The Colposcopy Exam: Are There Any Risks?

What You Should Know When Your Doctor Suggests a Colposcopy

A woman at the gynecologist having a colposcopy
What are the risks of a colposcopy?. Keith Brofsky/Getty Images

An abnormal pap smear can prompt your doctor to advise that you undergo a colposcopy exam. A colposcopy is a common follow-up procedure that allows a doctor to view the cervix more closely. It involves the use of a colposcope which is a lighted instrument that is like a large microscope, allowing the cervix to be magnified.

During a Colposcopy Exam

A colposcopy exam begins much like a Pap Test, where the patient is lying down on an examination table with feet up in stirrups.

The doctor inserts a speculum into the vagina and opens it slightly to see the cervix. After applying a vinegar solution to the cervix and vagina with a cotton swab (so that the abnormal tissue can turn white), the doctor looks through the colposcope to look at the tissues on the cervix and vaginal walls closely. In some cases, the doctor will take a small sample of tissue (called a cervical biopsy) to be further examined by a lab.

A colposcopy is a painless exam and is usually performed in the doctor's office. Normally, a colposcopy is completed in 30 minutes or less.

Common Reasons For a Colposcopy

The doctor uses the colposcope to diagnose and assist in the treatment of:

  • Diethylstilbestrol (DES) exposure - DES exposure in utero (when your mother was pregnant with you) can raise the risk of a type of cervical cancer known as clear cell cervical cancer. DES was not prescribed after 1971, so woman born after that date are not at risk.

Risks and Possible Complications Associated with Colposcopy

A colposcopy procedure can be visualized as a Pap smear with a magnifying glass, and as such, poses little risk.

As noted below, most risks (which occur infrequently) occur when a biopsy is done during the procedure. Risks and complications associated with having a colposcopy may include:

  • Vaginal irritation (from the vinegar solution used to turn abnormal tissue white.)
  • Bleeding (if a biospy is performed) - Bleeding is an uncommon complication sometimes associated with a biopsy during a colposcopy. Heavy bleeding (more than a pad per hour) or bleeding that lasts longer than a week should prompt you to call your doctor. Avoiding heavy lifting (and anything which strains your abdominal muscles) following your procedure can longer your risk of this occurring.
  • Infection (if biopsy is performed) - Infections may occur after a biopsy but are uncommon. This risk can be reduced by following your post-procedure instructions carefully, such as avoiding intercourse, not using tampons, avoiding douching, and taking showers rather than tub baths for a certain period of time.
  • Allergy or sensitivity to iodine, medications used to numb the cervix (lidocaine plus epinephrine) during a biopsy, or latex may occur rarely. It is important to let your doctor know if you are allergic to latex, iodine, or any other medications.
  • False negative results - Perhaps the most common, yet still uncommon, risk related to a colposcopy is a false negative, or an exam that appears normal even though there is a area of concern on the cervix. It is very important to see your doctor regularly after a colposcopy and have follow up exams as instructed. The chance of this, however, is fairly low. In one study, the chance that a woman would develop CIN II or more severe changes in the cervix was only around two percent during the three years following colposcopy.

If you are pregnant, make sure to let your doctor know. While some cervical procedures such as repeated cone biopsies are associated with preterm labor, your doctor will want to talk to you about any small risks related to a colposcopy and balance this with any risk related to a delay in following up on any cervical abnormalities.

There may be other risks based on your condition. Be sure to discuss any concerns with your doctor before the start of the procedure.

Certain Conditions That May Interfere With a Colposcopy

Conditions which can increase the risk of complications such as infection following your colonoscopy include:

Before the colposcopy is performed, your doctor will give you a consent form to sign that outlines the risks of having a colposcopy and other important information. Be sure to read over the information carefully, and ask questions if you don't understand something.

How to Minimize the Risk of Infection or Bleeding After Colposcopy

Your doctor will send you home with a list of instructions. These instructions usually advise:

  • No sex for a specific amount of time after the exam (This can vary depending on whether or not a biopsy or other procedure are performed)
  • No tampon use
  • No douching or vaginal medications
  • No heavy lifting (more so for those who had a cervical biopsy with colposcopy)
  • No tub bathing for first the 24 hours after the exam (this may be longer if you have had a biopsy, especially with a large biopsy)

When to Call Your Doctor

Call your doctor if the following occurs:

  • Bleeding through an average sanitary napkin in the span of an hour
  • Spotting for more than seven days
  • Cramping or lower abdominal pain that is not relieved by over-the-counter pain medications
  • Fever of 100 degrees F or more
  • Bright red bleeding
  • Chills
  • Foul smelling discharge
  • Any symptoms that are concerning to you

After a colposcopy, it is normal to experience spotting. If a biopsy is done, a thick, brownish discharge can also be expected. Some women experience minor cramping that can be relieved with over-the-counter pain medications.

Sources:

Cruickshank, M., Cotton, S., Sharp, L. et al. Management of Women with Low Grade Cytology: How Reassuring is a Normal Colposcopy Examination? BJOG. 2015. 122(3):380-6.

Feltmate, C., and S. Feldman. Colposcopy. UpToDate. Updated 09/26/16.

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