Colposcopy

Colposcopy is a close-up examination of the cervix (the lower opening of the uterus, or womb) using a colposcope, a magnifying instrument that lets a gynaecologist see the surface of the cervix in much greater detail than a standard pelvic examination allows.

During the examination, a mild liquid is applied to the cervix. This liquid makes any abnormal cells stand out so they are easier to see. The colposcope stays outside the body the entire time — nothing enters the uterus. If an area looks unusual, the doctor may take a small tissue sample, called a biopsy, from that spot so it can be studied in a laboratory.

Colposcopy is most often recommended when a cervical screening test (sometimes called a Pap smear or liquid-based cytology) returns an abnormal result. It is a follow-up step — it does not replace screening, but it helps the doctor understand what is causing the abnormality.

• Abnormal cervical screening result, such as low-grade or high-grade cell changes (dysplasia — cells that look different from normal but are not yet cancer)
• Positive test for high-risk HPV (human papillomavirus, a common virus that can, over time, cause cervical cell changes)
• Unexplained bleeding between periods, after sexual intercourse, or after menopause
• A cervix that looks inflamed, ulcerated, or unusual during a routine pelvic examination
• Monitoring of previously identified abnormal cells that are being watched rather than treated immediately

Colposcopy is generally safe for most women, but there are some situations where the timing or approach may need to be adjusted. Your doctor will advise based on your individual circumstances.

• Active menstrual bleeding — the examination is usually rescheduled because blood can make the cervix harder to see clearly
• Active vaginal or pelvic infection — this is usually treated first before the procedure is performed
• Pregnancy — colposcopy can still be done during pregnancy if necessary, but a biopsy is usually delayed until after delivery unless cancer is strongly suspected

Colposcopy itself is a low-risk diagnostic procedure. The main risks arise if a biopsy is taken at the same time.

• Mild discomfort or cramping during and shortly after the examination — similar to period pain
• Light spotting or bleeding after the procedure, which usually settles within a day or two
• If a biopsy is taken: heavier or prolonged bleeding, though this is uncommon
• If a biopsy is taken: a small risk of infection at the biopsy site, which may require antibiotics
• Temporary dark-coloured vaginal discharge if a haemostatic solution (a liquid used to stop bleeding) is applied to the biopsy site — this is normal and not a sign of infection
• Rarely, significant bleeding that requires further treatment

Colposcopy does not require fasting, a general anaesthetic (medication that puts you fully to sleep), or a hospital stay. Most patients attend as an outpatient and go home the same day. However, there are a few steps that help the examination go smoothly.

Before the appointment, doctors usually advise the following:

• Avoid placing anything inside the vagina for at least 24 hours beforehand — this includes tampons, vaginal creams, and sexual intercourse — so that the cervix is not disturbed
• Do not douche (rinse the inside of the vagina), as this can alter the appearance of the cervix
• If you take blood thinners, let your doctor know in advance, as these may need to be paused before any biopsy
• Over-the-counter pain relief such as a mild painkiller taken about an hour before the appointment may help reduce cramping — ask your doctor whether this is appropriate for you
• Try to schedule the appointment for a day when you are not menstruating, if possible

Before or at the time of the appointment, your care team may review your recent cervical screening results and your medical history. No special blood tests are routinely needed before a colposcopy alone, but if a biopsy is anticipated, some clinics check your blood clotting function.

Here is what typically happens during the procedure:

• 1. You lie on an examination table with your feet in supports (stirrups), in the same position as a pelvic examination.
• 2. A speculum (a smooth instrument that gently holds the vaginal walls open) is inserted so the cervix is visible.
• 3. The colposcope is positioned outside the vagina and the doctor looks through it — the device does not touch you.
• 4. A mild solution such as acetic acid (diluted vinegar) is gently applied to the cervix with a swab. Any abnormal areas turn white, making them easier to identify.
• 5. An iodine-based solution (Lugol's iodine) may also be applied to further highlight any unusual areas.
• 6. If an abnormal area is found, the doctor may use small forceps (a pincer-like instrument) to take one or more biopsies. Each biopsy takes only a few seconds.
• 7. If a biopsy is taken, a small amount of solution may be applied to the site to help stop any bleeding.
• 8. The speculum is removed and the examination is complete. The whole procedure usually takes between ten and twenty minutes, though this can vary.

Because colposcopy is a brief outpatient procedure with no general anaesthetic, most people feel well enough to go home and resume normal activities quite quickly. If a biopsy was taken, there are a few extra precautions to follow while the biopsy site heals.

• You may experience light spotting or mild cramping for a day or two — this is normal after the procedure
• If a haemostatic solution was applied, you may notice dark brown or black vaginal discharge for several days; this is the solution coming away and is not a cause for concern
• Avoid placing anything inside the vagina — tampons, vaginal creams, or sexual intercourse — for at least one week after a biopsy, or as long as your doctor advises, to allow the biopsy site to heal
• Sanitary pads (not tampons) can be used for any discharge or spotting
• Avoid vigorous exercise, heavy lifting, or swimming until any spotting has fully stopped, usually within a few days
• Contact your doctor if you experience heavy bleeding (soaking more than one pad per hour), a foul-smelling discharge, fever, or severe lower abdominal pain, as these may indicate infection or another complication
• Biopsy results are usually available within one to several weeks, depending on the laboratory; your doctor will explain the results and discuss whether any treatment or further monitoring is needed
• Follow-up appointments and the interval before your next cervical screening will be determined by your doctor based on the biopsy findings