Colposcopy is simply looking at the cervix with a microscope; it is often combined with biopsies of the cervix. Colposcopy is most commonly done to evaluate the cervix after an abnormal pap smear. It may also be done for bleeding after intercourse or to get a closer look at a visible lesion on the cervix. For most women the colposcopy is not that much more uncomfortable than a pap smear. There will be some cramping at the end but that usually only lasts a few seconds to a minute. There should not be pain when leaving the office. There may be bleeding or spotting for one or two days after the procedure. Women should be on pelvic rest, nothing in the vagina, for two days after a colposcopy.

A colposcopy starts with the woman lying down in the same position as a pap smear. A speculum is inserted in the vagina and the cervix is rinsed with a vinegar solution. The vinegar allows abnormal cells to be seen more clearly. The cervix is then viewed through the microscope until the entire transformation zone is visible. Abnormal areas are then sampled with a biopsy. The biopsy specimen is very small, about the size of a head of a pin. The biopsy can cause bleeding but for most women it is not painful. The doctor will usually do an ECC (endocervical curettage). This is a scraping of the inside of the cervix and will cause cramping. This cramping usually only lasts a few seconds to a minute and is not severe. The ECC samples the inner part of the cervix, the endocervix. This area is difficult to see with the microscope, so it needs to be sampled and separately examined to be sure it is not the reason for the abnormal pap smear. Finally, the doctor will use either silver nitrate or Monsel’s solution to control the bleeding. The application of these chemicals is done with a Q-tip and will not cause pain.

After the colposcopy most women feel fine and are not in any pain. There might be some spotting for one or two days. It is recommended to be on pelvic rest, which means nothing in the vagina, no sex, tampons, douching, or anything else for two days. If there is spotting or bleeding tampons should be avoided and pads used instead. Apart from the spotting, most women do not have any physical changes after the colposcopy and are free to do all of their normal activities.

It can take a week or more to get the results back. Colposcopy is generally done to look for dysplasia it is extremely rare to find a cervical cancer on a colposcopy. Cervical dysplasia is easily treated so try not to worry when you are waiting for your results.

Sometimes colposcopy is necessary in pregnancy. Colposcopy in pregnancy is safe and will not cause a miscarriage. An ECC is usually not done in pregnancy but cervical biopsies are safe. If a cervical biopsy is done it will likely cause some vaginal bleeding. This bleeding is from the outside of the cervix and will not affect the baby in any way.