A colposcopy-directed biopsy uses a low-powered microscope called a colposcope to help view the surface of the cervix and show abnormalities.

You will lie on a table and place your feet in stirrups to position your pelvis for examination. The health care provider will insert an instrument (speculum) into your vagina to open the vaginal canal and examine the cervix.

The cervix is then swabbed with a chemical solution (acetic acid) to remove the mucus that covers the surface, and to highlight abnormal areas. The health care provider will place the colposcope at the opening of the vagina, and examine the area. Photographs may be taken.

If any areas look abnormal, a small sample of the tissue will be removed (biopsy) using small biopsy forceps. Many samples may be taken, depending on the size of the area.

There is no special preparation. You may be more comfortable if you empty your bladder and bowel before the procedure. You should not douche or have sexual intercourse for 24 hours before the exam.

A colposcopy is painless. Some women feel a slight sting from the vinegar solution. The biopsy may feel like a pinch each time a tissue sample is taken. You may have some cramping after the biopsy.

It is typical for women to hold their breath during pelvic procedures because they expect pain. Concentrating on slow, regular breathing will help you relax and help relieve pain.

This procedure is usually done after a positive Pap smear to identify the abnormality.

A smooth, pink surface of the cervix is normal. A biopsy is only done when the health care provider sees or suspects abnormal tissues because of abnormal Pap smear results.

Abnormal results may indicate:

• Cancer
• Cervical intraepithelial neoplasia
• Cervical warts (human papilloma virus)
• Precancerous tissue changes

The colposcopy may be used to keep track of precancer and look for abnormalities that come back after treatment.

Abnormal findings during a colposcopy include:

• Abnormal patterns in the blood vessels
• Whitish patches on the cervix
• Areas that are swollen, worn away, or wasted away (atrophic)

Any of these problems may be signs of cancerous changes.

The test also may be done if an abnormal Pap smear shows signs of cervical dysplasia.

After the biopsy, you may have some bleeding for up to a week. To allow the biopsy area to heal, for 2 weeks avoid:

• Douching
• Sexual intercourse
• Using tampons

Call your health care provider:

• If bleeding is very heavy or lasts for longer than 2 weeks
• You notice any signs of infection (fever, foul odor, or discharge)

If the colposcopy or biopsy does not show why the Pap smear was abnormal, your health care provider may suggest that you have a more extensive biopsy.

See also: Cold knife cone biopsy

Katz VL, Lentz GM, Lobo RA, Gershenson DM. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby; 2007.