Human papillomavirus (HPV) is a very common virus that can be spread through sexual contact. There are over 100 different types of HPV, and some types are more likely to cause health problems than others. HPV infections are so common that nearly all sexually active people will get the virus at some point in their lives. In most cases, the virus goes away on its own without causing any health issues. However, sometimes HPV infections persist and can cause cell changes that may lead to cancer over time. This is why getting screened and following up on abnormal test results is important.
What is a colposcopy?
A colposcopy is a procedure that allows a doctor to closely examine the cervix for any abnormalities. It is done when screening tests like a Pap smear show cell changes that could indicate precancer or cancer. During a colposcopy, the doctor uses a special magnifying device called a colposcope to get a magnified view of the cervix and vagina. The colposcope does not enter the body – it simply magnifies the view of the area.
The procedure typically involves:
- Positioning you on an exam table and inserting a speculum to open the vagina
- Swabbing the cervix and vagina with a dilute vinegar solution – this makes abnormal areas appear white
- Examining the cervix and vagina under magnification and looking for any white, irregular areas
- Taking a small tissue sample (biopsy) from any abnormal looking areas for laboratory testing
The tissue removed during the biopsy is sent to a lab where it is examined under a microscope to determine if any precancerous or cancerous changes are present. A colposcopy is the best way for your doctor to determine if abnormal cells are present on your cervix.
Why do I need a colposcopy if I have HPV?
There are a few reasons why your doctor may recommend getting a colposcopy if you have HPV:
Abnormal Pap test result
If you have HPV and your Pap test showed abnormal cell changes, a colposcopy is usually the next step to examine your cervix more closely. The Pap test is a screening test, while a colposcopy is a diagnostic procedure that can determine where the abnormal cells are located. The colposcopy results, along with the biopsy results, will indicate whether you need treatment or if you can just be monitored by your doctor.
High-risk HPV strains
Some types of HPV are considered high-risk because they are more likely to cause cancer. Two strains in particular, HPV 16 and HPV 18, account for about 70% of all cervical cancers. If your Pap test was normal but testing shows you have a high-risk HPV strain, your doctor may want to do a colposcopy to examine your cervix.
HPV infection persists longer than usual
Most HPV infections go away within 1-2 years as your immune system clears the virus. However, sometimes an HPV infection persists longer than expected. If a high-risk HPV strain has not gone away after 3-5 years, a colposcopy can help determine if any precancerous changes have developed.
Your doctor is closely monitoring your HPV
If you have ongoing HPV that your doctor is monitoring, colposcopy exams may be recommended on a regular basis, such as once per year. This allows your doctor to keep a close eye on your cervix for any signs of cell changes.
What happens during a colposcopy?
Here is a step-by-step look at what you can expect during a standard colposcopy procedure:
1. Pelvic exam
The first part of the exam will be a basic pelvic exam. You’ll lie on the exam table and place your feet in stirrups. Your doctor will insert a speculum to open up your vagina and allow access to your cervix.
2. Visual inspection
Your doctor will first examine your cervix visually, looking for any abnormalities or suspicious areas. They will inspect both the inside lining of the cervix (endocervix) and the outside portion (ectocervix).
3. Vinegar solution
Your doctor will use cotton swabs or a spray to apply a diluted vinegar solution to your cervix. This causes abnormal or precancerous cells to turn white, making them easier to see.
4. Colposcope exam
Your doctor will examine your cervix under magnification using the colposcope – a large instrument that stays outside the body. The colposcope has bright lights and magnifies the view up to 15 times. This allows the doctor to identify abnormal cells.
5. Biopsy
If any precancerous or suspicious areas are seen, your doctor will take a small sample of tissue (biopsy) from those regions. The biopsy may feel like a quick pinch or cramp. The tissue is sent to a lab for examination under a microscope.
6. End of procedure
When the colposcopy exam is complete, your doctor will remove the instruments and speculum. You may have some mild cramping, bleeding or watery discharge afterward. Your doctor will let you know when to expect biopsy results.
How long does a colposcopy take?
The actual colposcopy procedure typically takes between 10 and 20 minutes to complete. However, you should plan to be at your doctor’s office for at least an hour for the entire visit, including:
- Paperwork and consent forms
- Waiting for your turn
- Pelvic exam
- Colposcopy
- Time preparing and changing after the procedure
If you have a biopsy taken, you may need to stay for observation for up to 30 minutes after the procedure to ensure bleeding has stopped.
Does a colposcopy hurt?
For most women, a colposcopy does not hurt. You may feel some mild discomfort or pressure during the speculum exam, which is also felt during a routine Pap test. The application of vinegar solution can cause a mild stinging sensation. The biopsy can cause cramping, similar to menstrual cramps. If the biopsy is taken from an area with more nerve endings, it may also cause a sharp pinch. Taking over-the-counter pain medication like ibuprofen an hour before your appointment can help minimize discomfort. Tell your doctor if you feel any pain so they can take steps to reduce it.
How do I prepare for a colposcopy?
Follow these tips to prepare for your colposcopy:
- Schedule the appointment for a time when you will not be on your period. This allows for better visualization.
- Avoid any vaginal creams, lubricants, douches or tampons for 2 days beforehand.
- Take ibuprofen an hour before the procedure to reduce cramping.
- Wear a skirt or loose pants so you can easily undress from the waist down.
- Limit your fluid intake for 1-2 hours prior to reduce the need to urinate.
- Arrive on time and expect to be there for up to an hour.
- Have someone available to drive you home afterward if possible.
Are there any risks or complications?
Colposcopy is generally a very low-risk procedure. Possible side effects include:
- Mild bleeding – spotting may persist for several weeks after biopsy
- Infection – rare, but see your doctor if you have a fever after the exam
- Weakness or lightheadedness – from the biopsy or anxiety, have someone with you to help if needed
- Discharge – watery or discolored discharge is common for a few days
More serious risks like severe bleeding or injury to the cervix are extremely rare. Talk to your doctor if you have any concerns.
What happens after the colposcopy?
After your colposcopy, you will likely have some mild cramping and spotting. You can use pads for bleeding and take over-the-counter pain relievers as needed. Avoid sex, tampons, and douching for 1-2 days. Your doctor will let you know when your biopsy results will be available, often within a few days or a week. Normal activities can be resumed once any bleeding or discharge has stopped.
Your doctor will go over your colposcopy and biopsy results at a follow up visit and discuss whether any treatment is recommended based on the findings. Your options may include:
- Monitoring and repeat Pap/HPV tests – if results show mild cell changes that are likely to resolve on their own
- LEEP – loop electrosurgical excision procedure to remove abnormal areas
- Cryotherapy – freezing abnormal cells
- Cone biopsy – removing a cone-shaped portion of the cervix containing abnormal cells
- Hysterectomy – surgical removal of the uterus and cervix; only done for severe cases
Frequently asked questions about colposcopy
Is a colposcopy the same thing as a Pap smear?
No, a Pap smear is a screening test that collects cells from the cervix to detect any changes. A colposcopy is a follow-up diagnostic procedure done after an abnormal Pap to examine the cervix in detail and take biopsies.
Can a colposcopy detect cervical cancer?
A colposcopy alone cannot definitively diagnose cervical cancer. However, it can identify suspicious areas that can then be biopsied. The biopsy results give the final diagnosis by identifying any cancerous cell changes under the microscope.
Will a colposcopy affect my fertility or ability to get pregnant?
No, a simple colposcopy does not affect fertility. More invasive treatments like LEEP or cone biopsy may increase the risk of problems like cervical insufficiency. But even these procedures do not rule out pregnancy altogether. Discuss any fertility concerns with your doctor.
Does insurance cover colposcopy? What is the cost?
Most insurance plans cover colposcopy as a diagnostic procedure when abnormal Pap results are present. The cost varies based on location, doctor fees, and any biopsies or lab work needed. Talk to your insurance provider to understand exactly what is covered. Without insurance, you may pay $400-$600 or more out of pocket.
Do I need a referral for a colposcopy?
A referral is not necessarily required for a colposcopy, but your doctor will generally recommend one after getting abnormal Pap or HPV test results. Make an appointment with a gynecologist or specialist to have the colposcopy performed.
How accurate is a colposcopy?
Colposcopy itself allows for excellent visualization of the cervix for abnormalities. However, the biopsy results provide the most accurate diagnosis. In expert hands, colposcopy biopsy has an accuracy rate of over 90% in detecting precancer compared to final pathology results after excision.
How often do I need to have colposcopies?
If you have mild cell changes, your doctor will likely recommend a colposcopy every 6-12 months to monitor for any progression. If your results are normal, you may only need a repeat colposcopy in 3-5 years. More frequent colposcopies may be advised based on the extent of cell changes.
Can cervical cancer be cured if found early?
Yes, the 5-year survival rate for early stage cervical cancer is over 90%. Regular screening and prompt treatment of precancerous changes found on colposcopy can prevent progression to cancer. Cervical cancer is considered highly curable when detected in the early stages through exams like colposcopy.
The bottom line
Having HPV does not mean you will get cervical cancer. However, some types of HPV can cause cell changes that may lead to cancer over many years if left untreated. Getting a colposcopy performed after an abnormal Pap test can determine if you need treatment for these cell changes. While waiting for a colposcopy appointment or results can cause anxiety, try to stay positive – following up on abnormal tests allows precancerous changes to be treated before they become cancer. With routine screening and management as needed, the outlook for HPV and precancer is excellent.