcopy.

5. What should I do before a colposcopy?

Your doctor may suggest that, for 24 to 48 hours before a colposcopy, you stop using vaginal medicines, creams, powders, or foams. During this period, you should also stop having vaginal sex, using tampons, or placing any other products in your vagina. Don’t schedule a colposcopy during the week of your period, and be sure to let your doctor know if you’re pregnant or might be pregnant before your appointment. You may also want ask your doctor if you should take an over-the-counter pain medication before the examination in case you have a biopsy.

6. Will I have any side effects from the colposcopy?

There are no direct side effects that a colposcopy will cause. However, if you have a biopsy during a colposcopy, then you could have a dark vaginal discharge for a few days. This comes from the solution doctors use to reduce bleeding that can happen with a biopsy. You may also have some bleeding, cramping, or soreness. If these or other symptoms get worse or don’t go away, or you have extremely heavy bleeding, severe pain in your lower abdomen or pelvis, or a fever after the examination, call your doctor immediately. Like before the colposcopy, don’t have vaginal sex or use any type of products or medications that go inside the vagina until your doctor says it’s OK.

7. What happens when the biopsy results come back?

If a biopsy taken during your colposcopy shows that you have precancerous tissue, the tissue may need to be removed to keep cancer from developing. Your doctor will explain the different removal methods that may be right for you. If the biopsy shows that cancer is present, you may need to have more tests before you begin treatment. Your doctor will likely refer you to a gynecologic oncologist, who specializes in treating gynecologic cancer. During treatment for any precancerous tissue or cancer, you may have additional colposcopies to see how well a treatment is working and to look for additional abnormal changes over time.

Colposcopy

What is a colposcopy?

A colposcopy is a type of women’s health exam. It is often performed by your family doctor or a gynecologist. They use a tool called a colposcope. It shines a light on the cervix and magnifies the view.

A colposcopy often is done if you have an abnormal Pap smear. The purpose of the exam is to get a close look at a woman’s cervix. The doctor can see and diagnose problems they can’t see with the naked eye. For example, the doctor can detect cervical cancer at an early stage.

Path to improved health

Before the exam

A colposcopy is a short outpatient exam. It is typically done in a doctor’s office. Prior to the exam, you should empty your bladder and bowels. Do not douche, have sex, or use vaginal medicines or tampons 24 hours before your appointment. Be sure to let your doctor know if you are pregnant or are allergic to latex, iodine, or certain medicines.

During the exam

The complete exam takes about 20 to 30 minutes. The doctor has you lie face up on an exam table. You bend your legs and place your feet in stirrups, as you would for a pelvic exam or Pap smear. First, the doctor inserts a speculum into your vagina. This small tool opens your vagina so they can see inside your vagina and the outside of your cervix. Then, the doctor applies a solution of vinegar or iodine to your cervix with a cotton swab. The solution makes potentially abnormal tissue turn white.

Next, the doctor looks at your cervix through the colposcope. They may take photographs with a tiny camera. If the doctor sees spots of abnormal tissue, they will perform a biopsy. This involves removing small samples of tissue from the abnormal area in or around your cervix. The samples are sent to a lab to examine.

You may experience some discomfort during the exam. You could have mild cramps caused by the speculum opening your cervix. You may feel a slight pinch and cramping when the doctor removes tissue to biopsy. Try to relax your muscles and take slow, deep breaths.

After the exam

Following the exam, you may have mild cramps. You can take an over-the-counter medicine to help relieve the pain. Ask your doctor what kind to take, as well as how much and when to take it. You also could have some vaginal discharge for 1 or 2 days. During the biopsy, your doctor may put a thick paste on your cervix to stop any bleeding. When this paste mixes with blood, it can form a thick, dark discharge. Light spotting is normal as well. Your doctor will probably recommend wearing a sanitary pad.

You should not use a tampon, have sex, or put anything in your vagina for at least 1 week after the exam.

Things to consider

It takes about 1 to 2 weeks for the lab to process the biopsy. Your doctor’s office will contact you with the results and let you know if treatment is needed.

Normal results indicate that no abnormal changes were found. Abnormal results can indicate several things.

  • Cervical polpys (growths on the cervix). These are not cancerous.
  • Cervical warts.
  • HPV (human papilloma virus). The biopsy can diagnose the specific strain of the infection.
  • Cervicitis (inflammation of the cervix).
  • Cervical dysplasia (precancerous changes in the cervical tissue).
  • Cervical cancer.

The risks of a colposcopy are very low. You can have mild pain, bleeding, or discharge. A colposcopy should not prevent you from getting pregnant in the future.

When to see a doctor

Call your doctor right away if you have any of the following symptoms after your exam.

  • Heavy vaginal bleeding (using more than one sanitary pad per hour).
  • A bad-smelling vaginal odor.
  • Severe lower stomach pain.
  • Fever or chills.

Questions to ask your doctor

  • Is it possible to do a colposcopy if I am pregnant?
  • What are the benefits and risks of a colposcopy?
  • How soon after a colposcopy can I return to my normal activities?
  • What types of treatment may be needed if my biopsy results come back abnormal?

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