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A colposcopy-directed biopsy uses a low-powered microscope called a colposcope to help view the surface of the cervix and show abnormalities.

You will lie on a table and place your feet in stirrups to position your pelvis for examination. The health care provider will insert an instrument (speculum) into your vagina to open the vaginal canal and examine the cervix.

The cervix and vagina are gently swabbed with a chemical solution (acetic acid) to remove the mucus that covers the surface, and to highlight abnormal areas. Sometime an iodine-based solution (Lugol's) similar to solutions used for cleaning skin may also be swabbed on the cervix and vagina.

The health care provider will place the colposcope at the opening of the vagina and examine the area. Photographs may be taken. The colposcope does not touch you.

If any areas look abnormal, a small sample of the tissue will be removed (biopsy) using small biopsy forceps. Many samples may be taken, depending on the size and location of the area. Sometimes a tissue sample from inside the cervix is removed. This is called curettage.

There is no special preparation. You may be more comfortable if you empty your bladder and bowel before the procedure. You should not douche, place any products into the vagina, or have sexual intercourse for 24 hours before the exam. You should not be menstruating.

The placement of the instrument (speculum) to better see the cervix may be more uncomfortable than for a regular Pap smear.

Some women feel a slight sting from the vinegar or Lugol's solution.

The biopsy or curettage may feel like a pinch each time a tissue sample is taken. You may have some cramping or slight bleeding after the biopsy. Heavy bleeding is unusual; if you have bleeding that soaks a pad in an hour, call your doctor.

It is typical for women to hold their breath during pelvic procedures because they expect pain. Concentrating on slow, regular breathing will help you relax and help relieve pain. Ask your doctor or nurse about brining a support person with you if that will help.

This procedure is usually done after a positive Pap smear to identify the abnormality.

A smooth, pink surface of the cervix is normal. A biopsy is only done when the health care provider sees or suspects abnormal tissues because of abnormal Pap smear results.

Abnormal findings during a colposcopy include:

• Abnormal patterns in the blood vessels
• Whitish patches on the cervix
• Areas that are swollen, worn away, or wasted away (atrophic)

Any of these problems may be signs of:

• Cancer
• Cervical intraepithelial neoplasia (precancerous tissue changes that are also called cervical dysplasia)
• Cervical warts (infection with human papilloma virus, or HPV)

The colposcopy may be used to keep track of HPV, and to look for abnormalities that come back after treatment.

After the biopsy, you may have some bleeding for up to a week.

Call your health care provider if:

• Bleeding is very heavy or lasts for longer than 2 weeks.
• You notice any signs of infection (fever, foul odor, or discharge).

If the colposcopy or biopsy does not show why the Pap smear was abnormal, your health care provider may suggest that you have a more extensive biopsy.

See also: Cold knife cone biopsy

Biopsy - colposcopy-directed

Katz VL, Lentz GM, Lobo RA, Gershenson DM. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby; 2007.

Updated by: A.D.A.M. Editorial Team: David Zieve, MD, MHA, Greg Juhn, MTPW, David R. Eltz. Previously reviewed by Peter Chen, MD, Department of Obstetrics & Gynecology, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network (2/19/2008).