COLPOSCOPY OVERVIEW

Having a regular screening test for cervical cancer (Pap smear) 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 healthcare provider to look at your cervix using magnification. (See "Patient information: Cervical cancer screening".)

Not all women with an abnormal cervical screening test will need treatment. Colposcopy can help to determine if and when treatment of the abnormality is needed.

More detailed information about colposcopy is available by subscription. (See "Colposcopy".)

WHY DO I NEED COLPOSCOPY?

Colposcopy is used to follow up abnormal cervical cancer screening tests (eg, Pap smear, human papilloma virus (HPV) testing) or abnormal areas seen on the cervix, vagina, or vulva. Your Pap smear may be abnormal if you have cervical pre-cancer or cancer, often caused by HPV infection of the cervix. HPV is explained in detailed separately. (See "Patient information: Cervical cancer screening".)

The colposcope magnifies the appearance of the cervix (picture 1A-B). This allows the clinician to better see where the abnormal cells are located and the size of any abnormal areas. The size and location of abnormal cells helps to determine how severe the abnormality is and also helps to determine what treatment, if any, is needed. When monitored and treated early, pre-cancerous 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) and you should not have sex for at least three days.

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

If you take any medication to prevent blood clots (aspirin, warfarin, heparin, clopidogrel), notify your healthcare 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 healthcare provider know. Colposcopy is safe during pregnancy, although your provider may not perform biopsies of the cervix.

COLPOSCOPY PROCEDURE

Colposcopy can be performed by a physician (including most gynecologists), 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 pelvic examination, while you lie on an exam table. The healthcare provider will use an instrument called a speculum to open your vagina and find your cervix (picture 1A-B). The provider will usually repeat a Pap smear, 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 healthcare 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.

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

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

AFTER COLPOSCOPY

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 women are able to return to work or school immediately after having a colposcopy. Most women do not have pain or cramping.

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

If you have a biopsy, ask your healthcare provider when your results will be available (usually within seven to 14 days). In most cases, further testing and treatment will depend on the results of the biopsy. (See "Patient information: Management of atypical squamous cells (ASC-US and ASC-H) and low grade cervical squamous intraepithelial lesions (LSIL)" and "Patient information: Management of high grade cervical squamous intraepithelial lesions (HSIL) and glandular abnormalities (AGC)" and "Patient information: Treatment of abnormal Pap smears".)

Do not assume that the biopsy results are normal if you do not hear from your healthcare provider — call and inquire about the results. Most women will need a follow up test (repeat cervical cancer screening (Pap smear) and/or colposcopy) within 6 months.

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

• Heavy vaginal bleeding (soaking through a menstrual pad in an hour for two hours in a row)
• Vaginal bleeding for more than 7 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 100.4ºF or 38ºC

WHERE TO GET MORE INFORMATION

Your healthcare provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed every four months on our web site (www.uptodate.com/patients).

Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.

Patient level information

Patient information: Cervical cancer screening
Patient information: Management of atypical squamous cells (ASC-US and ASC-H) and low grade cervical squamous intraepithelial lesions (LSIL)
Patient information: Management of high grade cervical squamous intraepithelial lesions (HSIL) and glandular abnormalities (AGC)
Patient information: Treatment of abnormal Pap smears

Professional level information

Cervical adenocarcinoma in situ
Cervical cancer in pregnancy
Cervical cancer screening tests: Techniques for cervical cytology and human papillomavirus testing
Cervical cytology: Evaluation of atypical and malignant glandular cells
Cervical cytology: Evaluation of atypical squamous cells (ASC-US and ASC-H)
Cervical cytology: Evaluation of high grade squamous intraepithelial lesions
Cervical cytology: Evaluation of low grade squamous intraepithelial lesions
Cervical intraepithelial neoplasia: Ablative therapies
Cervical intraepithelial neoplasia: Definition, incidence, and pathogenesis
Cervical intraepithelial neoplasia: Management
Cervical intraepithelial neoplasia: Procedures for cervical conization
Clinical presentation and diagnosis of human papillomavirus infections
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 Society for Colposcopy and Cervical Pathology

      (www.asccp.org/patient_edu.shtml)

• American College of Obstetricians and Gynecologists

      (www.acog.org/publications/patient_education/bp135.cfm)

[1-3]