The colposcope helps to identify abnormal areas of the cervix or vagina so that small pieces of tissue (biopsies) can be taken for further analysis.

Colposcopy is used to identify or rule out the existence of any precancerous conditions in the cervical tissue. If a PAP test shows abnormal cell growth, further testing, such as colposcopy, often is required. A PAP test is a screening test that involves scraping cells from the outside of the cervix. If abnormal cells are found, the physician will attempt to find the area that produced the abnormal cells and remove it for further study (biopsy). Only then can a diagnosis be made.

Colposcopy may also be performed if the cervix looks abnormal during a routine examination. It may also be suggested for women with genital warts and for diethylstilbestrol (DES) daughters (women whose mothers took DES when pregnant with them).

Women who are pregnant, or who suspect that they are pregnant, must tell their doctor before the procedure begins. Pregnant women can, and should, have a colposcopy if they have an abnormal PAP test. However, special precautions must be taken during biopsy of the cervix.

A colposcopy is performed in a physician's office and is similar to a regular gynecologic exam. An instrument called a speculum is used to hold the vagina open, and the gynecologist looks at the cervix and vagina through the colposcope instead simply by eye, as in a routine examination.

The colposcope is placed outside the patient's body and never touches the skin. The cervix and vagina are swabbed with dilute acetic acid (vinegar). The solution highlights abnormal areas by turning them white (instead of a normal pink color). Abnormal areas can also be identified by looking for a characteristic pattern made by abnormal blood vessels. In 2004, a study showed that a new optical detection system used with colposcopy greatly improved visual detection of precancerous changes in the cervix during the procedure.

If any abnormal areas are seen, the doctor will take a biopsy of the tissue, a common procedure that takes about 15 minutes. Several samples might be taken, depending on the size of the abnormal area. A biopsy may cause temporary discomfort and cramping, which usually go away within a few minutes. If the abnormal area appears to extend inside the cervical canal, a scraping of the canal may be done. The biopsy results are usually available within a week.

If the tissue sample indicates abnormal growth (dysplasia) or precancer, and if the entire abnormal area can be seen, the doctor can destroy the tissue using one of several procedures, including ones that use high heat (diathermy), extreme cold (cryotherapy), or lasers. Another procedure, called a loop electrosurgical excision (LEEP), uses low-voltage high-frequency radio waves to excise tissue. If any of the abnormal tissue is within the cervical canal, a cone biopsy (removal of a conical section of the cervix for inspection) will be needed.

Colposcopy is a painless procedure that does not require any anesthetic medication. If a biopsy is done, there may be mild cramps or a sharp pinching when the tissue is removed. To lessen this pain, your doctor may recommend 800 mg of ibuprofen (Motrin) taken the night before and the morning of the procedure (no later than 30 minutes before the appointment). Patients who are pregnant or allergic to aspirin or ibuprofen can take two tablets of acetaminophen (Tylenol) instead.

If a biopsy was done, there may be a dark vaginal discharge afterwards. After the sample is removed, the doctor applies Monsel's solution to the area to stop the bleeding. When this mixes with blood it creates a black fluid that looks like coffee grounds for a couple of days after the procedure. It is also normal to have some spotting after a colposcopy.

Patients should not use tampons or put anything else in the vagina for at least a week after the procedure, or until the doctor says it's safe. In addition, women should not have sex or douche for at least a week after the procedure because of the risk of infection.

Occasionally, patients may have bleeding or infection after biopsy. Bleeding is usually controlled with a topical medication.

A patient should call her doctor right away if she notices any of the following symptoms:

• heavy vaginal bleeding (more than one sanitary pad an hour)
• fever, chills, or an unpleasant vaginal odor
• lower abdominal pain

If visual inspection shows that the surface of the cervix is smooth and pink, this is considered normal. If abnormal areas are found and biopsied and the results show no indication of cancer, a precancerous condition, or other disease, this also is considered normal.

Abnormal conditions that can be detected using colposcopy and biopsy include precancerous tissue changes (cervical dysplasia), cancer, and cervical warts (human papilloma virus).