Colposcopy: Closer Look After an Abnormal Screening
A detailed, in-office evaluation that uses gentle solutions and magnification to map changes and, when needed, take targeted biopsies.
Colposcopy is a focused exam of the cervix (and sometimes the vagina and vulva) performed after an abnormal Pap or positive high-risk HPV result. We apply dilute acetic acid and/or Lugol’s iodine to make cellular changes more visible, then examine the area under magnification. If we see patterns concerning for dysplasia, we take small, directed biopsies and may perform an endocervical curettage (ECC) to sample the canal. The goal is clarity—confirming whether treatment is needed or if watchful follow-up is appropriate.
Fast Facts About Colposcopy
In-office procedure; no general anesthesia required
Uses acetic acid (“vinegar”) and/or Lugol’s iodine to highlight changes
Allows targeted cervical biopsies and optional ECC
Most visits take 10–20 minutes; crampy pressure is common
Results guide next steps: observation, repeat testing, or treatment
Who It May Help
- Abnormal Pap smear (ASC-US, LSIL, HSIL, ASC-H) or positive high-risk HPV
- Persistent HPV with prior normal or borderline cytology
- Post-treatment surveillance after LEEP, cone, or ablation
- Evaluation of visible cervical lesions or unexplained bleeding
- Immunocompromised patients needing closer assessment
How It Works
After placing a speculum, we apply dilute acetic acid to the cervix. Areas with increased nuclear activity temporarily whiten (acetowhitening), helping us identify possible dysplasia. Lugol’s iodine can further differentiate glycogenated (benign) from non-glycogenated epithelium. Using a colposcope (a specialized microscope) we inspect vascular and surface patterns, then take small, directed biopsies from any suspicious zones. An endocervical curettage (ECC) may be done to sample the cervical canal when indicated.
Candidacy & Alternatives
Colposcopy is typically recommended after specific abnormal screening results per guideline-based algorithms. It is generally avoided during heavy bleeding or untreated pelvic infection. In pregnancy, colposcopy can be safely performed; we typically defer ECC and limit biopsies to areas with high concern. Alternatives depend on context and may include repeat Pap/HPV testing at defined intervals, expedited treatment for very high-risk results, or diagnostic excisional procedures (e.g., LEEP or cone) when warranted. We individualize recommendations to your results, age, fertility plans, and medical history.
Colposcopy vs. Related Steps
Colposcopy
- Diagnostic, in-office magnified exam
- Uses acetic acid/Lugol’s iodine to guide biopsies
- Determines whether treatment is needed
- Minimal downtime; light spotting common
Pap/HPV Screening
- Non-invasive population screening
- Flags who needs further evaluation
- Does not diagnose dysplasia grade
- Leads to colposcopy if abnormal
LEEP / Excisional Treatment
- Removes a cone of tissue to treat confirmed high-grade dysplasia
- Therapeutic rather than diagnostic alone
- Requires more recovery and specific aftercare
- Reserved for confirmed or highly suspected HSIL
What to Expect
The visit usually lasts 10–20 minutes. You may feel pressure from the speculum and mild cramping with biopsies or ECC. A brown or dark discharge can occur if we apply a hemostatic solution. Plan for light spotting up to a few days. Avoid intercourse, tampons, and douching for 48 hours (or as directed) after biopsies. Results typically return within 1–2 weeks and guide next steps—ranging from routine follow-up to treatment if high-grade changes are confirmed.
Safety & Considerations
Colposcopy is generally safe with low risk of complications. Expected effects include brief cramping, spotting, and discharge. Uncommon risks include heavier bleeding or infection at a biopsy site. Let us know if you have bleeding disorders, are on anticoagulants, or could be pregnant. If you have a history of cervical procedures or difficulty with speculum exams, we can adjust positioning, instruments, and comfort measures.
Before Your Visit
- ✓Schedule when you are not on heavy menstrual flow if possible
- ✓Avoid vaginal medications, intercourse, or douching for 24–48 hours before
- ✓Take an over-the-counter pain reliever 30–60 minutes prior if recommended
- ✓Bring prior Pap/HPV results and any recent procedure notes
- ✓Tell us if you might be pregnant or have bleeding disorders
Frequently Asked Questions
1Does colposcopy treat abnormal cells?
Colposcopy is primarily diagnostic. It helps locate and grade abnormal areas with targeted biopsies. If high-grade dysplasia is confirmed, treatment options such as LEEP or excision are discussed.
2What is an ECC and will I need one?
Endocervical curettage (ECC) samples cells from the cervical canal when the squamocolumnar junction is not fully visible or results suggest higher risk. Whether it is done depends on your findings and guidelines.
3Is it painful?
Most people feel pressure and brief, cramp-like discomfort with biopsies. Discomfort is usually mild and short-lived; over-the-counter pain relief can help.
4What is the downtime?
Expect light spotting for up to a few days. Avoid tampons, intercourse, and swimming/hot tubs for 48 hours—or as directed—after biopsies to reduce infection and bleeding risk.
5Is it safe during pregnancy?
Yes, colposcopy can be safely performed in pregnancy to rule out high-grade disease. We typically avoid ECC and limit biopsies to areas of clear concern.
6When will I get results and what happens next?
Pathology usually returns within 1–2 weeks. Based on results, we may recommend observation with repeat testing, treatment for high-grade lesions, or routine screening intervals.
Need a Colposcopy After an Abnormal Pap or HPV Test?
We’ll perform a careful, guideline-based evaluation, explain your results clearly, and outline the safest next steps for your goals and fertility plans.
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