Colposcopy and Cervical Biopsy

Colposcopy is a way for your doctor to use a special magnifying device to look at your vulva, vagina, and cervix. If a problem is seen during colposcopy, a small sample of tissue (biopsy) may be taken from the cervix or from inside the opening of the cervix (endocervical canal). The sample is looked at under a microscope. See a picture of the vagina or cervix .

Colposcopy is usually done to look at the vagina and cervix when the result of aPap test is abnormal. Many abnormal Pap tests are caused by viral infections, such as human papillomavirus (HPV) infection, or other types of infection, such as those caused by bacteria, fungi (yeast), or protozoa (Trichomonas). Natural cervical cell changes (atrophic vaginitis) related to menopause can also cause an abnormal Pap test. In some cases, untreated cervical cell changes that cause abnormal Pap tests may progress to precancerous or cancerous changes. During colposcopy, your doctor uses a lighted magnifying device that looks like a pair of binoculars (colposcope). The colposcope allows your doctor to see problems that would be missed by the naked eye. A camera can be attached to the colposcope to take pictures or videos of the vagina and cervix. Your doctor may put vinegar (acetic acid) and sometimes iodine (Lugol's solution) on the vagina and cervix with a cotton swab or cotton balls to see problem areas more clearly. Why It Is Done Colposcopy is done to: Look at the cervix for problem areas when a Pap test was abnormal. If an area of abnormal tissue is found during colposcopy, a cervical biopsy or a biopsy from inside the opening of the cervix (endocervical canal) is usually done. Check a sore or other problem (such as genital warts) found on or around the vagina and cervix. Follow up abnormal areas seen on a previous colposcopy. Colposcopy can also be done to see if treatment for a problem worked. Look at the cervix for problem areas if an HPV test shows a high-risk type of HPV is present. How To Prepare Tell your doctor if you: Are or might be pregnant. A blood or urine test may be done before the colposcopy to see whether you are pregnant. Colposcopy is safe during pregnancy. If a cervical biopsy is needed during a colposcopy, the chance of any harm to the pregnancy (such as miscarriage) is very small. But you may have more bleeding from the biopsy. A colposcopy may be repeated about 6 weeks after delivery. Are taking any medicines. Are allergic to any medicines. Have had bleeding problems or take blood thinners, such as aspirin or warfarin(Coumadin). Have been treated for a vaginal, cervical, or pelvic infection. How To Prepare continued...

Do not have sexual intercourse or put anything into your vagina for 24 hours before a colposcopy. This includes douches, tampons, and vaginal medicines. You will empty your bladder just before your colposcopy. You may want to take a pain reliever, such as ibuprofen (Advil or Motrin), 30 to 60 minutes before having a colposcopy, especially if a biopsy may be done. This can help decrease any cramping pain that can be caused by the colposcopy. Schedule your colposcopy for when you are not having your period. Heavy bleeding makes it harder for your doctor to see your cervix. The best time to schedule a colposcopy is during the early part of your menstrual cycle, 8 to 12 days after the start of your last menstrual period. You will need to sign a consent form that says you understand the risks of colposcopy and agree to have the colposcopy done. Talk to your doctor about any concerns you have regarding the need for the colposcopy, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form. How It Is Done Colposcopy is usually done by a gynecologist, a family medicine physician, or anurse practitioner who has been trained to do the test. If a biopsy is done, the sample will be looked at by a pathologist. Colposcopy can be done in your doctor's office. You will need to take off your clothes below the waist. You will be given a covering to drape around your waist. You will then lie on your back on an examination table with your feet raised and supported by foot rests (stirrups). Your doctor will put an instrument with smooth, curved blades (speculum) into your vagina. The speculum gently spreads apart the vaginal walls so your doctor can see inside the vagina and the cervix. See a picture of a pelvic examination with a speculum . The colposcope is moved near your vagina and your doctor looks through the microscope at the vagina and cervix. Vinegar (acetic acid) or iodine (Lugol's solution) may be used on your cervix to make abnormal areas more visible. Photographs or videos of the vagina and cervix may be taken. If areas of abnormal tissue are found on the cervix, your doctor will take a small sample (cervical biopsy) of the tissue. Usually several samples are taken. The samples are looked at under a microscope for changes in the cells that may meancancer may be present or is likely to develop. If bleeding occurs, a special (Monsel's) liquid or silver nitrate swab may be used on the biopsy area to stop the bleeding. If a sample of tissue is needed from inside the opening of the cervix (the endocervical canal), a test called endocervical curettage (ECC) will be done. Since the endocervical canal cannot be seen by the colposcope, a small sharp-edged tool called a curette is gently put into the endocervical canal to take a sample. ECC takes less than a minute to do and may cause mild cramping. An ECC is not done during pregnancy. Colposcopy and a cervical biopsy usually take about 15 minutes. How It Feels You may feel some discomfort when the vaginal speculum is inserted. You may feel a pinch and have some cramping if a biopsy sample is taken. Risks In rare cases, a cervical biopsy can cause an infection or bleeding. Bleeding can usually be stopped by using a special liquid or swab on the area.

After the test If you have a biopsy, you may feel some soreness in your vagina for a day or two. Some vaginal bleeding or discharge is normal for up to a week after a biopsy. The discharge may be dark-colored if Monsel's solution was used. You can use a sanitary pad for the bleeding. Do not douche, have sex, or use tampons for one week, to allow time for your cervix to heal. Do not exercise for one day after your colposcopy. Follow any instructions your doctor gave you. Call your doctor if you have: Heavy vaginal bleeding (more than a normal menstrual period). A fever. Belly pain. Bad-smelling vaginal discharge. Results Colposcopy is a way for your doctor to use a special magnifying device to look at your vulva, vagina, and cervix. Your doctor will talk to you about what he or she sees at the time of the colposcopy. Lab results from a biopsy may take several days or more. Colposcopy and cervical biopsy Normal: The vinegar or iodine does not show any areas of abnormal tissue. The vagina and cervix look normal. A biopsy sample does not show any abnormal cells. Abnormal: The vinegar or iodine shows areas of abnormal tissue. Sores or other problems, such as genital warts or an infection, are found in or around the vagina or cervix. A biopsy sample shows abnormal cells. This may mean cervical cancer is present or likely to develop. What Affects the Test Reasons you may not be able to have the colposcopy or why the results may not be helpful include: If you have sexual intercourse 24 hours before the colposcopy. The use of douches, tampons, or vaginal creams or medicines 24 hours before the colposcopy. If you are having a menstrual period at the time of the colposcopy. If a vaginal or cervical infection is present. If you have gone through menopause. Hormonal changes may make it difficult to see the cervical canal clearly. What To Think About

Colposcopy is not usually used as a screening test for women at high risk for cervical cancer. A Pap test is done for that purpose. But a colposcopy gives you and your doctor more information if you have an abnormal result from a Pap test. Sometimes only abnormal cervical biopsy results are reported back to the woman. Tell your doctor if you want to be informed of normal biopsy results. If a colposcopy and cervical biopsy are normal, it is not likely that you have cell changes that can lead to cervical cancer. Another biopsy may be needed if a Pap test, colposcopy, and cervical biopsy show different results. In some cases, a larger biopsy area, called a cone biopsy, is removed. Special tools, such as laser or a heated loop, can be used to remove a cone-shaped wedge of normal and abnormal tissue from the cervix. A cone biopsy may treat the problem because all of the abnormal tissue is removed. Your doctor will give you more instructions if a cone biopsy is needed. Women with human immunodeficiency virus (HIV) have a higher chance of developing cervical cancer. A colposcopy is recommended for all women with HIVand an abnormal Pap test. Related Information

Abnormal Pap Test Other Works Consulted

Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders. Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins. Pagana KD, Pagana TJ (2010). Mosby?s Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby.

By Primary Medical Reviewer

Healthwise Staff Kirtly Jones, MD, MD - Obstetrics and Gynecology

Specialist Medical Reviewer Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology Last Revised January 6, 2010