Colposcopy
What is a colposcopy?
A colposcopy is a procedure in which the provider uses a multi-lens instrument (a colposcope) to magnify the external genital area, vagina and cervix. This magnified view allows the provider to easily examine and identify any areas of abnormal cells. The colposcope is not inserted into the vagina but stands outside the area, like a free standing microscope. If suspicious areas of cervical tissue are seen during the colposcopy, the provider may take samples of tissue (biopsy) from the area for microscopic examination as well. The sample is then sent to the laboratory for analysis, and the lab findings determine the next step in the treatment.
The procedure is essentially painless and quite simple. It only takes a few minutes to perform, and colposcopy can adequately evaluate about 90% of women who have abnormal Pap smear results.
When is it used?
A colposcopy is recommended for women who have an abnormal appearing cervix or have had abnormal Pap test results , meaning that abnormal size and shaped cells have shown up on the Pap smear. There are different categories of abnormal Pap test results, which may indicate possible infection, a precancerous growth, or cancer. Whereas the Pap test is only a screening test, the colposcopy is a diagnostic test used to define the exact nature of the problem.
How can I prepare for a colposcopy?
Do not make your appointment during your menstrual period as a colposcopy cannot be performed while a woman is menstruating.
Twenty-four hours before the procedure, refrain from intercourse, the use of spermicidal jelly, vaginal medications, douches, or tampons, as these can interfere with the accuracy of the tests.
Also, one hour before your scheduled procedure, it is suggested that you take 400-600 mg of ibuprofen (e.g. Motrin, Advil), unless you are allergic to this medication.
What happens during the procedure?
You will lie on the examining table, just as in a regular pelvic exam, with your feet in the stirrups. The provider will use a speculum to separate the walls of the vagina as in a Pap smear. The speculum stays in the vagina throughout most of the procedure.
The colposcope is placed at the vaginal opening in order to examine the genital area, vagina and cervix. The colposcope does not touch you. The provider will apply a vinegar solution to enable abnormal cells to be more visible. This may sting a bit.
If abnormal cells are found during the procedure, the provider will take a tissue sample (biopsies) of those areas, removing a tiny sample of cells from that area with a tweezer like instrument. The provider may also do an endocervical scraping in which they will take some cells from the os, the opening of the cervix. You may feel pinching or cramping when the provider performs the biopsies. Some providers put a numbing gel on your cervix to lessen this feeling. Your discomfort will go away shortly after the procedure. If the provider has done a biopsy, s/he may put a ‘paste’ on your cervix so that you do not bleed. This ‘paste’ is a yellow-mustard color. The tissue samples are then sent to the laboratory for analysis, and the lab findings determine the next step in the treatment.
What happens after the procedure?
Immediately following the procedure, the provider will explain what he or she saw.
After you leave the clinic, slight bleeding may continue for several days as your body heals the area where any tissue samples were taken from. You may have vaginal discharge which looks like coffee grounds mixed with blood and the yellow-mustard paste. This is normal. You may use menstrual pads but there should be no sexual intercourse, tampons, or douching for at least 3-7 days after the procedure.
Make sure to rest after the procedure. You may take 400 mg of ibuprofen every four hours if you have cramping or pain.
What follow up tests do I need after the colposcopy?
The provider will help you make a follow up appointment after the procedure to discuss the results of the biopsy in 1-2 weeks. At that time, you and the provider will determine how your follow up should be handled. If you have any questions, do not hesitate to ask. It is very important to understand this follow up.
Colposcopy is not a cure for an abnormal Pap smear; it just allows us to identify the reason why the Pap smear was abnormal. Follow up may consist of having more frequent Pap smears. This is to make sure the abnormality does not progress to cancer. These follow up Pap smears may vary between every 3 to 6 months; this will be determined by the provider.
Benefits of this procedure
The provider should be able to better diagnose the problem in the cervix and vagina and suggest further treatment if necessary.
Risks associated with this procedure
Risks are minimal. Limited cramping and minor bleeding from the biopsy site may occur.
Other less common risks include:
- heavy bleeding (more than one pad per hour or more bleeding than your menstrual flow)
- fever
- infection
- pelvic or abdominal pain
In the event that any of the above occurs, you should contact your provider immediately.
Insurance coverage
You should check with your insurance company about the coverage for this procedure. If your insurance covers colposcopy, but not through the Student Health Center, you may decide to have the procedure done elsewhere. If you decide to get colposcopy at a site other than Duke Student Health, we just ask that you notify our Pap Tracking Nurse by replying to your email message/letter which notified you of your Pap result.
If you plan to have colposcopy performed at Duke Student Health, please bring your insurance information to your visit, so that we may process your insurance claim.
Where can I go for more information and support?
Duke students who want additional information about colposcopy, dysplasia, abormal Pap smears, and/or HPV can make an appointment to see a Health Education Specialist one-on-one at the Student Health Center. The health educator will be able to answer any of your questions about colposcopy, as well as any other reproductive health issues.
To make an appointment, call 919-681-WELL and ask to schedule an HPV consultation with Lindsey Bickers Bock.
Online resources:
American Academy of Family Physicians.
Colposcopy
National Library of Medicine
Provides an
online tutorial about colposcopy.
Requires Flash player to view.
Planned Parenthood
Colposcopy - Questions & Answers
Colposcopy and Cervical Biopsy
Reviewed by the Office of Health Promotion, August 2006.