In colposcopy and cervical punch biopsy, a doctor uses a colposcopea long, thin tube equipped with a magnifying lens and a light—to visually inspect the vagina and cervix (the bottom of the uterus that opens into the vagina) for abnormalities and uses a low-powered microscope to make the cervix appear much larger, Photographs may be taken of any suspicious lesions. In some cases, the cervix may be biopsied to obtain tissue samples for microscopic examination; this procedure is called cervical punch biopsy. Colposcopy is most commonly performed to evaluate women who have had an abnormal Pap smear.
Purpose of the Colposcopy and Cervical Punch Biopsy
- To confirm the presence of precancerous conditions (such as cervical intraepithelial neoplasia, or CIN) or cervical cancer detected by a Pap smear
- To evaluate suspicious vaginal or cervical lesions identified during a pelvic exam
- To monitor women receiving conservative treatment for precancerous CIN
- To monitor women at high risk for developing reproductive cancers, such as those whose mothers took diethylstilbestrol (DES) during pregnancy
Who Performs Colposcopy and Cervical Punch Biopsy
- A gynecologist
Special Concerns about Colposcopy and Cervical Punch Biopsy
- Punch biopsy should ideally be performed one week after your last menstrual period has ended, since menstrual blood can obscure the view of the cervix.
- In some cases, cervical punch biopsy may be performed without the aid of a colposcope. Instead, an applicator stick is used to apply iodine and stain the normal cervical tissue (but not abnormal tissue) to identify sites for biopsy.
Before the Colposcopy and Cervical Punch Biopsy
- Tell your doctor if you are pregnant or may be pregnant.
- Inform your doctor if you have an allergy or sensitivity to any medications, latex, tape, iodine or anesthetic agents (local and general).
- Tell your doctor about all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
- Tell your doctor if you have a history of a bleeding disorder or are taking blood thinners (anticoagulants), such as aspirin, or other medications that affect blood clotting. In some cases, you must stop taking these medications before colposcopy and cervical punch biopsy.
- Do not apply any vaginal creams or medications for 24 hours prior to the procedure.
- Empty your bladder just before the test.
- You will be asked to undress from the waist down and put on a drape or hospital gown.
What You Experience during Colposcopy and Cervical Punch Biopsy
- You will lie on your back on an examining table with your knees bent and feet resting in stirrups.
- The doctor gently inserts a speculum—a metal or plastic instrument that pushes apart the walls of the vagina to provide a view of the cervix—into your vagina. The device may feel cold and uncomfortable, but causes no pain. Relax and breathe through your mouth to ease the insertion.
- A cotton swab, small brush, or wooden spatula may be inserted through the speculum to perform a Pap smear.
- The doctor swabs the vaginal walls and the cervix is, cleansed with a solution that removes excess mucus and helps highlight any abnormal areas. This vinegar-like acetic acid solution may cause a little burning feeling. Iodine may also be applied to make abnormal cervical cells easier to see.
- The colposcope is passed through the speculum and focused on the cervix (the instrument never enters the body of the uterus). The doctor will note abnormal areas (with, for example, an unusual tissue color or blood vessel pattern). Photographs or sketches may be made of any abnormalities.
- If a biopsy is performed, a special scissors-like instrument (biopsy forceps) is inserted through the speculum or colposcope and used to snip tiny specimens approximately the size of half a grain of rice, from selected sites on the cervix. You may feel a brief pinching sensation as each sample is taken.
- Following a biopsy, the doctor may apply pressure or use special solutions or a cautery device to control any bleeding. If bleeding continues, the doctor may insert a tampon (you should leave it in place for 8 to 24 hours, according to your doctor’s instructions).
- The procedure takes about 10 minutes.
Risks and Complications of Colposcopy and Cervical Punch Biopsy
- Colposcopy alone is not associated with any risks or complications.
- Rare complications associated with cervical punch biopsy include excessive bleeding for up to a week after the procedure and infection . Mild cramping, vaginal soreness, and dark discharge for 13 days may occur.
After the Colposcopy and Cervical Punch Biopsy
- You may return home (someone should accompany you home after a biopsy).
- If you had a biopsy, avoid strenuous activity for 8 to 24 hours. Your doctor will also instruct you to avoid sexual intercourse, douching, and tampons for several days to 1 week until the biopsy sites have healed.
- You may experience mild cramping after a biopsy. An over-the-counter pain reliever, such as ibuprofen, should provide some relief.
- Slight bleeding may also follow a biopsy. Use sanitary napkins rather than tampons. You may also develop a foul-smelling, gray-green vaginal discharge for several days.
- Inform your doctor if you experience heavy bleeding (more than during menstruation) or vaginal discharge that persists for more than 21 days.
Colposcopy and Cervical Punch Biopsy Results
- During visual inspection of your vagina and cervix, the doctor will note any abnormalities.
- If a biopsy was obtained, a pathologist examines the tissues sample under a microscope for the presence of unusual cells.
- If a definitive diagnosis can be made, your doctor will recommend an appropriate course of medical or surgical treatment, depending on the specific problem.
- If results are unclear, more invasive tests, such as a cone biopsy of the cervix, may be needed to confirm a diagnosis
The Johns Hopkins Consumer Guide to Medical Tests
Simeon Margolis, M.D., Ph.D., Medical Editor
Updated by Remedy Health Media