A colposcope is a lighted magnifying instrument that allows the clinician to examine the cervix at high magnification — approximately 10 to 40 times normal size — to identify areas of abnormal tissue that are not visible to the naked eye. Colposcopy is the standard next step after an abnormal Pap test or HPV result that warrants further evaluation. It is a diagnostic procedure: its purpose is to identify where to biopsy, not to treat. The biopsy results provide the histologic diagnosis that guides management.
Colposcopy is performed in the office, takes approximately 10 to 20 minutes, and does not require general anesthesia. Most women describe the procedure as similar to a Pap test in terms of discomfort — with some additional cramping during biopsy. Understanding what to expect before the procedure significantly reduces the anxiety that accompanies a test most women have never encountered before.
Positioning and Speculum Placement
You will be positioned in the exam table in the same way as for a Pap test. A speculum is inserted to open the vaginal walls and expose the cervix — the same first step as any pelvic examination. The colposcope is positioned outside the vagina and does not enter the body. It magnifies the view of the cervix from outside.
Acetic Acid Application
A dilute acetic acid solution (similar to white vinegar) is applied to the cervix with a cotton swab. The acetic acid causes abnormal cells, which have a higher protein content, to temporarily turn white — a reaction called acetowhitening. This highlights areas of potential dysplasia against the normal pink cervical tissue, identifying where to look more closely and where to target biopsies. The acetic acid may cause a mild stinging or burning sensation for a few seconds.
Lugol’s Iodine (Optional)
Lugol’s iodine solution may be applied after the acetic acid. Normal cervical cells take up iodine and turn brown. Abnormal cells do not take up iodine and remain unstained (yellow or white). Iodine application provides complementary information to acetowhitening and may help further characterize the extent and location of abnormal areas.
Cervical Biopsy
Any areas that appear abnormal under the colposcope are biopsied — a small sample of tissue is removed with biopsy forceps for histologic examination. The biopsy instrument produces a sharp pinching or cramping sensation lasting a few seconds. Multiple biopsies may be taken from different areas. A brown, paste-like solution (Monsel’s solution) or silver nitrate is applied to the biopsy sites to stop any bleeding. Some women experience brief lightheadedness or cramping after biopsies, which typically resolves within minutes with rest.
Endocervical Curettage (ECC)
An endocervical curettage — sampling of cells from inside the cervical canal with a small curette — is performed in some colposcopy evaluations, particularly when the transformation zone (the area where dysplasia arises) is not fully visible, or when the result that triggered colposcopy suggests possible glandular involvement (AGC results). ECC produces a cramping sensation and in some women produces the most uncomfortable part of the colposcopy procedure. It is included when clinically indicated based on the indication for colposcopy and the colposcopic findings.
After the Procedure
After colposcopy, mild to moderate cramping similar to menstrual cramps may persist for several hours. Dark discharge from the Monsel’s solution is normal and may continue for several days. Light spotting from the biopsy sites is expected. Sexual intercourse, tampons, and vaginal insertions should be avoided for 48 hours or until spotting resolves. Biopsy results are typically available within one to two weeks and are reviewed at a follow-up appointment or by telephone with a clear explanation of the findings and the next recommended step.
Mild cramping and dark discharge are normal after colposcopy. Contact our office if you experience:
- Heavy vaginal bleeding — soaking a pad in an hour or more
- Fever above 38°C (100.4°F) suggesting possible infection at the biopsy site
- Significant worsening of pelvic pain beyond what was present immediately after the procedure
Before the Procedure
Taking ibuprofen 400 to 600mg one hour before your colposcopy reduces cramping during and after the procedure. Avoid scheduling your colposcopy during your menstrual period if possible, as bleeding makes visualization more difficult. You do not need to fast or make other special preparations. Wearing comfortable clothing is helpful, as some women prefer to rest briefly after the biopsies.
During the Procedure
Dr. Andrei narrates the procedure as it proceeds, explaining what is being seen and what is being done at each step. Most women find that knowing what is happening reduces anxiety significantly. The entire procedure including preparation, examination, biopsies, and hemostasis typically takes 15 to 20 minutes. You will be able to rest briefly afterward if needed before leaving the office.
After the Results
Biopsy results are reviewed with a clear explanation of the histologic diagnosis (CIN 1, CIN 2, CIN 3, or other findings), what the diagnosis means, and the recommended next step — whether that is surveillance with repeat testing, return to routine screening, or treatment with LEEP or another procedure. No result is communicated without adequate explanation of its implications.
Dr. Andrei performs colposcopy with clear explanation at every step. No referral required.
Schedule a Gynecologic VisitEducational purposes only. Not medical advice. Content reviewed by Dr. Ramona D. Andrei, MD PhD FACOG.
Gynecologic care for women of every age
Lapeer Women’s Health — Rochester Hills
2710 S Rochester Rd, Suite 2
Rochester Hills, MI 48307
Serving patients in Lapeer, Rochester Hills, and surrounding communities throughout Southeast Michigan.